The Care Quality Commission
  • Mental Health
  • Independent mental health service

Ashwood Court Nursing Unit

Overall: Good read more about inspection ratings

Woodford Avenue, Lowton, Warrington, Cheshire, WA3 2RB (01925) 571680

Provided and run by:
Making Space

All Inspections

20 and 21 June 2023

During a routine inspection

Our rating of this location improved. We rated it as good because:

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured staff received training, supervision, and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • 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.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured ward procedures ran smoothly.
  • Due to the improvements noted at this inspection the service is no longer in special measures.

14 September 2022

During an inspection looking at part of the service

This was a focussed inspection of elements of the safe and well-led key questions only. We did not re-rate this service and the previous ratings remain in place.

  • Policies, processes and other documentation were not robust enough to ensure the service was able to provide safe and consistent care. Many policies lacked specific detail to ensure staff knew what action to take. This included the child visitor procedure, the safeguarding adults and children policies and the missing persons policy. There was no search policy in place. The physical interventions policy did not describe how to manage situations of unplanned floor restraint. There were no processes in place to review blanket restrictions. Team meeting agendas were inconsistent. The admission criteria and pre-assessment paperwork did not demonstrate how patients who were likely to require higher levels of physical intervention were prevented from being admitted. The ligature risk assessment required further development.
  • Mandatory training compliance figures did not always meet the required standard for all modules. First aid training was 44% and manual handling of people training was 65%. Some staff had been booked onto this training in the weeks following the inspection.
  • Restraint training was only to a basic level and did not include floor restraint. There was no clear rationale how this met the needs of the patients. There was no evidence how this was risk assessed.
  • Admission criteria and pre-assessment documents did not clearly demonstrate how patients at risk of being violent and aggressive were prevented from being admitted to the service.

However:

  • All patients now had risk assessments in place. Risk assessments clearly identified all risks. Risk management plans were also now in place for all patients. Staff now knew about all patient risk and how to respond appropriately.
  • The care record system had been improved. Care records were now an accurate, complete and contemporaneous record in respect of each patient. All patients now had comprehensive care plans and other documents that were individualised and person centred.
  • A new suite of robust audits had been introduced to assess, monitor and improve the service. This included care record audits and medicines management audits. These had been completed regularly and information was shared with the senior management team to check the quality of the service.
  • New policies had been developed such as the medicines management policy. Some policies required further consideration. We checked the medicines on site and the medication audits. All were seen to be correct and in order.
  • Incidents were now reported appropriately. We saw examples of incidents being reported internally and externally. There was evidence of incidents being reviewed and actions taken to consider future learning.
  • All staff had received training in physical interventions. There was a physical interventions policy and staff described being aware of always attempting de-escalation prior to any other action being taken.
  • Staff now responded to incidents appropriately. There had been a series of minor incidents which staff had responded to correctly.
  • There was a new care plan and risk assessment policy in place. This policy explained that risk assessments should be updated every six months as a minimum or following changes in needs. However, it not specifically state that risk assessments should be updated following incidents.

05 May 2022

During a routine inspection

Following this inspection, we took urgent action and served a Notice of Decision which placed conditions on the service’s registration. The Notice of Decision prevented the provider from admitting any further patients to Ashwood Court Nursing Unit. In addition to the Notice of Decision we served two Warning Notices under Section 29 of the Health and Social Care Act, due to concerns about the safe care and treatment of the patients and the lack of good governance.

Our rating of this location went down. We rated it as inadequate because:

Safety systems, processes and standard operating procedures were not fit for purpose and did not keep people safe. Resuscitation equipment was out of date or missing and had been for several months at the time of inspection.

There was no evidence of learning from events or action taken to improve safety. There was no incident management policy for staff to follow and no evidence of learning from incidents.

The information needed to plan and deliver effective care, treatment and support was not available at the right time. The service did not have an environmental ligature risk assessment. Staff did not have access to Mental Health Act and Ministry of Justice paperwork to inform the care they provided.

