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Woodbourne Priory Hospital Good

Inspection Summary


Overall summary & rating

Good

Updated 12 September 2017

We rated Woodbourne Priory Hospital as good because:

  • Staff carried out environmental assessments and identified and removed areas of risk on most wards.
  • Medications were stored safely and staff followed good management and administration processes on wards. There were adequate numbers of staff on wards and the provider could adjust staffing levels upwards as needed. Staff reported incidents and lessons were learned from incidents. There were good processes in place across all wards to share lessons learned.
  • Staff completed comprehensive assessments of patients on admission. Doctors monitored patients’ physical health regularly and following use of rapid tranquilisation. Care plans were holistic, recovery-orientated and included patients’ views. Patients had access to a therapy programme while on the ward.
  • Where patients were detained under the Mental Health Act 1983, their rights were protected and staff complied with the code of practice. There was a Mental Health Act administrator responsible for scrutiny of detention paperwork. Patients had access to Independent Mental Health Advocacy (IMHA). Mandatory training rates, including safeguarding training, overall were good across most wards.
  • Staff were caring, friendly, and respectful towards patients. Staff had a good understanding of patients’ needs and involved relatives in patients’ care. Patients had the opportunity to give feedback to the service about their care and treatment.
  • The governance structure that supported the safe delivery of services was good. Senior managers had good oversite and communicated well with ward staff. Staff knew how to use the whistleblowing process and felt able to raise concerns. Staff carried out quality walk arounds to ensure good quality services were maintained. Staff demonstrated the values of the organisation in their work.

However:

  • Emergency equipment was found to be out of date on two wards, despite staff signing to say it had been checked. Maple and Rowan wards we found out of date equipment in the emergency bag on the ward, despite staff signing to say it had been checked.
  • We found that the Mental Capacity Act diagnostic test was not present on the capacity assessment form. This meant that capacity assessments did not cover all areas required.
  • Staff did not carry out routine audits of paperwork relating to the use of the Mental Capacity Act at the time of our inspection. We did not find that capacity to consent to treatment was recorded correctly in all records.
  • Staff were not recording discharge plans comprehensively in care records on Maple, Beech and Aspen wards and patients we spoke with were unaware of their discharge plans.
  • Risk assessments on Maple and Beech wards were not consistently recorded in a clear manner and care plans included jargon.
  • Compliance rates for safeguarding adults and children training were very low on Maple, Beech and Aspen wards.
  • Recording of staff supervision was not consistent across all wards and did not take into account managerial and reflective practice sessions.   
  • Not all staff were aware of the values of the organisation. The organisation had undergone a merger and rapid expansion in the 12 months before inspection and the values of the organisation had not yet been embedded.

Inspection areas

Safe

Requires improvement

Updated 12 September 2017

We rated safe as requires improvement because:

  • Maple and Rowan wards we found out of date equipment in the emergency bag on the ward, despite staff signing to say it had been checked.
  • We found a significant number of security checks on Beech Ward had not been completed between March 2017- June 2017.
  • Compliance rates for safeguarding adults and children training were very low on Maple and Beech Wards, and in one instance on Aspen Ward. Safeguarding adults on Maple Ward was 11% and Beech Ward was 19%, Aspen ward was 50%. Safeguarding children on Maple Ward was 22% and Beech Ward 31%.  

However:

  • Sickness and turnover rates were low on most wards.
  • Risk assessments on Oak, Mulberry and Rowan wards were detailed and person centred. Staff updated them frequently and they reflected recent changes in patient risk history.
  • Medications were stored safely and staff followed good management and administration processes on most wards. A pharmacist visited the wards weekly.
  • There were adequate numbers of staff on wards and the provider could adjust staffing levels upwards as needed. We saw staffing rotas that showed all shifts had been covered by either permanent, bank or agency staff between March and May 2017.
  • Staff reported incidents and learned lessons were learned from incidents. There were good processes in place across all wards to share lessons learned.

