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Inspection carried out on 18 June 2020

During an inspection looking at part of the service

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 carried out on 1 and 2 May 2018

During a routine inspection

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 carried out on 24 and 25 and 31 October and 1 November 2017

During an inspection looking at part of the service

  • The monitoring of side effects following rapid tranquilisation (RT) was not always completed in line with the National Institute for Health and Care Excellence (NICE) guidance. Not all registered nurses knew where Flumazenil, (which is a medicine that is used to reverse the potentially harmful effects of benzodiazepine medication), was kept or what it was for. Although improving, there were various medication administration errors on Mendip ward, including missed staff signatures. Records to show that emergency medical equipment on Mendip ward was checked regularly was missing or incomplete.
  • Mendip ward was currently experiencing a high volume of patient on patient and patient on staff assaults. This was due to the current mix of patient’s. All five patients we spoke with shared concerns relating to staffs ability to safely diffuse situations. Although there was a comprehensive induction programme for all new starters at the hospital, this had failed to ensure that staff understood the differences between patients being nursed within a medium and low secure setting. Morale was varied at the hospital. Some staff that we spoke with prior, during and post the inspection visit described low morale, but did not feel able to raise this with senior managers for fear of recrimination. Not all staff said that their colleagues represented the values set by Elysium Healthcare, describing situations where communication could be better.
  • The rights of patients on Mendip, the low secure ward, were not being protected. Policies and procedures that should have been in place to protect the rights of patients not requiring medium security were either inadequate or missing. Care records were not in line with professional standards for record keeping. Daily records relating to patients general wellbeing, mental health and activity levels were either missing or poorly recorded. Care pans relating to specific health needs and or patient activities were poorly recorded and or absent. Records relating to the seclusion of patients were either completed incorrectly and / or incomplete. Dental care was available for patients who were able to leave the hospital but was not available for those that could not.

However:

  • Ligature risks had been reduced by minimising ligature points within the building. Ligature assessments were up to date and available on each ward. There was a meeting each weekday morning to discuss incidents, staffing and other risk related issues.
  • Safeguarding events were recorded by staff and information sent to the safeguarding lead for further consideration and escalated to the local authority if necessary. The importance of relational security was covered in the staff induction. There was access to an advocate Monday to Friday.
  • The assessment of patient’s physical health was completed on admission and routinely and regularly thereafter. We observed staff interacting with patients in a patient and caring manner. Community meetings were held weekly on both wards. There was a patient council group within the hospital. A daily planning book was completed by patients in partnership with the lead occupational therapist (OT). All patients had their own bedrooms with ensuite facilities