Staff did not assess, monitor or manage the risks to people who used the service. Staff did not complete a risk assessment or crisis plan for all patients and did not review patient risk following incidents. Opportunities to prevent or minimise harm were missed.

Information about people’s care and treatment was not appropriately shared between staff or with partner agencies. Staff did not notify the Care Quality Commission of all incidents that met the threshold for reporting.

There was insufficient attention given to safeguarding. Staff did not follow the provider’s own safeguarding policy. Staff did not report all safeguarding concerns to the local authority that met the threshold for reporting.

Staff did not have the knowledge and skills needed to keep people safe. Staff did not have adequate training to safely manage incidents of violence and aggression that occurred on the unit. Staff were not up to date with mandatory training and did not have training in basic life support. There was not enough medical input to ensure the safe care and treatment of patients.

The service did not involve patients, families and carers in their care and treatment. Discharge planning was not well managed and not all patients had a discharge plan in place.

The service did not protect the privacy and dignity of patients. Male patients could see into female patients’ bedrooms from the garden.

Leaders did not have enough oversight of the service to ensure patients were receiving safe care and treatment. At the time of inspection, the service did not have a risk register in place. The provider was not aware of the concerns found at this location until the inspection. The registered manager had responsibility for two locations and there was no deputy manager in place at Ashwood Court Nursing Unit.

The governance arrangements were unclear and there was no clear audit system in place to assess, monitor and improve the quality and safety of the service. The medicines audit was out of date, equipment checks were not completed in line with manufacturers requirements and managers did not audit care records.

However:

Staff demonstrated a caring attitude towards the patients and patients spoke positively about the unit. Patients also stated they had a good relationship with bank and agency staff.

Patients described the unit as clean and comfortable.

Staff supported patients to take up volunteering opportunities within the local community.

The service had a good physical health pathway in place for patients.

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Letter from the Chief Inspector of Hospitals

I am placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

28 June 2018

During a routine inspection

We rated Ashwood Court Nursing Unit as good because:

  • The environment was safe, and where there were risks these were identified and managed. The service complied with guidance on mixed sex accommodation. All patients had their own bedroom, and there were designated corridors for men and women. The clinic room was clean and appropriately stocked. Medical devices and resuscitation equipment were readily available.
  • The service did not use restrictive interventions such as restraint and seclusion. One-to-one observations and rapid tranquillisation were rarely used. Staff were aware of the safeguarding policy, and knew how to raise concerns. Incidents were reported and responded to appropriately.
  • The service had enough staff with the right skills, training and experience. Patients received care and treatment from a multidisciplinary team of staff which included occupational therapy and psychology. All staff received supervision and appraisal.
  • Medication was safely prescribed, administered, stored and managed by the service. All patients had an assessment of their needs, and care plans developed in response to identified needs. All patients had a physical examination on admission, and ongoing monitoring of their physical health. Staff used rating scales to monitor patient’s progress.
  • Patients were mostly positive about the care they received and the service that was provided. The service held weekly community meetings, where patients gave their opinions about the service, and raised their concerns. Patients had access to an advocacy service. Patients were involved in their care, and this was reflected in some of the care records.
  • All patients had a key to their own room, and access to a phone, computer and wifi. Patients had access to outdoor, space, and were encouraged to engage in activities inside and outside the unit. Food was prepared and cooked in the onsite kitchen. Patients could make hot and cold drinks when they wished.
  • The Mental Health Act was implemented effectively. Staff were trained in the Mental Health Act and the Mental Capacity Act. They could access additional advice and support when required. There were systems for the implementation and monitoring of the Mental Capacity Act and Deprivation of Liberty Safeguards.
  • The building was accessible to people using a wheelchair. The service had carried out care and treatment reviews for patients with a learning disability, in accordance with national guidance.
  • There were governance structures in place. These ensured that key elements of the service were monitored, and areas for improvement identified and action taken. Regular audits were carried out, and the findings reviewed and implemented at both local and board level. Key performance indicators were used to monitor the service both inside the organisation, and by external bodies such as the clinical commissioning group.

