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Inspection Summary


Overall summary & rating

Outstanding

Updated 11 July 2018

We rated Wast Hills House as outstanding because:

Staff minimised risk to patients by ensuring the environment was clean and tidy, equipment was safe and effective to use and appropriate measures were put in place when risks to patients and staff were identified.

The service managed incidents well. Clinical and non-clinical staff were trained in conflict resolution and positive behavioural support and managed challenging behaviour in the least restrictive way. Managers investigated incidents and analysed themes and trends, which ensured staff could adapt and modify patient care when required to reduce the frequency of further incidents.

Skilled and experienced staff worked exceptionally well together as a team, using a variety of nationally recognised assessment tools to create holistic, individualised, person centred care plans. They focused on positive behavioural support and these were written in patients preferred communication style.

The service used the ‘Personal PATHS’ model of care which we saw adopted across the service. This shaped the way the service provided care and treatment, and ensured they monitored their effectiveness by sharing the findings and making improvements to maintain quality of care and treatment.

All staff employed by the service received specialist training and worked together with mutual support and respect to provide good quality care and treatment. Staff worked closely and proactively with families, external agencies and partners to ensure the patients best interests were always prioritised when decisions were made.

Staff had good knowledge of the Mental Capacity Act, which was embedded within the service. Staff supported patients to make decisions, and when they could not, staff recorded detailed reasons why decisions were made on their behalf. Staff understood their roles and responsibilities under the Mental Health Act 1983 and this was effectively applied across the service.

There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted patients’ dignity. Patients told us that staff treated them well, with kindness and respect. Staff had excellent knowledge of their patients, their likes and dislikes and their preferred communication style. This meant they understood their individual needs.

Carers, families and external agencies were extremely positive about the service and believed the service always managed challenging behaviour well. They were confident their relatives were receiving great care and treatment in a safe environment. They felt involved and included in their relatives care and the service was open and honest, providing regular feedback on their relatives care and when things went wrong.

The service encouraged feedback and saw it as an opportunity to improve. Patients and carers had opportunities to provide feedback to the service and staff listened and made improvements when required.

The service worked proactively with external agencies and families to ensure the patients were treated in line with the NHS Transforming Care agenda. Staff adapted the service to meet the needs of individual patients and ensured that appropriate care packages were in place before they were discharged from the service. The service ensured a smooth transition between services by providing an intensive face to face handover over many weeks before and after discharge.

Patients engaged in wide ranging meaningful activity plans which were individualised to meet their needs, encouraged independence and improve their skills. Staff used communication ‘grab sheets’ so patients’ interactions were consistently understood. Staff understood what was important to patients and provided them with information to make informed choices.

The service had a robust governance structure in place to monitor its effectiveness and sought to continually improve the quality of the service they provided. The service was committed to quality improvement and had signed up to a national project, making changes to the service when required. They provided training in autism for external agencies and partners. Staff were nominated for nationally recognised awards and they were accredited with the National Autistic Society.

The service promoted a positive culture that supported and valued staff. Staff enjoyed working with their patients and the majority thought that staff morale was high. Staff had opportunities to develop their skills and were provided with specialist training.

Inspection areas

Safe

Good

Updated 11 July 2018

We rated safe as good because:

The service controlled infection risk well and ensured physical health and emergency equipment worked effectively and was safe to use. Effective medication management processes were in place to ensure medicines were safe to use, although a recent audit had highlighted areas that required improvement. However, we saw that many of the actions had been completed.

The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Patients had a minimum of one staff member allocated to them. Staff were proactive at completing safeguarding referrals and all staff that worked at Wast Hills had access to safeguarding training.

The service identified any risks to staff and patients and put measures in place to manage them. Staff undertook assessments of the environment regularly and observed patients to keep them safe. Clinical and non-clinical staff were trained in conflict resolution techniques and managed challenging behaviour in the least restrictive way.

The service managed patient safety incidents well. Staff recognised incidents, reported them and received debriefs and lessons learnt when appropriate. Managers investigated incidents, and monitored and analysed incident data, including the use of physical intervention and staff discussed their findings. This ensured staff could adapt and modify care plans to reduce the frequency of incidents and the need for physical intervention where required.

Effective

Outstanding

Updated 11 July 2018

We rated effective as outstanding because:

Staff completed comprehensive, detailed and up to date patient care records. They used a variety of assessment tools to identify patients’ needs, and created a variety of holistic, individualised, person centred care plans. Staff referred to national guidance related to learning disabilities and autism to ensure they followed best practice.

Patients physical health was assessed, monitored and treated. All patients with a co-existing physical health condition had appropriate care plans in place and staff worked closely with specialist services. One nurse had developed his skills so he could take patients’ blood on site which had greatly enhanced the monitoring of patients’ physical health.

Patients had a range of personalised plans in place so staff and other people could easily understand their individual preferences and communication needs. This meant patients had their needs met effectively and quickly.

The service used the ‘Personal PATHS’ model of care, incorporating five key principles: positive behavioural support, appreciative inquiry method, therapeutic outcomes, healthy lifestyle and safe services. These principles were adopted across the service which led to a care pathway centred around the patient group.

The service monitored the effectiveness of care and treatment and used the findings to improve them. Findings were shared with patients and staff and compared to other services within the Danshell Group. This ensured the service was always looking to make improvements to maintain quality of care and treatment.

Staff of different kinds worked together as a team to benefit patients. Each member of the team had a specific role that contributed to the patients care, staff were mutually respected and they felt their contribution and opinions were valued.

