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

Well Led- this means we looked for evidence that service, leadership, management and governance assured high quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection this key question was rated as requires improvement. At this assessment, the rating for this key question remained the same. We reviewed 6 quality statements in the well-led domain. Although we identified areas of good practice, the provider failed to ensure the recommendations of the previous inspection in relation to the lack of rehabilitation model had been addressed. This remained a breach of regulation in relation to person centred care.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The manager on the ward supported staff, and staff were clear on their individual roles and responsibilities. The manager met with staff on an ad hoc basis and through staff meetings regularly. Staff felt that the culture of the ward had improved and this was largely due to the recruitment of new staff to reduce the requirement to use agency staff.

Arrangements for the risk management of patients were being followed and staff were aware of the risk assessments and felt they were suitable for the safety of the patient group.

Team meetings were happening regularly and governance messages from the organisation were being filtered down to the ward staff.

Not all staff were aware of the organisation’s values. However, staff consistently spoke of improved morale and said they felt more supported than they did during our last assessment.

The manager completed clinical quality checks audits every week which covered medication audits and multiple issues relating to the safe running of the ward and we could see these were being used to feed into the hospital’s clinical governance structure. Actions were identified at a ward level to improve and were monitored by the governance team.

However, the ward did not follow a rehabilitation model which was recognised by the patients and staff. This was identified as a breach of regulation 9 of the Health and Social Care Act in the 2023 inspection and remains a breach at the time of this assessment. Many patients had continued to stay on the ward for extended periods of time. The high-dependency unit specification as outlined in the CQC’s brief guide states that the length of stay should be up to one year, which the service was currently commissioned for. The continued lack of a clear rehabilitation model increased the risk that patients might be inappropriately admitted to the service and their needs not adequately met. The ward manager hoped to implement a recovery model the week after the inspection but could not provide us with a copy of the draft proposal.

Staff provided positive feedback about the supportiveness of ward manager and senior leaders. One spoke of the ward manager, “I have supervision every month and the manager is available for emotional support.”

Staff felt able to report incidents, including those of racial abuse from the patients, to the police with the support of the management team when required and were happy with the level of support they received.

The ward manager had a well-developed understanding of equality, diversity and human rights. However, the manager did not ensure that staff received all statutory and mandatory training in line with the company policy.

Systems and processes were effective to ensure that there was a positive culture within the service. The manager met with staff regularly for supervision as per the hospital’s policy and conducted regular staff and patient community meetings.

Staff felt respected, supported and valued. They said the hospital promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

There was a whistleblowing policy in place and staff knew where to find this and how to use it . The Freedom to Speak up Guardian regularly visited the ward and staff could contact them if they had concerns to discuss.

Staff were positive about workforce planning and wellbeing. Staff said they felt safe on the ward and that they felt valued at work and were well supported by the senior leadership team. The ward manager felt supported by the line management structure and that the hospital director had an open door policy and they were approachable.

Staff felt that incidents of bullying had been dealt with appropriately by the management team and they had been supported to involve the police when necessary.

Mandatory training was in place to support staff with understanding discrimination in the workplace. However only 64% of staff were in date at the time of the assessment.

The ward manager had put reasonable adjustments in place for staff members to help them carry out their role. For example there were staff who had shift timings changed to enable them to meet their caring responsibilities.

The ward manager had time and resources to undertake effective local governance and manage risk on the ward. There was a good range of accurate and timely data and information available in the audits to understand performance and quality and improvements were made as needed. Staff spoke positively about the new ward manager, who had been visible on the ward and took time to talk with staff and patients to improve communication.

There were regular multidisciplinary governance ward meetings led by a consultant psychiatrist and the nursing team. These discussed and addressed key areas of performance relating to the clinical management of the ward. Minutes we reviewed showed areas of patient’s clinical concern were identified and supportive actions were taken.

However, there was a lack of effective oversight of the governance and assurance processes to keep people safe. There were environmental concerns around the ability of staff to respond effectively in the event of a fire and this had not been identified through the provider’s internal assurance processes. In addition, despite being recorded as a breach of regulation 9 in the previous inspection, the lack of patient and carer involvement in care planning on Seaford ward was evident and was not being audited effectively to identify and drive improvement.

The organisational risk register provided by the hospital identified one risk relating to The Langford Centre which was the previous CQC report. This risk identified the financial impact of the report as the main risk. The risk register identified that all actions from the previous inspection had been addressed, this means that the hospital felt that the breaches had been met. However this was not represented in the evidence from the assessment.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The ward manager shared feedback from complaints with staff and learning was used to improve the ward. The service used compliments to learn and celebrate success. Overall, staff were positive about their experiences at the hospital and gave examples of occasions when they had made suggestions to improve the culture of the ward which had been supported by the ward manager, such as addressing racism issues within the patient group leading to racism and cultural divergence being addressed in the community meetings.

The hospital carried out an annual staff survey and then generated an action plan based on the findings. Most staff in the survey felt happy to work at the hospital.

There was no discussion of quality improvement projects on the ward and we could see no evidence of quality improvement happening in the clinical governance meeting minutes that we reviewed.