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Inspection Summary


Overall summary & rating

Good

Updated 31 July 2020

Wellesley hospital provides forensic inpatient / secure wards to patients from the south west of England.

We carried out a focused inspection of forensic wards at Wellesley hospital. We did not re-rate this service as we only inspected one (Selworthy ward) of the five forensic wards. The purpose of the inspection was to follow up on specific concerns that had come to our attention around the management of a serious incident.

We found that:

  • The hospital managed patient incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • Observations were proportionate and risk based. For example, if there was an increased risk to an individual patient or to others, the patient`s level of observations would be increased. There was an observation sheet that required staff to sign at the time of observation and note where the patient was and confirm if response was gained. In addition, every patient was observed hourly and this was recorded in the same way.

  • Selworthy ward provided safe care. The ward environment was safe and clean. The ward had enough nurses and doctors to ensure safe care and treatment for patients. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff were appropriately trained in restraint and used this as a last resort.
  • We observed 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.
  • Selworthy ward was well led, and managers fostered a culture amongst the team where staff felt able to challenge practice and raise concerns without fear of repercussions.
  • Managers within the service promoted an open and honest culture. All staff had received training on their responsibilities under the duty of candour and additional information was available on the intranet. Duty of candour is a statutory (legal) duty to be open and honest with patients, or their families, when something goes wrong that appears to have caused or could lead to significant harm in the future.

However:

  • At the time of this inspection, the investigation and analysis of the death of the patient on Selworthy ward was ongoing and staff told us they were waiting for this to share learning across the hospital.

Inspection areas

Safe

Good

Updated 31 July 2020

This was a focused inspection, so we did not rate this key question. We found that:

  • The ward was safe, clean, well equipped, well furnished, well maintained and fit for purpose.

  • The service had enough nursing and medical staff, who knew the patients and received mandatory training to keep patients safe from avoidable harm.

  • Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed.

  • Observations were proportionate and risk based, for example if there was an escalating risk to self or others, the patient`s level of observations would be increased. There was an observation sheet that required staff to sign at the time of observation and note where the patient was and confirm if response was gained. Every patient was observed hourly and this was recorded in the same way.

  • The service managed patient incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • At the time of this inspection, the investigation and analysis of the death of the patient on Selworthy ward was ongoing and staff told us they were waiting for this to share learning across the hospital.

Effective

Good

Updated 31 July 2020

At the last inspection in May 2018 we rated effective as good. Since that inspection we have received no information that would cause us to re-inspect this key question or change the rating.

Caring

Good

Updated 31 July 2020

This was a focused inspection, so we did not rate this domain. We found that:

  • We observed staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.

Responsive

Good

Updated 31 July 2020

At the last inspection in May 2018 we rated effective as good. Since that inspection we have received no information that would cause us to re-inspect this key question or change the rating.

Well-led

Good

Updated 31 July 2020

This was a focused inspection, so we did not rate this key question. We found that:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.

  • Managers within the service promoted an open and honest culture. All staff had received training on their responsibilities under the duty of candour and additional information was available on the intranet.