The service made sure staff were competent for their roles by providing specialist training, supervision and appraisals. Non- clinical staff received training in positive behavioural support, Mental Capacity Act, safeguarding and de-escalation skills.

The service worked proactively with external agencies to ensure the NHS Transforming Care programme was followed. Staff, families, commissioners and other professionals worked closely to ensure the patients best interests were considered when decisions were made.

All staff had exceptional knowledge of the Mental Capacity Act, and we saw that it was embedded within the service. Recording of patients’ capacity and decision making when patients lacked capacity was to a high standard, and staff supported patients to make their own decisions.

Staff understood their roles and responsibilities under the Mental Health Act 1983 and this was effectively applied across the service.

Caring

Outstanding

Updated 11 July 2018

We rated caring as outstanding because:

There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted patients’ dignity. Staff were respectful and responsive to patients’ needs. Staff took the time to get to know their patients, their individual communication needs and their likes and dislikes were central to care provided. Exceptional knowledge of their patients’ meant staff anticipated and could predict patient’s needs, and this was reflected in the way care was delivered. Patients, carers and families we spoke with were very complimentary about staff and believed they were consistently caring, compassionate and supportive.

Staff ensured that patients and those close to them were empowered as partners in their care; fully involved in decisions about their care and treatment. Patients and carers attended multidisciplinary meetings and received good information and feedback about their relatives. Carers told us staff respected their views, listened and respected them. Staff were committed to working in partnership to ensure the patients best outcomes were realised.

Carers, relatives and external partners were extremely positive about the service. They believed the service consistently managed challenging behaviour well and were confident their relatives were receiving great care in a safe environment. Their views about the service were sought regularly and they said staff were open and transparent when things went wrong. Families were invited to annual events at the service and the provider encouraged families and carers involvement at all levels.

Patients attended a weekly service user forum to discuss activities, what they enjoyed and anything they didn’t like about the service. Patients that could were encouraged to complete satisfaction questionnaires. Staff acted on patient feedback and displayed this on a ‘you said, we did’ board.

Responsive

Good

Updated 11 July 2018

We rated responsive as good because:

The service worked to the guidance set out in the NHS Transforming Care programme for people with learning disabilities and autism to ensure that discharge planning started at the point of admission. They worked proactively with external agencies such as commissioners and community teams to facilitate a thorough discharge plan with the right level of care and support.

Staff carefully considered the suitability of a patient’s admission following assessment, considering the needs of their existing patient group. The service was flexible and could accommodate patients’ complex needs making adaptions to the environment when necessary to ensure they were fully met.

Staff ensured smooth patient transition between services when a patient was discharged. Carers and support staff from the new provider were invited to spend time at the service to get to know their new patient and received an in-depth, thorough handover of their care needs. Staff from Wast Hills also spent time at the ongoing placement, and could provide an individualised training package about that patient if required. This prevented readmission and ensured the patient settled in well within the new environment.

The service took account of patients’ individual needs and their preferences were central to the delivery of a tailored service. Staff had an exceptional knowledge of their patients and their preferred communication styles, and had quick access to ‘grab cards’. The chef prepared fresh food daily and was knowledgeable about the needs of the individual patients; patients and staff had choice of a variety of foods which were nutritionally balanced and beautifully presented. Staff understood what was important to patients and provided them with visual, easy read information so they could make informed choices.

Patients made use of the environment, which was situated in large, spacious grounds. Staff engaged patients in outdoor pursuits and focused on their meaningful activity plans which were individualised to meet their needs, encouraged independence and improved their skills. Patients that could, were encouraged to engage in their local community, and staff escorted them on day trips across the Country.

The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff. Staff had good knowledge of the complaints process. Carers and relatives told us staff responded quickly and appropriately when they raised concerns and kept them informed of progress.

However:

Despite the efforts staff were putting in to the transfer arrangements of patients with very complex needs, those with the longest stays had not yet resulted in discharge from the service.

Well-led

Outstanding

Updated 11 July 2018

We rated well-led as outstanding because:

The service was committed to quality improvement. It was accredited with the National Autistic Society. Staff were nominated for a range of upcoming nationally recognised awards. It was committed to its work with a national project aimed at reducing the over medication of people with learning disabilities and autism. It recognised good practice within the service, sharing and applying innovative ideas across the whole provider.

Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. Staff told us managers were open, supportive and they felt valued. Staff were motivated to help and support their patients and improve their quality of life.

The service had a robust governance structure in place to monitor its effectiveness and sought to continually improve the quality of the service they provided. Action plans were in place where required and managers used a variety of methods to monitor the safety of the service, the effectiveness of staff, areas of good practice and where improvements were required. Managers actively over recruited staff to proactively reduce risk and improve care and treatment.

Senior staff recognised the importance of maintaining and improving staff morale. The service had acted upon comments from feedback sessions with senior staff and the staff survey. We saw an excellent team working together to support each other and their patients approach, across the whole service. Most staff we spoke with said their morale was high and they enjoyed working within the service.

Opportunities for staff to improve knowledge and skills were available through training and professional courses. Staff were encouraged to develop their ideas and implement their new skills and we saw examples of where this had improved the quality of the service. There were robust systems in place for staff to receive supervision by skilled and experienced practitioners.

The service worked collaboratively with external agencies and provided training in learning disabilities and autism to organisations such as the police, schools and acute hospitals. The service was keen to extend the training to other agencies.

Checks on specific services

Wards for people with learning disabilities or autism

Outstanding

Updated 11 July 2018