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

The provider did not have effective governance, management and accountability arrangements in place. Most of our findings had not been identified by the governance and assurance processes that were in place. This included oversight of how medicines were managed and the quality of care and treatment plans. The manager had not identified that a patient who had repeated falls did not have a record of falls monitoring chart in place. There was no evidence of advance statement or decisions in any of the care plans we looked at.

Even though the provider had completed personal evacuation plans for the patients, these evacuation plans were not kept in a easily identifiable place in the the main office and therefore staff could not easily access the plans during an emergency which posed a risk to the patients. Staff did not conduct the required quality assurance checks for blood glucose monitoring machines. The windows on the ward that did not have safety guards in place posed a ligature risk to patients. Staff felt senior managers were not caring and did not always seek staff wellbeing. Staff said they sometimes felt the senior managers blamed them when things went wrong within the service.

However, leaders were visible within the service and had the experience, capacity, capability and integrity to ensure that the organisational vision could be delivered. Leaders fostered a positive culture where patients felt that they could speak up and that their voice would be heard. Managers acted on information about risk, performance and outcomes, and shared this with the staff team to bring about improvements.

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.

Staff felt the senior managers did not have a good approach towards staff when things went wrong within the service. Staff felt senior managers did not acknowledge the positive contributions staff gave to the service but rather blamed staff when things went wrong.

However, staff told us the provider aimed to provide quality mental health services and had a caring mind to provide therapeutic environment for patients who use the services. Staff were aware of the provider’s vision. Most staff we spoke to told us they had not experienced any bullying or harassment from their managers or colleagues and staff generally felt the culture on the ward was good.

Staff had a clear understanding of equality, diversity and human rights and felt that they received equal opportunities for development. Staff said they were asked about what needed to change within the hospital in their morning meetings with managers. Staff felt the provider sometimes cared about staff and patients, and invested in the team, describing strong teamwork, improved organisation, and regular staff supervision and support.

The provider had initiated several approaches to prevent closed cultures across all wards. Managers ensured there was consistent leadership presence and included staff from all shifts in information sharing and were available for support when needed. Staff attended regular team meetings, reflective practice sessions and received regular supervision.Leaders were visible at the service and ensured there was a shared vision and strategy that staff understood and supported. Managers ensured the service had a risk register, and staff and leaders ensured any risks to delivering the strategy, were understood, and had an action plan to address them. They monitored and reviewed progress against delivery of the strategy and relevant local plans.

Staff said managers acted in line with the culture and values of the service, and had the skills, knowledge, experience, and credibility to lead effectively. They described managers as having integrity and being open to engage with them. Leaders we spoke with demonstrated that they had the experience, capability and understanding to deliver the service’s vision, and manage risks. Managers were knowledgeable about issues and priorities for the service and said that they could access appropriate support and development in their role. The provider supported doctors to attend awareness training for forensic patients.

The service had inclusive leaders who understood the context in which they delivered care, treatment, and support. Leaders demonstrated the culture and values of their workforce and organisation. High-quality leadership was sustained through safe, effective, and inclusive recruitment and succession planning, and professional development opportunities for all staff. Minutes of daily operations meetings indicated that staff discussed all relevant issues to ensure safe care and treatment including allocation of patient observations, and current physical and mental health needs of patients.

Staff told us senior managers and hospital director visited the ward every Thursday to meet with staff to discuss concerns that staff about the ward.

Staff told us the hospital had a Freedom to Speak up guardian (FTSUG) and felt confident in speaking up to managers at the service. FTSUG is a person who helps workers peak up when they feel they cannot do so through other channels. Staff said they were able to speak up when they had to. Staff we spoke with were very positive about working at the service. Staff indicated that they felt heard, with action plans put in place to address areas of concern they raised. Staff and leaders spoke with openness and transparency.

Leaders ensured there was a positive culture where patients felt they could speak up and that their voice would be heard. Leaders actively promoted staff empowerment to drive improvement. There was a poster at the service detailing how staff could contact the Freedom to Speak Up Guardian. No recent issues had been raised from staff at the service.

Internationally recruited nurses told us they did always feel well supported by the senior managers. Staff said sometimes the leaders did not care about staff wellbeing. Staff told us managers threatened staff with dismissal when staff were sick, so staff went to work while sick due to fear of being dismissed from work. Some managers did not respect the diversity and culture of the staff especially during the Month of Ramadan.
However, the hospital director held monthly face to face meetings with the manager and drop-in sessions weekly with staff to listen to their concerns. Managers discussed career progression and any concerns with staff.

Staff managers felt there was good relationship with the hospital directors and managers resolved staff problems quickly.

The provider’s policies indicated that they valued diversity in the workforce and worked towards improving equality for staff. Leaders acted to continually review and improve the culture of the service in the context of equality, diversity, and inclusion. Leaders took steps to review policies and procedures to deal with structural and institutional discrimination and bias to achieve a fair culture for all. Where possible the provider made reasonable adjustments to support staff to carry out their roles well.

