The Langford Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed seven quality statements. We rated well-led as requires improvement because the hospital had a risk register which contained issues raised by CQC from the last inspection including ligature risks from the sash style windows, but leaders could not tell us when they would be replaced.

The wards were not always cleaned to a high standard and the problems with cleanliness had not been detected by the provider’s own checking systems.

The wards had allocated fire marshals, but staff were unaware that they could not access the fire equipment on Cooden ward which could put people at risk in a fire emergency.

There were concerns around the poor recording and management of medicines, but this had not been reported as a risk. People from all wards told us their care plans were not relevant to them, but this had not been discussed and appropriate actions taken to address them at clinical governance level.

Ward managers were responsible for carrying out infection prevention control audits on their respective wards. However, there was no specific training provided to them on how to carry out these audits effectively.

This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17.

However, the hospital director had a vision for what they wanted to achieve at the service and was developing and implementing processes focused on supporting staff wellbeing and ensuring everyone promoted a culture of good practice, while providing safe care and treatment. Staff spoke highly of their managers and their senior leadership team.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Leaders ensured there was a shared vision and strategy and that staff in all areas knew, understood, and supported the vision, values, and strategic goals and how their role helped in achieving them. The vision, values and strategy were developed through a structured planning process in collaboration with people who used the service, staff, and external partners. Staff and leaders demonstrated a positive, compassionate, listening culture that promoted trust and understanding between them and people using the service which focused on learning and improvement. Staff at all levels understood the importance of equality, diversity, and human rights in their day to day work. Staff told us equality and diversity was actively promoted. Staff had no concerns around workforce inequality, and they felt they could raise any concerns around inequality and action would be taken by leaders to address these.

Leaders discussed the shared vision, strategy and culture thought regular meetings with staff including at staff meetings and clinical governance meetings. The strategy was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and communities. For example, the hospital director had a weekly drop-in session with staff to discuss any concerns. Leaders were reviewing the sickness policy following feedback from staff to ensure it is more inclusive. Leaders shared weekly newsletters with staff to keep them up to date about strategic decisions.

Leaders had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and risks were managed well. Leaders at every level were visible and led by example, modelling inclusive behaviours. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. Some staff reported that that they were not able to go on longer term leave because of the restrictions on leave duration at any one time. The hospital leaders informed us that 90% of annual leave requests were approved in the last year. Leaders were now reviewing the annual leave policy in collaboration with staff to ensure that it was inclusive and met people’s needs.

The provider had a system in place to ensure high-quality leadership was sustained through safe, effective, and inclusive recruitment and succession planning. The current hospital manager was previously a ward manager and was well supported with their leadership development by the provider. Leaders were alert to poor culture that may affect the quality of people’s care and have a detrimental impact on staff. When there were concerns around poor care for example, poor restraint practices, leaders addressed these quickly by providing extra training for staff.

Staff and leaders felt the culture at the hospital was based on openness, honesty, and transparency.

Staff and leaders actively promoted staff empowerment to drive improvement. We observed good interactions between staff and ward mangers. Leaders encouraged staff to raise concerns and promote the value of doing so. All staff were confident that their voices would be heard if they raised concerns.

The provider promoted a positive culture where people could speak up and that their voices would be heard. Staff who spoke up including whistleblowers, were supported without fear of retribution. When concerns were raised, leaders investigated them sensitively and confidentially, and lessons were shared and acted on. When something went wrong, people received a sincere and timely apology and staff told them about the actions they were taking to address their concerns.

Leaders continually reviewed and improved the culture of the organisation in the context of equality, diversity, and inclusion. Leaders took action to prevent and address bullying and harassment at all levels and for all staff, with a clear focus on those with protected characteristics under the Equality Act and those from excluded and marginalised groups. The provider took active steps to ensure staff and leaders were representative of the population of people using the service. Staff were from diverse backgrounds and ethnicities. Feedback from staff was the Langford Centre was an inclusive place that promoted equal opportunities for everyone. Leaders ensured there were effective ways to engage with and involve staff, with a focus on hearing the voices of staff and people with protected equality characteristics and those who were excluded or marginalised, or who may be least heard within their service. Staff felt empowered and were confident that their concerns and ideas resulted in positive change to shape services and created a more equitable and inclusive organisation.