However

  • The quality of the care plans varied and they were not consistently person centred.
  • There was no specific documentation in patient’s records regarding the use of high dose antipsychotic therapy.
  • New medical equipment had not been routinely checked in accordance with the manufacturer’s instructions. Some of the disposable items in the clinic room were beyond their printed expiry date.

26 May 2016

During a routine inspection

We rated Ashwood Court as good because :

  • Effective systems were in place to monitor and manage environmental risks
  • There were enough staff to meet patients’ needs and minimal bank and agency staff were used which provided consistency in the care delivered. Mandatory training was completed in line with the organisation’s requirements. Staff were knowledgeable about safeguarding procedures, and knew how to raise any concerns appropriately.
  • Restrictions were individualised and based on a clear risk assessment for individual patients.
  • Initial assessments, care plans and risk assessments were individualised, recovery focused and took in to account patient views. There was a clear physical health care pathway and staff prioritised patient physical health care.
  • Staff received supervision and a yearly work performance appraisal in line with their organisational requirements. Team performance was managed through supervision.
  • There was a wide range of multi disciplinary professionals, and effective multi disciplinary team meetings including care programme approach meetings took place. Recognised rating scales were used to measure outcomes for patients.
  • Patients told us that they were treated in a kind and supportive way, and they felt safe within the hospital. Staff were knowledgeable about their patients’ care and treatment.
  • Patients felt involved in their care planning and could have a copy of their care plan if they wished.
  • There was a clear governance structure in place and the registered manager had oversight of the performance of the service through key performance indicators.

However,

  • Care plans were not written from the patient perspective.

17 July 2013

During a routine inspection

We met with six patients who told us that they were treated with respect by staff and other professionals who visited the hospital. They told us that they were provided with clear information about the service prior to admission. They said they were asked what they wanted from the service and what goals they wished to be set. Everybody we spoke with said they felt that their dignity was not compromised in any way by the staff. Comments included "I have been in many hospitals over the years but they don't compare to Ashwood Court. This place is wonderful, they do their best to get us better and ready for life in the community. God bless them."

Care files held relevant information, however they were being reviewed to ensure they were indexed and easy to access.

Staff were trained and supported to provide needs led care and treatment to the patients. Comments from staff included "I love my job and enjoy working with the team", "I feel supported in my role and get good training in anything I feel I need."

The organisation had effective quality assurance systems in place to enable patients and other people who accessed the hospital to have their say about the staff and services provided.

27 September 2012

During a routine inspection

We visited Ashwood Court Independent hospital and asked patients to tell us what it was like living there.

We spoke with five patients who said that they understood the care and choices available to them and that they were involved in making decisions about the treatment and support they received. They told us that they were provided with clear information about the service prior to admission. They said they were asked what they wanted from the service and what goals they wished to be set.

Everybody we spoke with said they felt that their dignity was not compromised in any way by the staff. They said staff always knocked at the door before entering their room and maintained their dignity when providing treatment or support.

Patients told us that when they were assessed for a placement at the unit they were invited to visit as many times as they wanted to make sure it was the right place for them. They said that they were asked what they wanted to achieve and how they would like their care to be delivered. One person told us that they felt that staff understood them and made them feel better. Other comments included 'staff treat me well', 'staff make time for us all although they are very busy people', 'Staff are very kind and caring', ' We can have visitors anytime we want', 'We have just been on holiday look at the photographs, it was great.'

Patients said that they would raise any concerns they had with the care staff or the manager as appropriate. Comments included 'We feel safe here',' Staff protect us from harm.'

Patients said they felt fully supported by the staff.

Comments included 'I trust the staff. I don't really want to be here but I know they will do their best to make me better', 'staff are kind and supportive and help us to achieve our goals', 'staff have good skills and can help us to understand our problems and hopefully overcome them.'

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.