There were not effective governance, management and accountability arrangements in place. Most of the issues we identified during the inspection were not already known by the provider. Our findings had not always been identified by the governance and assurance processes that were in place. This included oversight of medicines and their side effects on patients and their health, recording of patients physical health when they were prescribed high risk medicines and care planning. There was no evidence of advance statements or decisions in any of the care plans we looked at despite some of the patients having long-term health conditions or their health was deteriorating. The manager had not identified that a patient who had repeated falls did not have a falls monitoring chart in place.

At the time of our inspection we found that staff did not respond to the call bell alarm even though staff had pagers on them and the call sounded in the office. We found that the windows on the ward that did not have safety guards in place which posed a ligature risk to patients. We also found trailing wires and cables in the communal room which were accessible by patients. We raised these concerns to the provider at the time of our inspection. Even though the provider had completed personal evacuation plans for the patients, these evacuation plans were kept in the main office and were not stored in a designated folder that could be easily identified. Therefore the staff did not have easy access to the plans during an emergency. Staff did not conduct the required quality assurance checks for blood glucose monitoring machines to ensure they were working correctly.

Staff felt senior managers were not caring and did not always seek staff wellbeing. Staff said they sometimes felt the senior managers blamed them when things went wrong within the service.

However, staff told us they participated actively in clinical audits and patients were also involved in suggesting which aspects of care should be prioritised for audits. Managers and staff engaged in clinical audits to evaluate the quality of care they provided. The manager said they attended clinical governance meetings each month with the multidisciplinary team where staff discussed incidents and how to improve the service. Staff received updates from managers and the maintenance team. Staff also discussed improvements, physical health monitoring of patients and safeguarding.

Managers ensured all staff were compliant with their mandatory and specialist training. All staff had received restrictive practice training and minimised the use of blanket restrictions. Staff received regular supervision and received an annual appraisal.

The provider had a framework for what managers discussed at governance meetings and how this was fed back to staff. Team meetings were available for all staff to attend, and they included discussions about learning and reflective practice.

The service had an audit schedule in place which covered many areas of the service including medication, safeguarding, health and safety, physical health, Mental Health Act and Mental Capacity Act, observation and engagement and Infection Prevention and Control. The doctor completed three monthly physical health audits to ensure there was good physical health monitoring of patients.

The service was also involved with the Quality Network for Forensic Mental Health Services and were expecting a peer review the month of the inspection.

Staff reported incidents and learned from incidents, complaints and service user feedback. Managers ensured that staff followed safeguarding, Mental Health Act and Mental Capacity procedures. The team completed capacity assessments for patients and Mental Health Act officers completed six monthly audits for patients. The provider used key performance indicators to gauge the performance of the team. However, we found some omissions in the physical health monitoring of some patients after the administration of clozapine. We saw evidence that action was taken from audit data to ensure improvements were made.

Patients and carers told us they had contact with commissioners and could access an independent advocate. One patient told us the care coordinator attended the fortnightly ward round via Teams.

Staff were aware of their need to provide opportunities for patients to access activities in the community to support their recovery.

Staff said the service worked well with other specialist services outside the organisation to provide good care for the patients. Staff worked with GPs, community teams, care coordinators, community treatment teams and community liaison teams. The local chaplain visited the wards.

Staff shared information and learning with partners and collaborated for improvement, for example in working towards discharge with patients and their careers, addressing their specific needs and preferences

The service was part of the Royal College of Psychiatry Quality Network for Forensic Mental Health services. The services peer reviewed each other’s performance and benchmarked it against standards. Managers had links and meetings with Community Mental Health Teams who joined ward rounds and collaborated with other community services.

We saw evidence of input from different professionals who were involved in the assessment, care planning and management which were evidenced in the care records. The service had good links with case managers, community consultants, forensic outreach teams and probation officers. Staff and managers at the service understood their duty to collaborate and work in partnership. They shared appropriate information and learning with partners and collaborated for improvement.

Staff told us the manager sent two policies to staff each month for staff to read and sign and discuss with the manager during their supervision session.

The provider had introduced Antecedent, Behaviour and Consequences (ABC) charts which are tools used to understand and address challenging behaviours by examining the sequence of events surrounding a specific behaviour. The provider also introduced psychological support sessions in the service to support staff when dealing with incidents.

Staff told us patients were engaged in the gardening project and were given vouchers after the proceeds from the garden were sold.

The provider had made some improvement on the storage of paper records based on the findings from our previous inspection. Staff could access records and policies and procedures. At the time of inspection, the provider was switching from manual record keeping to electronic record keeping and ensured that all staff completed training and were waiting to use the new electronic record system. Staff confirmed they had easy access to paper records and that paper records were scanned and saved onto the computer. Some staff had gone to other services to review their electronic patient record system to be able to understand the system better and apply the knowledge when the electronic records system went live at Langford centre.