Effective

Good

Updated 12 September 2017

We rated effective as good because:

  • Care plans were personalised, holistic and recovery focussed. On Oak, Mulberry and Rowan wards, care plans reflected the patient’s voice and showed clearly that they were involved in their care.
  • Staff offered a range of interventions in line with guidance from National Institute of Health and Care Excellence guidelines.
  • There was a commitment to the development of staff across the hospital; the service ensured staff were suitably skilled and qualified to work wards.
  • Health care assistants had been supported to obtain their care certificates. Specialist training had been designed for bank and agency staff working on Oak Ward to ensure they had the competency to support patients with an eating disorder.
  • Staff had received appraisal across all wards. Staff accessed profession specific clinical supervision and monthly team supervision meetings were chaired by an external facilitator.
  • Staff held weekly multidisciplinary meetings to review patient’s progress and patients and carers were actively involved. The senior management team met with ward managers in a daily morning meeting to review all patient progress and discuss any issues on the ward.
  • Where patients were detained under the Mental Health Act 1983, their rights were protected and staff complied with the code of practice.

However:

  • We found that the Mental Capacity Act diagnostic test was not present on the capacity assessment form. This meant that capacity assessments did not cover all areas required.
  • Staff did not carry out routine audits of paperwork relating to the use of the Mental Capacity Act at the time of our inspection. We did not find that capacity to consent to treatment was recorded correctly in all records.
  • Care plans on Maple, Beech and Aspen wards included jargon and some patients and carers told us they were not involved in care plans.

Caring

Outstanding

Updated 12 September 2017

We rated caring as outstanding because:

  • Staff were caring, friendly, and respectful towards patients. Staff had a good understanding of patients’ needs and involved relatives in patients’ care.
  • Patients across the hospital were able to become involved in decisions about the service and took an active role in the recruitment process of new staff.
  • We saw many examples of staff engaging with patients in an outstandingly caring and compassionate manner during our inspection.
  • Staff adapted their communication and approach to each individual patient. 
  • Patients were able to become involved in decisions about the service and took an active role in the recruitment process of new staff as part of a service user directed team recruitment and team performance programme.
  • On Oak Ward, all feedback received from carers and people that used the service was without exception outstanding. We found examples of patients engaging collaboratively with staff to engage in community based initiatives and support a local charity for eating disorders.

Responsive

Good

Updated 12 September 2017

We rated responsive as good because:

  • When patients were discharged from wards, this was following a period of planning and preparation for patients in collaboration with the clinical ward team and was always scheduled for an appropriate time of day.
  • We found evidence in all care records reviewed of the consideration of section 117 aftercare services for patients admitted to the ward and detained subject to the Mental Health Act.
  • Staff supported patients to personalise their bedrooms during their stay on the wards.
  • During the 12 months before our inspection, all wards had received compliments relating to their care and treatment during their hospital stay. There were no complaints received by the provider relating to the care and treatment of patients on Oak Ward.

However:

  • Staff were not recording discharge plans comprehensively in care records on Maple and Beech wards. All but one of the patients on Maple and Beech wards we spoke with were unaware of their discharge plans.

Well-led

Good

Updated 12 September 2017

We rated well-led as good because:

  • The governance structure that supported the safe delivery of services were good. Senior managers had good oversight and communicated well with ward staff. 
  • Staff knew how to use the whistleblowing process and felt able to raise concerns. Designated staff carried out regular quality checks of the hospital to ensure good quality services were maintained.

  • Morale across all wards was excellent and staff told us they loved their jobs. Staff reported that they felt valued and respected by the ward managers and that a culture of mutual support, learning and reflection underpinned the approach of the clinical teams.
  • Senior managers were visible on the wards. Everyone we spoke with talked positively regarding their ward managers and the senior managers within the hospital.

However:

  • Recording of staff supervision was inconsistent and did not take into account reflective practice sessions and management supervision.
  • Not all staff were aware of the values of the organisation. The organisation had undergone a merger and rapid expansion in the 12 months before inspection and the values of the organisation had not yet been embedded.
Checks on specific services

Child and adolescent mental health wards

Good

Updated 27 May 2016