Windermere House Independent Hospital

Updated 27 June 2018

Windermere House Independent Hospital is a specialist independent mental health service based in Kingston-Upon-Hull. It is part of the Barchester hospital and complex care services division. It provides care and treatment for men with a functional mental health problem (such as schizophrenia or bipolar disorder) or organic mental health problems (such as dementia and brain injuries). The hospital accommodates up to 41 patients and comprises three units:

• Coniston, an 11-bed unit for men that provides complex care and treatment for working age men with either drug induced or treatment resistant functional mental health needs. At the time of the inspection, there were 11 patients on the unit. Eight patients were detained under the Mental Health Act. One patient was subject to a Deprivation of liberty safeguard and one patient was awaiting authorisation of their application by the local authority. There was one informal patient.

• Kendal, a 15-bed unit for men that provides complex care and treatment for men aged 50 and over with either functional or organic mental health difficulties. At the time of the inspection, there were 13 patients on the unit. Three patients were detained under the Mental Health Act, four patients were subject to a Deprivation of liberty safeguard and six patients were awaiting authorisation of their application by the local authority.

• Ullswater unit, a 15-bed unit that provides care and treatment for older aged men with complex dementia and mental health needs. At the time of the inspection, there were five patients on the unit. Two patients were detained under the Mental Health Act. Three patients were either subject to a Deprivation of liberty safeguard or awaiting authorisation of their application by the local authority.

Windermere House Independent Hospital has been registered with the Care Quality Commission since 2011 to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury

A hospital director was in place at the location. The hospital director, along with the registered provider, is legally responsible and accountable for compliance with the requirements of the Health and Social Care Act 2008 and associated regulations. The hospital director was also the controlled drugs accountable officer. The accountable officer is a senior manager who is responsible and accountable for the supervision, management and use of controlled drugs.

The Care Quality Commission has inspected Windermere House Independent Hospital six times. The previous comprehensive inspection took place in December 2015. We carried out an unannounced follow up inspection that took place in November 2016 and found the hospital had breached Health and Social Care regulations. We issued the provider with three requirement notices. These related to the following regulations under the Health and Social Care Act (Regulated Activities) Regulations 2014:

Regulation 15 HSCA (RA) Regulations 2014, Premises and equipment

Regulation 17 HSCA (RA) Regulations 2014, Good governance

Regulation 18 HSCA (RA) Regulations 2014, Staffing.

There have also been two Mental Health Act monitoring visits in the past 12 months.

Updated 27 June 2018

We rated Windermere House Independent Hospital as good because:

• The hospital had made improvements following feedback from our previous inspection. The hospital environment was clean and well maintained. Staff exceeded the provider targets in key areas for mandatory training, supervision and appraisals. Hospital managers had introduced a robust process to effectively assess and manage the risks identified on the risk register.

• The hospital had systems in place to protect patients from harm. Each unit had an up to date environmental risk register and risk management plans. Staff identified and managed risks appropriately. Risk assessments included monitoring of existing and potential physical health risks. Patients told us they felt safe.

• Patients on both units had detailed, personalised care plans, which included information about physical health needs. Staff gathered information from carers to reflect a patient’s history and preferences, which contributed to their care plan. Patients felt involved in decisions about their care. Patients had positive behavioural support plans in place.

• Carers and patients praised the care and treatment the service provided. Staff involved patients in decisions about their care where possible. They engaged with and supported carers where appropriate. Staff contacted carers with updates on patient progress and held regular carers meetings. The hospital was open to visitors throughout the day apart from during mealtimes.

• The hospital had discharged nine patients since 1st January 2017. They considered discharge from admission and actively sought suitable placements that could best meet their patients’ needs. Patients visited all proposed placements and made the final decision about their future placement. All units experienced delays in discharging patients due to the lack of availability of suitable placements.

• The organisation’s governance structure ensured effective communication from the hospital to board level and vice versa. There were effective systems in place to monitor performance, share good practice and manage risks. The hospital investigated serious incidents, fed back lessons learned to staff, and put in place any identified improvements to practice.

However:

• Staff working on the rehabilitation units struggled to relate best practice to the care and treatment they provided. The hospital was not currently using any recognised rating scales to assess and record severity and outcomes. Not all staff had a clear understanding of the hospital’s transcription process for prescription charts, which had the potential to cause errors in administration.
• Patients at the hospital had limited involvement from psychology and currently no access to a qualified occupational therapist. The opinion of the psychiatrist and nursing staff dominated individual patient reviews and these meetings lacked the perspective of other qualified disciplines.
• On Kendal unit, staff did not have a clear understanding of the Mental Capacity Act and its basic principles. They did not distinguish between the Mental Health Act and the Mental Capacity Act and said they treat all patients the same, whether they were detained, informal or had deprivation of liberty safeguards authorisation. Capacity assessments varied in quality on the rehabilitation wards.
• The hospital could not always guarantee a consultant psychiatrist could attend the service within 30 minutes in the event of an emergency.

Updated 27 June 2018

Updated 27 June 2018