Weaver Lodge

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

There was a lack of psychology available within the service, the MDT did not have a psychologist, and at provider level, psychological input was limited.  

However, staff from different disciplines worked together as a team to benefit patients. The service worked well across teams and services to support people. 

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

During the inspection we reviewed 9 care records.

A START assessment was completed before a patient was admitted into the service, and an admission checklist was completed within 72 hours of admission to ensure initial care plans had been completed. Care plans were holistic, and considered an individual’s history, their social and mental health needs. Outcomes in care plans were available; however, they were broad and lacked specificity, and outcome measures to be able to assess patient progress and areas for further development. 

There was clear evidence of discharge planning from the point of admission. Care plans identified what progress patients required to begin detailed discharge planning, such as accessing the community safely. Other patients were accessing leave to support the discharge process or engaging with social workers to plan for transition. 

We scored the service as 1. The evidence showed significant shortfalls.  The service did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

Weaver Lodge did not have a psychologist as part of the MDT, best practice is that rehabilitation service should have a psychologist that contributes to the assessment and formulation of a patient’s psychological needs. NICE Guidance also states that services should offer additional psychological interventions, especially for people who are not ready to engage in Cognitive Behavioural Therapy (CBT). This is a breach of Regulation 18: Staffing. 

At the provider level, there was an advanced nurse practitioner who could provide some psychological input such as CBT; however, this was limited, and only 1 patient was currently accessing this support. To reduce this risk, when a patient was referred into the service, staff assessed if they required psychological input as part of their care and treatment, if an increased level was required they referral was declined. However, this was not clear in their admission criteria.

There was a long period, between November and May, without dedicated OT in the service. The service did have regular OT cover from another service within the provider, which ensured that assessments were completed, however there was a decline in activities available in the service. In the care records we reviewed, there was limited evidence of patients engaging in activities. However, the occupational therapy offer within the service was being developed and strengthened, a daily activity planner had been completed and as new patients were being admitted individual planners were being developed and would be created for existing patients. Staff had responded well to the increased OT available, working alongside the OT to support the offer. 

The service had weekly Well Man and Well Woman clinics to support the monitoring of physical health within the service. Patients were registered with a local GP and had access to local opticians and podiatry services. Care records showed involvement with these external services, including speech and language therapists and dieticians. A third-party pharmacy also completed regular audits within the service. 

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new staff with appropriate induction, there was a checklist for agency staff to complete which included patient overview, records and emergency information. For new staff there was also a Common Induction Standards booklet which managers used to track an individual’s induction progress within the first 12 weeks. 

Managers ensured that staff had regular appraisal and supervision. Appraisal compliance was currently 89.5%, and supervision compliance was 88.9%, this was below the service’s 95% target due to new staff, and some absence. However, the managers in the service were prioritising appraisal and supervision completion. 

Managers ensured that staff had access to regular team meetings, during the inspection we observed a team meeting where staff were engaged and encouraged to voice any concerns or praise. Meetings were completed on a monthly basis and included an online option for staff who were unable to attend in person. All agenda items had an owner, ongoing actions were rated red, amber or green. Learning was highlighted during these meetings, and opportunities for specialist training such as phlebotomy were also explored. This allowed all staff to contribute to the discussion. 

Mental Health Act

The service admitted patients detained under the Mental Health Act 1983. Staff received training on the Mental Health Act as part of their mandatory training, the compliance rate at the time of inspection was 100%. They had a good understanding of the Mental Health Act, the Code of Practice and it’s guiding principles. The service had good access to administrative support through the provider, this included legal advice on implementation of the Mental Health Act and its Code of Practice, and relevant policies and procedures that reflected the most recent guidance.

Staff explained to each patient their rights under the Mental Health Act, and this was recorded by the Mental Health Act administrator and evidenced within care records. Patients we spoke with understood whether they were detained under the Mental Health Act but some patients where not sure if they had been advised of their rights. Staff ensured that patients were able to take section 17 leave (permission for patients to leave hospital) when this had been granted. Escorted leave was rarely cancelled and always re-arranged as soon as possible if unable to go ahead.

At the entrance of the service there was an information board, which included how to access Independent Mental Health Advocacy (IMHA). During our inspection some patients were informal (not detained under the Mental Health Act), we raised with staff that there was not a notice informing informal patients that they were able to leave. This was addressed by staff and raised in the staff meeting to ensure awareness. 

Staff completed a regular bi-monthly audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

During the inspection we observed a ward round and a discharge meeting. Staff held regular and effective multidisciplinary meetings, with monthly ward rounds for all patients. In the ward round we observed, the patient was involved in the meeting, gave feedback about their medication and the consultant gave a clear rationale for their decisions. Staff raised concerns about the engagement of patient’s care co-ordinators and their attendance at ward round, during the meeting this was raised for escalation. Staff also confirmed that they were working with commissioners to ensure more effective working relationships. 

We observed a  discharge planning meeting as part of the inspection, within this meeting there was a good representation of external teams to support the handover and transition of the patient. The service had worked closely with the local authority social services to support and ensure a wide range of engagement, including community mental health teams, future placements and alcohol and drug services. The service had also completed a lot of work with police to support drug reduction in the service, such as working with drug dogs. 

Staff shared information about patients at effective handover meetings within the team.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Activities provided on the ward helped to promote a healthy lifestyle for patients. The new activity timetable included a daily walking group, as well as physical activity groups such as yoga or stretching, and a living well group led by the OT. There was a display of the work patients had done in the living group in the activity room, where they considered the effects of diet, exercise, stressors and sleep hygiene. These sessions were also used to promote smoking cessation. As the service had not had a dedicated OT since November, patient involvement in activities could be limited, but staff were aware of this, and were working with patients to encourage them to join in. Similarly, more personalised activity plans were beginning to be developed for patients. 

Around the service there was information on balanced diets, portion sizes, and alternative diets, and the garden had exercise equipment for patients to use. Patients could also access an external gym where appropriate and in line with their individual care and risk management plans. The service also held regular Well Man and Well Woman clinics at weekends to promote physical health, screening and preventative healthcare. 

Patients could also access external drug and alcohol services, where there was an identified need. During the inspection, we observed the staff working alongside the external service to support a smooth transition to discharge.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes such as Health of the Nation Outcome Scales (HoNOS). Occupational therapy also used the Model of Human Occupation Screening Tool (MOHOST), to set goals for patients by evaluating patients’ participation in daily life.

The service also had access to the Tech Lending Library through the provider, which gave patients access to assistive technology that can support independence, safety and wellbeing throughout their rehabilitation.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions, staff we spoke with understood the importance of capacity, and enabling patients to make their own decisions. 

An initial capacity assessment was completed on admission, and further assessments were completed when staff identified a concern regarding a patient’s capacity. When a patient did lack capacity, capacity to consent was recorded appropriately. Assessments were completed on a decision-specific basis, and staff were aware of patients who lacked capacity and in what area of their care and treatment. 

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff included families and carers, as well as external stakeholders such as care coordinators where appropriate.