The provider promoted a diverse and inclusive workforce through fair and inclusive recruitment and staff retention practices. Leaders took action to improve where there were any disparities in the experience of staff with protected equality characteristics, or those from excluded and marginalised groups. Any interventions were monitored to evaluate their impact. For example, leaders ensured that the ward staff were from a range of diverse backgrounds to remove biases from practices, and they regularly reviewed the staffing mix. This ensured equality of opportunity and experience for people. Leaders worked towards removing workforce inequalities which included checking accountability such as ongoing review of policies and procedures to tackle structural and institutional discrimination and bias to achieve a fair culture for all. While leaders told us they made reasonable adjustments to support disabled staff do their jobs, the service did not accept people in a wheelchair.

Leaders told us they were rolling out training for staff to upskill them in areas where there was a learning need. For example, the ward managers on Fairlight ward had conducted some workshops with staff. Managers and leaders felt staff were positive and willing to learn and improve. Leaders held weekly meetings and weekly drop-in sessions with ward teams to discuss specific issues including how they would meet the regulatory standards. Staff told us they ensured data and notifications were submitted to external organisations as required, including the CQC. Leaders told us they could identify poor staff performance early and took action to address them.

Whilst there had been significant improvement in the services governance processes since the last inspection in 2023 including complaints and incident management reviews and learning from these, there were still areas that required improvement. The wards were not always cleaned to a high standard and the problems with cleanliness had not been detected by the provider’s own checking systems. The wards had allocated fire marshals but were unaware that they could not access the fire equipment on Cooden ward which could put people at risk in a fire emergency. There were concerns around the management of medicines and the side effects that some medicines had on patients' physical health. The risk register contained issues raised by CQC from the last inspection including the sash-style windows on the ward that were identified as potential ligature anchor points, posing a risk to patients. At the time of the inspection, leaders could not tell us when they would be replaced. People from all wards told us their care plans were not relevant to them, but this had not been discussed and appropriate actions taken to address them. Ward managers were responsible for carrying out audits on their respective wards such hygiene and cleanliness. However, we identified that these audits did not accurately reflect the poor standard of cleanliness that we observed at the time of our inspection. There was no specific training provided to staff on how to carry out these audits.

Staff and leaders were open and transparent about the services they provided, and they collaborated with all relevant external stakeholders and agencies. Staff told us they worked closely with the local mental health NHS trust community teams and home treatment teams, and they invited them to peoples’ ward rounds where required. Leaders told us they had improved how they worked with carers. The service now had a carers lead who helped with discharges. Staff told us they recently had a social barbecue event involving people and carers. Staff and leaders told us they collaborated with people, communities, and partners to identify new or innovative ideas where they can learn from each other and improve outcomes for people.

The provider met regularly with system partners including the NHS trusts, police, and social care partners. The service made regular quality and performance reports for commissioners and the NHS trust.

Staff and leaders told us they ensured that people using the service and their families and carers participated in developing and evaluating improvement and innovation initiatives. For example, the service had developed a social worker-led carers event to improve carer engagement. This included a planned barbecue event. Leaders informed us that the aim was to emphasise to staff the importance of engaging with families and carers. Leaders encouraged staff to speak up with ideas for improvement and innovation and actively invested time to listen and engage. For example, there was “A Day with the hospital manager” where staff could discuss innovative ideas. Staff reported good working relationship with senior leaders.

Staff and leaders had a good understanding of quality improvement. The approach was consistent and included measuring outcomes and impact. There were processes to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem-solving. Staff were encouraged to contribute to improvement initiatives. For example, the provider commenced the ‘Culture of Care’ project in May. This programme was aimed at improving trauma-informed care, autism-informed care and race equality. The provider worked to continually improve services including improving staff recruitment and retention, reviewing care plans and risk assessments to identify any learning, reviewed closed circuit television (CCTV) following incidents and implemented weekly reflective practice sessions for staff. The provider carried out an observation survey to improve how therapeutic observation of people was working. The observations policy was co-produced with people using the services. The provider sought feedback from staff and people using the services to improve.