The Care Quality Commission
  • Mental Health
  • Independent mental health service

Arbury Court

Overall: Requires improvement read more about inspection ratings

Townfield Lane, Winwick, Warrington, Cheshire, WA2 8TR (01925) 400600

Provided and run by:
Elysium Healthcare Limited

Important: The provider of this service changed. See old profile

All Inspections

28 and 29 November 2023

During an inspection looking at part of the service

Our rating of the forensic inpatient or secure wards stayed the same. We rated it as requires improvement because:

  • At a previous inspection in August 2023 we found that safe and caring required improvement.
  • Not all patients had an up to date consent to treatment in line with the Mental Health Act Code of Practice.
  • The documentation of and response to complaints was not in line with the provider’s policy and could be improved.

However

  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and mostly discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff worked with commissioners and other providers to support patients to move onto a suitable placement on discharge.

8th - 10th August 2023

During an inspection looking at part of the service

Our rating of this location stayed the same. We rated it as requires improvement because:

  • Some of the ward environments were not always clean or well maintained. Two of the wards were not clean and some areas of the wards were poorly maintained which presented risks on the ward. The service did not ensure that infection control risks were eliminated from food preparation areas.
  • Staff did not always minimise the use of restrictive practices. There were high uses of restraint, on some of the wards. There was also a high use of prone restraint. Prone restraint means that a person is restrained in a face down position. Levels of blanket restrictions were high, and it was not always clear why these restrictions were in place.
  • Staff did not always carry out restraints safely.
  • Staff did not always manage medicines safely. Medicines cards on some wards were confusing which increased the risk of medication errors. We also found some concerns with Mental Health Act medication paperwork.
  • Staff did not always respect patient’s privacy and dignity on all wards. We observed conversations about patients between staff in busy bedroom corridors.
  • Staff did not always actively involve patients, families and carers in care decisions and communication with families was sometimes poor on some wards.

However:

  • Staff had completed a range of mandatory training that was appropriate to the needs of the service.
  • There were systems in place for managing the ward environment, ligature risk assessments were up to date and security checks were carried out regularly. The wards had enough nurses and doctors. Staff assessed and managed risk well, patients all had up to date, relevant risk assessments.
  • Staff followed good practice with respect to safeguarding. Staff had received appropriate safeguarding training and there were systems in place to support staff make safeguarding referrals when required.
  • Staff mostly treated patients with compassion and kindness and understood the individual’s needs.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly. Leaders had a good understanding of the service. There were systems in place for monitoring and managing risk and managers collated and used this information effectively. The service had a culture of learning. 

10, 11 and 12 May 2022

During a routine inspection

Our rating of this location went down. We rated it as requires improvement because:

  • The service did not always provide safe care. The wards did not have enough nurses and support staff to safely care for patients or who knew patients well. There were many shifts that did not have the full complement of staff. The ward environments on the forensic wards were damaged in parts and required maintenance.
  • Risk management of individual patients was not robust. Staff were not completing patient risk assessments in a timely manner or updating them following incidents.
  • Staff were not fully trained to support the needs of all patients. Staff had not received training in learning disability and autism despite having many patients with a learning disability or who were autistic. Mandatory training compliance was low on the psychiatric intensive care unit.
  • Staff were not following infection prevention and control guidance regarding use of masks and wearing nail varnish and false nails on the forensic wards.
  • Staff on the forensic wards were not receiving regular supervision and did not have access to regular team meetings and updates about the service.
  • Patients were not discharged promptly on the psychiatric intensive care unit when their mental health had improved. There were excessive delays for patients to return to their home areas. However the provider was working with external stakeholders and discharges were improving.
  • Governance systems were ineffective in identifying areas of concern and responding promptly. Governance processes did not ensure that wards procedures ran smoothly. This included the oversight of the agency induction process, the quality of the patient risk assessments and the sickness and vacancies at ward level.

However:

  • Staff minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. The ward environments were safe and clean on the psychiatric intensive care unit.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well on the forensic wards. Staff liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

4 and 5 November 2020

During an inspection looking at part of the service

  • The service provided safe care. Staff assessed and managed risk well. They minimised the use of restrictive practices and in the majority followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment.
  • The wards had enough nurses and doctors. Managers ensured that these staff received training, supervision and appraisal.
  • Staff in the majority treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients in care decisions.

However

  • The provider’s policies did not outline all the safeguards required for patients who were segregated.
  • The service had not implemented all the necessary safeguards for a minority of patients subject to restrictive interventions.
  • Some patients and staff felt that the necessary balance between familiarity and professional boundaries was sometimes blurred.

What people who use the service say

  • Patients gave mixed feedback about their experience of the service. Some patients felt very supported, that most staff were helpful, and that when restrictive interventions were used (such as restraint or seclusion) this was in the least restrictive way. Other patients were more critical of staff and did not agree with the care they received. Other patients gave a mixed view – they thought most staff were okay, but there were some who were less helpful. Some patients and staff described overfamiliarity and “banter” between some staff, and in some staff interactions with patients. This was not described as abuse, but that they did not like the attitude of some staff, and felt it was not appropriate and demonstrated a lack of professional boundaries.

23-25 July 2019

During a routine inspection

Our rating of this service stayed the same. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, mostly managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions, and encouraged and supported them to keep in touch with each other.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

21-23 August 2017

During an inspection looking at part of the service

​We rated Arbury Court as good because:

  • Ward environments, including clinic and seclusion rooms, were safe and clean. Almost all staff were compliant with mandatory training. Individual risk assessments were up to date and included all relevant information. Staff followed the principles of least restrictive practice and used de-escalation and positive behaviour support to manage conflict where possible. Safeguarding procedures were effective and medication was stored and administered correctly. Serious incidents were investigated, and lessons learned were shared with staff.
  • Patient care plans were up to date, holistic and recovery-focused. Care plans were informed by detailed assessments. Patients had their physical healthcare needs assessed and treated where necessary. Patients had access to evidence-based psychological and occupational therapies that were appropriate to their individual needs. Most staff were up to date with clinical supervision and appraisal. Practice was compliant with the Mental Health Act and Mental Capacity Act.
  • Patients and carers were mostly positive about the staff and the service. Patients described staff as supportive, friendly, respectful and caring. Patients were involved in their own care, in staff recruitment and training, and in making decisions about the running of the hospital. Patients and carers said that the service responded to their complaints and concerns.
  • New referrals were assessed and admitted quickly. Arbury Court staff worked closely with commissioners and patients to plan discharge. There were rooms and facilities available for a wide range of patient activities, as well as a recovery college and a real work programme. Individual needs (including mobility, learning disability and cultural needs) were catered for. The service effectively responded to complaints.
  • The provider’s vision and values were reflected in staff behaviour and attitudes. There was an effective clinical governance structure in place. Electronic ‘dashboards’ were used to monitor and improve the care of individual patients and the overall performance of the wards and hospital. Managers had responded to staff concerns about patient aggression and incidents, for example by employing a psychotherapist to support staff. Staff told us that they felt supported and able to raise concerns. Arbury Court had a very low sickness rate.

However

  • A number of patients had missed doses of physical health medication due to a lack of stock. Staff did not always fully monitor and record a patient's physical health during clozapine initiation and after rapid tranquilisation.
  • Staff and patients told us that wards were busy and that there were not always enough staff to meet needs.