Wellesley Hospital

Wellesley Hospital, owned by Elysium Healthcare, is a purpose-built hospital in South-West England for men and women with mental health problems and/or learning disability or autism. It provides care for patients aged over 18 years.

The hospital forms part of the South West Provider Collaborative under the new care models. This programme aims to reduce patients’ length of stay and reduce the number of out-of-area patient placements.

We undertook this inspection as part of our inspection programme and inspected the following two mental health core services.

Forensic inpatient and secure wards

• The last comprehensive inspection was on the 1st and 2nd of May 2018 where the forensic inpatient and secure wards were rated “Good.” Following this inspection our rating for the service stayed the same.
• Many patients who are admitted to a secure service will have been in contact with the criminal justice system. Patients who are admitted to a secure hospital will be subject to detention under the Mental Health Act 1983.
• During this inspection we inspected the following wards: Quantock ward, a medium secure wards for men, Selworthy and Mendip wards, a low secure wards for men, Blackdown ward, a medium secure ward for females and Polden ward, a low secure ward for females.

Wards for people with a learning disability or autism

• Winsford ward opened in April 2021 and has not been inspected previously. During this inspection we have rated the service as “Good.”
• Winsford ward provides a service for people with learning disabilities and/or autism who may be informal or detained under the Mental Health Act 1983.
• We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted.
• ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
• The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
• Right support: The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment. The environment met peoples’ physical needs while also feeling homely. However, although peoples’ sensory needs were considered, the sensory room was not equipped for sensory needs. For example, the room did not have a range of stimuli to help individuals develop and engage their senses such as lights, sounds or sensory soft play resources and aromas.
• Right care: Peoples’ care was individualised, planned and delivered in a manner that met their needs. Peoples’ care promoted their dignity, privacy and human rights, Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so.
• Right culture: Staff were supporting people with their transition to live successfully in the community. They were respectful to the people they supported. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff understood the importance of family values.

Our findings

We rated the forensic inpatient and secure wards and the ward for people with learning disability or autism as good because:

• Patients and people across both services had individual and personalised en-suite bedrooms which met their communications and physical needs. Patients and people who used services were protected from abuse and poor care and staff were knowledgeable about the signs of abuse and reporting processes.
• Staff assessed and managed risks well. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour.
• People on the learning disability or autism ward made choices and participated in activities which were part of their planned care and support.
• Staff supported patients and people across both services to achieve their goals through recognised models of care and treatment. Patients and people who use services were involved in all aspects of their care and treatment and support plans. On the learning disability or autism ward easy read copies of their care plans and social stories were developed in a manner that people were able to understand. Posters were in an easy read format to ensure people understood the information on display.
• The services managed safety 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 and people who use services honest information and suitable support.
• Managers ensured they had staff with the range of skills needed to provide high quality care. They supported staff with supervision and appraisals. Staff were provided with the opportunity to develop and update their skills. Managers provided an induction programme for new staff.
• People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005, and discharged these well. The services protected people’s human rights and provided good care, support and treatment. Staff helped people with communication, advocacy and cultural and spiritual support.
• Managers made sure that staff could explain patients’ rights to them.
• Staff understood the individual needs of patients on the forensic inpatients and secure wards and supported them to understand and manage their care, treatment or condition. People on the learning disability and autism ward had their communication needs met and information was shared in a way that could be understood. All patients and people who use services received kind and compassionate care from staff who protected and respected their privacy and dignity.
• Staff planned and managed discharges well. They liaised well with services that would provide aftercare. Staff did not discharge patients before they were ready and ensured they did not stay longer than they needed to.
• The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, which were shared with the whole team.
• Leaders had the skills, vision, knowledge and experience to perform their roles and understood the services they managed. Staff felt respected, supported and valued. The service promoted equality and diversity and provided opportunities for development and career progression. Leaders understood the services they managed and had a vision for these services. They were visible and approachable for patients, people and staff.

However:

• While the forensic inpatient and secure wards and the ward for people with learning disability or autism used systems and processes to prescribe and administer medicines safety, they did not always record, store or destroy medicines appropriately.
• Care records on the forensic inpatients and secure wards and the ward for learning disability or autism did not identify the reasoning for providing PRN (as required) medicines or demonstrate that patients were reviewed after administration of these medicines.
• While the services inspected had enough nursing and medical staff who knew the patients and the people who used services, and had received basic training to keep all safe, they did not have enough therapy staff to maintain daily activities on the forensic inpatient and secure wards.
• Across both services we found staff did not always monitor or record the physical health of patients and people who use services to ensure they responded appropriately to a potential deteriorating condition.