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Inspection Summary


Overall summary & rating

Good

Updated 17 July 2018

We rated Wellesley Hospital as good because:

  • Staff received appropriate training and support to keep patients safe. The number of incidents of patient on patient assaults had reduced. Patients told us they felt safe on the wards.
  • Staff used comprehensive assessments to inform care planning. Staff delivered care in line with guidance from the National Institute for Health and Care Excellence.
  • There were effective systems in place to ensure patients physical health needs were met. A local GP visited the hospital once a week and the hospital employed practice nurses. The hospital provided a number of initiatives to encourage patients to live healthier lives, including smoking cessation support and healthy eating advice.
  • The hospital employed a range of specialists required to meet the needs of the patients.
  • Staff understood and worked within the scope of both the Mental Health Act and Mental Capacity Act.
  • Staff treated patients with kindness, dignity and respect. Patients were involved in their care and treatment. Patient involvement in decisions about the service was improving and patients were able to give feedback on the service in a number of ways.
  • Facilities within the hospital promoted comfort, dignity and privacy. Improvements had been made to ensure low secure patients were not cared for in overly restrictive environments. The service listened to and learnt from concerns and complaints, including informal complaints and concerns.
  • Admissions were planned and overseen by the south west regional secure service, a partnership of eight providers working to get people the support they need as close to home as possible.
  • The service was well-led at ward and senior management level. Low morale amongst staff had been recognised and the service was working actively with staff to respond to their concerns and make changes that would benefit them.
  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service.
Inspection areas

Safe

Good

Updated 17 July 2018

  • We rated safe as good because:

  • Staff received appropriate training and support to keep patients safe. The number of incidents of patient on patient assaults had reduced and patients felt they were safe on the wards.
  • Risk assessments were present for both patients and the environment and staff updated these regularly. Management plans were in place to minimise any identified risks.
  • Ward areas were clean, modern and bright and the layout allowed staff to observe all areas of the ward.
  • The hospital had experienced difficulties recruiting and retaining nursing staff. The senior management team recognised this risk, had implemented plans for recruitment, and improved staff retention. Despite staffing challenges, safe staffing levels were maintained across the hospital.
  • Medical and nursing staff followed local policy and national guidelines for medicines management, rapid tranquilisation, restraint and seclusion.

However:

  • There were high vacancy rates and high levels of staff turnover within the 12 months before our inspection putting patient safety and quality of care at risk.
  • Not all staff were aware of the providers personal search policy or the differences in security level between medium and low secure wards. This meant that care could be overly restrictive for patients requiring a lower level of security.
  • Two mandatory training courses had a compliance rate of less than 75%. The compliance rate for health and safety training was 70.1%, the compliance rate for moving and handling training was 72.7%.

Effective

Good

Updated 17 July 2018

We rated effective as good because:

  • Staff used comprehensive assessments to inform care planning.
  • All staff received training, regular supervision and an annual appraisal. There were systems in place to encourage skill development and career progression.
  • The physical health of patients was a priority for staff. Patients were supported to live healthier lives through smoking cessation support, health eating advice and access to physical activity. 
  • The hospital participated in audits, quality improvement measures and recorded and monitored patient outcomes.
  • Patients had access to a range of specialists to meet their needs.
  • Staff understood and worked within the scope of both the Mental Health Act and Mental Capacity Act.

Caring

Good

Updated 17 July 2018

We rated caring as good because:

  • Staff treated patients with kindness, dignity and respect.
  • Patient involvement in decisions about the service was improving. Patients were able to give feedback through “you said, we did” boards, ward community meetings and hospital wide patient council meetings. There was also patient representation at hospital development meetings and groups.

However:

  • Patient involvement in their care and treatment varied across the hospital. Patients on two of the wards were not actively involved in care planning or making decisions about their care and treatment.
  • Care plans were not personalised or individual to each patient. Patients told us their care plans were not based on their individual goals.
  • Privacy of patients was compromised by staff behaviour. Patient’s reported that staff would enter their bedrooms before they had obtained permission from the patient.

Responsive

Good

Updated 17 July 2018

We rated responsive as good because:

  • Facilities within the hospital promoted comfort, dignity and privacy. Improvements had been made to ensure low secure patients were not cared for in overly restrictive environments.
  • The service listened to and learnt from concerns and complaints, including informal complaints and concerns.
  • Admissions were planned and overseen by the south west regional secure service, a partnership of providers that aims to get people the support they need as close to home as possible.
  • Patients were able to personalise their bright and spacious bedrooms. Lockable cabinets provided patients with secure storage for personal items.
  • A range of information was available to patients and carers, including leaflets on treatments, advocacy services and patient activities.

However:

  • Occupational therapy vacancies led to a lack of access to meaningful activities for patients. Extra nursing were employed at the weekends to provide access to some activities.

Well-led

Good

Updated 17 July 2018

We rated well-led as good because:

  • The service was well-led at ward and senior management level. Low morale amongst staff had been recognised and the service was working actively with staff to respond to their concerns and make changes that would benefit them.
  • All staff felt respected, supported and valued by the new management team.
  • The provider had a comprehensive schedule of meetings and reporting systems to ensure good governance of the service.
  • Leaders had the skills, knowledge and experience to perform their roles. Senior staff were visible to staff and patients and had a good understanding of the services they managed.
Checks on specific services

Forensic inpatient/secure wards

Good

Updated 17 July 2018

Wellesley hospital provides forensic inpatient/secure wards to patients from the south west of England. At the time of our inspection, three wards were open, offering care and treatment to males in medium and low secure settings and females in a low secure setting.