Spring Wood Lodge

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

Following our last visit we rated this key question required improvement. The service was in breach of legal regulations in relation to safe and clean care environments, and medicines management. This time we found that the service had made improvements and was no longer in breach of regulations. Both wards were safe and clean, and medicines were being managed effectively. At this inspection, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

All staff we spoke to knew what incidents to report and how to report them. Incidents were routinely reported by permanent staff. Staff told us that agency staff did not have access to the incident reporting system, but that permanent staff recorded incidents on their behalf.

Feedback from the investigation of incidents was routinely shared with staff. Staff told us that lessons learnt were posted on the notice board in the staff room and shared via email when appropriate. One staff member we spoke with gave us a recent example of guidance being issued promptly to staff after an incident. The service produced a quarterly ‘lessons learnt’ newsletter. We reviewed this and it showed changes made as a result of investigations. For example, the service had introduced new guidance to staff to ensure the reception area was not left unattended.

Staff met regularly to review incidents and discuss patient feedback. We saw evidence that lessons learnt was a standing agenda item for the monthly team meetings on both Byron and Bronte wards. Other agenda items included feedback to staff.

Formal and informal complaints were regularly reviewed by the service. The service kept logs of these which documented actions taken as a result of feedback. The logs we reviewed were up-to-date and showed evidence that patient feedback was actioned where appropriate.

Most staff we spoke to told us they had never been involved in a staff debrief to identify lessons learnt following an incident requiring physical intervention. The provider's policy on the use of force requires a debrief to determine whether any lessons can be learnt from that incident. However, some staff told us that supervision provided them with opportunities to reflect on incidents, and a there was a weekly drop-in session for staff to debrief on incidents. A reflective practice group was available to staff, and documentation stated that all staff were allocated to attend at least one session per quarter.

The service’s referrals process ensured that patients who were admitted could be safely cared for by the service. Staff told us how they worked with referring organisations to ensure admissions were appropriate, so they could safely meet a patient’s needs.

Staff told us they worked with commissioners and other services to ensure a patient’s discharge was planned to best meet their individual needs. For example, they advocated for their patients’ needs regarding discharge timing and placements which meant discharges were safe and robust.

Staff received training in safeguarding adults which also contained some contents on safeguarding visiting children. The contents covering visiting children was a small proportion of the training and did not cover the topic in the level of detail recommended in good practice guidance. The service also did not communicate in their training that safeguarding all children, not just children who are visiting, is a key responsibility of all healthcare staff which is outlined in good practice guidelines. The assessment used by the service as part of this training also did not assess staff’s understanding of safeguarding children. We raised this with the provider following this assessment and they agreed to implement training in this area.

Children were able to visit patients in off-ward spaces. The service had two visiting rooms and a café area within the hospital building, which all patients could be supported to access when meeting with visitors. Staff also gave examples of visits taking place outside on hospital grounds and in the local area. For example, where a risk assessment determined it was not within the best interests of the child to visit the hospital this took place in the hospital grounds instead Patients were also supported to remain in contact with their children.

Staff knew how to identify adults at risk of or suffering, significant harm. This included working in partnership with other agencies. There was evidence of good working relationships with the local authority safeguarding team.

Data showed physical interventions were more frequently used on Bronte than Byron ward. However, Bronte ward supported patients with a higher level of need. Staff we spoke to understood principles of reducing restrictive practice and used de-escalation techniques to prevent unnecessary restraint.

Both wards had checklists to identify and monitor restrictions in place. Neither ward reported any blanket restrictions on their checklists. All restrictions were marked in records as applying on an individual basis. However, staff and stakeholders told us that blanket restrictions were in place, and we also observed some during our visit. The restrictions which were in place appropriately supported patient safety.

Neither ward used seclusion or long-term segregation, but staff could explain what seclusion was and how to ensure it didn’t accidentally take place.

We reviewed 10 patient care records during this inspection. Patient voice was evident in all care plan documentation. For example, the needs and preferences of patients were highlighted consistently Patients told us staff valued their input in decision making, and both patients and carers shared examples with us of times when the patient was supported to understand treatment options, such as different medicines. Patients told us that they felt involved in care planning and stakeholders and commissioners told us patients often led their care planning meetings.

Patient care plans were detailed, but some patients told us that some parts could be confusing. For example, in some care plans we reviewed it was not clear if a statement was documenting patient preference, or if it was stating an agreed action.

Patients were able to access generic advocacy support and reported positive experiences of this.

Staff carried out regular risk assessments of the care environment. Ligature risk assessments had been recently completed for both wards and contained clear actions to mitigate any identified risks. Staff we spoke with demonstrated good knowledge of non-fixed ligatures and how to respond to a ligature incident. However, some of the staff we spoke to could not point out any of the fixed ligature points identified in the service’s risk assessment.

Patients were risk assessed before accessing higher-risk areas such as the laundry room. Patients on Byron ward could also be risk assessed to access a small kitchen area on the ward which also contained some cooking facilities. All patients had access to hot and cold drink making facilities. Access to an internal courtyard provided patients with outdoor space.

Ward staff had access to personal alarms and patients had access to nurse call systems. Additional alarms were available for visitors to the ward.

Clinic rooms were clean, well maintained, and equipped appropriately to meet patients' needs. The service undertook regular cleaning audits.

At the time of our visit, there were no vacancies in the nursing and support worker staff team on either ward. The Responsible Clinician post was vacant however this was filled by a regular, long-term locum. The speciality doctor post was also filled by a locum who was undergoing onboarding into a permanent role.

Managers had calculated the number and grade of nurses and healthcare assistants required. Staffing levels were regularly reviewed and could be adjusted where necessary. Most staff reported they felt there were enough staff on shift and that additional staff could be sourced at short notice when required.

Where necessary, the service did use agency and bank staff however the data we reviewed from the 6 months prior to inspection indicated this was low. Patients and staff told us that where agency staff were used, they were usually familiar with the ward and the patients.

Most patients told us that there were enough staff and that there was always someone available for them to talk to when needed. Patients told us they met with their named nurse regularly.

Mandatory training provided to staff covered a range of appropriate topics for the patient group. For both wards, all training sessions had been completed by over 75% of eligible staff and most training was completed by over 95%.

Staff maintained equipment well and kept it clean. All ward areas were clean, had suitable furnishings in good condition and were well-maintained.

Cleaning records were complete, up-to-date, and regularly reviewed by the service across both wards.

Staff adhered to infection control principles, including handwashing.

Staff followed good practice in medicines management and did so in line with national guidance.

Staff reviewed the effects of medication on patients’ physical health regularly. They carried out the appropriate health checks for patients based on their medications. For example, regular blood testing was carried out for patients on antipsychotic medicines.