Archived: Cygnet Whorlton Hall

We rated Whorlton Hall as good because:

• The service was clean and tidy with a fully equipped clinic room. The service complied with the Department of Health’s guidance on eliminating mixed sex accommodation by keeping male and female bedrooms separated. There were rooms where patients could spend time in private. Health and safety checks were made to ensure the building was safe and environmental risk assessments were up to date and contained details of all ligature points in the building.
• There were enough staff in place to meet the needs of patients, bank and agency staff were familiar with the way the service operated and knew what the patients’ needs were and staff sickness absence were at 4%, which was low. Staff were qualified, experienced, received regular supervision, were appraised, received mandatory training and had access to specialist training. A regional occupational therapist provided staff with advice and support in relation to the care and treatment of patients with autism. Staff knew about Danshell’s safeguarding and whistleblowing procedures and received information about learned lessons from incidents and complaints to improve practice within the service. Danshell reported on 31 May 2017 that there had been no complaints received about Whorlton Hall in the previous 12 months. Staff were motivated and morale within the team was positive.
• We observed staff interacting with patients in a kind, respectful and dignified manner throughout our inspection and patients and carers who spoke with us said staff treated them well and as individuals. They also told us that they were given the opportunity to provide feedback on care and treatment via patient forums, carers’ meetings and house meetings. A patient satisfaction survey in which nine patients participated was completed in September 2016. The responses to each question indicated that between 82% and 87% of patients were happy with the service they received.
• Patients were not placed in seclusion and physical restraint was only used as a last resort because staff were trained in de-escalation practices. Danshell also had a policy in place to ensure that any children visiting the hospital were kept safe. Risk assessments were in place for patients. Care and treatment plans were person-centred, recovery based and holistic and contained evidence that patients’ physical health was monitored and any issues identified were addressed. The service’s use of observations was appropriate to meet the needs of each patient.
• Mental Health Act and Deprivation of Liberty Safeguards documentation was in order. Staff received mandatory training in the Mental Health Act and Mental Capacity Act and audits took place to ensure staff complied with the Acts. Staff regularly reminded patients of their rights.
• Information was available on a wide range of topics in a variety of formats such as easy-read and foreign languages, which included how to make a complaint, patients’ rights and details of patients’ advocacy services. Hot drinks and snacks were available to patients 24 hours a day; the quality of the food was good with options to meet dietary and cultural needs. Patients could personalise their rooms and accessed their chosen place of worship within the community.
• Key performance indicators, clinical governance mechanisms and audits were used to monitor practice and improve service delivery. Staff could add items to the service and provider’s risk register. Staff agreed with Danshell’s visions and values and their team objectives were based around them.
• Danshell’s sports coordinator had been nominated for a Royal College of Psychiatrists award for innovation and best practice in relation to how their work had improved physical health for patients, including those at Whorlton Hall.

However:

• Curtain and shower rails in 12 rooms at the service were not of the collapsible type used to prevent suicide by hanging. However, these were included in the service’s environmental risk assessment and risks were rated, each patient had a risk assessment in place and the levels of observations were tailored according to each patient’s needs, which mitigated this. The service manager was also able to refuse any admissions that were unsafe due to the presence of ligature risks.
• Although the building was clean and tidy, there was a smell of urine in one of the male bedroom areas.
• Doors to rooms did not have signage on them to say what they were used for and were all painted white that made them look the same. This made it difficult to navigate around the building and risked people entering rooms being used for sensitive and personal discussions. Male patients did not have an in-house laundry service but female patients did which meant male and female patients were not being treated equally.
• During our inspection, a room being used for a patient’s multidisciplinary team slammed shut, which caused notable alarm to the patient.

We rated Whorlton Hall as requires improvement because:

• The provider had not taken sufficient action to address the requirement notice we issued following our inspection in March 2016. Although resuscitation equipment was clean and in date an essential stock item for anaphylaxis which we identified at our March 2016 inspection was not available at the time of our inspection.
• There were gaps in cleaning records and domestic staff vacancies meant that some days there was not a domestic on duty.
• Some minutes from governance meetings were brief and there had been gaps in monthly internal service reports. This had the potential to affect the organisations ability to effectively monitor performance and quality.
• The provider had not completed all the requirements for a patient being cared for away from other patient who was in long term segregation as defined by the Mental Health Act code of practice.
• A patient who had been given as required high-dose antipsychotic medication regularly refused physical health monitoring. The patient’s refusal was not always recorded.
• It was difficult to locate items in some paper care records.

However:

• The service had been proactive in addressing significant staffing and management issues which had occurred between June and August 2016. Senior managers in the organisation had put safeguards in place to support new managers. Active recruitment to vacant posts was continuing and a new post of deputy manager had been created.
• The provider was making good progress in addressing actions highlighted in recent audits and internal reviews. We saw improvements had taken place with regard to the environment, staff training and record keeping.
• Staff completed risk assessments of patients at admission and on an ongoing basis.
• Low morale amongst staff had been recognised and the service had worked actively with staff to respond to their concerns and make changes that would benefit them. Staff reported things had improved and they enjoyed their jobs.
• Senior manager support was continuing to maintain the improvements which had been made. An action plan was in place to ensure improvement was maintained and outstanding actions were monitored.

Whorlton Hall is an independent hospital in Barnard Castle, County Durham, which cares for people living with a learning disability or autism and complex needs, and for people who have additional physical or mental health needs and behaviours that challenge.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

We inspected Whorlton Hall in March 2016 and published our report in June. We rated the hospital as good overall but as requires improvement for safe.

This inspection was prompted by concerns about the quality of care that were brought to our attention since June.

We did not rate the safe domain for Whorlton Hall during this inspection because we did not carry out a full inspection. However, our findings during this inspection meant that we did rate the provider in the effective domain.

We found the following:

• We saw one patient who we considered to meet the Mental Health Act definition of long term segregation but were not identified as such by the provider.
• The hospital had had recent changes in management. A newly appointed registered manager had left at short notice resulting in temporary management arrangements needing to be put in place. An interim manager was in place and a permanent manager had been recruited. Staffing levels had not always been sufficient to keep staff and patients safe. This had resulted in concerns regarding the care of patients. At the time of our visit we saw that the provider had taken positive steps to ensure there were sufficient numbers of staff on duty to keep patients and staff safe.
• Some areas in the hospital were unclean despite the hospital having domestic staff. The provider had an improvement action plan which included a review of cleaning rotas.
• Care plans identified risks but did not always describe how to manage these risks.