Langdon Hospital

Updated 25 June 2019

Devon Partnership NHS Trust provides forensic/secure inpatient wards for male patients with mental health conditions who are detained under the Mental Health Act 1983 at Langdon Hospital, an NHS forensic hospital based in Dawlish, Devon. The hospital is owned and managed by Devon Partnership NHS Trust. The Dewnans centre has 60 inpatient beds on four medium secure wards: Ashcombe; Holcombe; Warren and Cofton. The Dewnans centre supports men on treatment pathways from admission through to long term and step-down care as their health and wellbeing improves. Ashcombe is an admission and assessment ward and Holcombe is a ward for patients with complex mental health needs, which might include personality disorder. Warren and Cofton provide on-going care and treatment for patients who are still deemed to require medium secure care. Patients can move on to low secure services from all wards within the medium secure care unit. Langdon Hospital provides low secure services at Avon House, a 14 bed ward, and Chichester House, a 15 bed ward, for men with stable but enduring mental health conditions.  It provides open secure rehabilitation services at Owen House, a 16 bed ward, and Connelly House, a 6 bed ward, for men with complex mental health needs. 

Most patients at Langdon hospital were from Devon, Plymouth and Cornwall but the hospital provided care and treatment to patients from other counties. The hospital accepted admissions from high secure services, other secure units, adult mental health services, prison and the courts.

At the last comprehensive inspection of this core service in January 2018, we rated the wards as good for safe and responsive and we rated effective, caring and well led as outstanding.

At this inspection we inspected the safe and well led domains at Owen House and Avon House. The service was not re-rated at this inspection.

Updated 25 June 2019

During this focused inspection we inspected the safe and well led domains at Owen House and Avon House at Langdon hospital.

The service already has an outstanding rating and on this occasion we did not re-rate it.

We inspected the service due to concerns that had been raised through safeguarding and through information shared with us.

Prior to the inspection, the trust had been responding to safeguarding concerns that had been raised. Owen House had seen a high turnover of staff over the previous year. Staff at Owen House had not been identifying and reporting safeguarding previously but were now using a matrix to support this process. A new manager and a new consultant were in place at Owen House. Efforts had been made to improve training and supervision compliance. Concerns had also been raised about communication from Owen ward with care coordinators and community providers and efficiency of discharge planning. Owen House had an action plan in place to address the following areas: discharge planning, leave planning, quality reporting, absent without leave (AWOL) processes, care records, staffing, skill mix, training, safeguarding and actions to address leadership and organisation of the ward.

We had received information about staffing shortages including sickness and vacancies at Avon House. These included vacancies for a substantive consultant, ward manager, social worker and occupational therapist. Although these were being covered by bank and agency staffing, we were concerned that staff were regularly being redeployed to medium secure wards at Langdon and that this was leaving Avon House with minimum staffing levels. This meant patients could not always take escorted leave they were entitled to. We understood that, in response to these concerns, the ward was holding regular team meetings and patient forums to reinforce a supportive culture.

We had asked the trust for information about the concerns raised and learned that there had been recruitment issues on both wards and the trust was addressing these with an ongoing recruitment programme. The trust told us that the senior management team were spending more time on site at Langdon hospital and holding staff engagement events to seek views from staff and patients.

During our inspection visit, we found:

• The service provided safe care. Wards were working towards improving recruitment and retention and safe staffing levels were being maintained. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• 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 that these 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 treated patients with compassion and kindness and understood the individual needs of patients.
• Staff planned and managed discharge well and liaised with services that would provide aftercare.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However

• There were blind spots on the stairwells at Avon House that had not been mitigated and there were delays in completing repairs to patient toilets, showers and telephones.

• There were staffing challenges on both wards although these had improved. There were two vacant nurse posts at Owen House and there had been a high turnover of staff over the previous 12 months. Staff from both wards were regularly redeployed to other wards and this left both wards with minimum staffing levels. Staff told us they struggled to provide a good level of service at the minimum staffing level.
• Staff did not routinely record when patients section 17 leave had been cancelled and this meant there was a lack of oversight of the extent of the issue.
• Ward and senior managers did not know that safeguarding referrals were reviewed by the trust’s safeguarding department and that not all referrals were sent to the local authority.
• Patients and staff had raised concerns about the replacement of metal cutlery and china crockery on all wards with plastic cutlery and crockery. Staff considered this to be an unnecessary blanket restriction.

Updated 17 April 2014

We found patients were well supported by the staff working at Langdon Hospital. Patients’ privacy, dignity, diversity, values and human rights were respected.

Staff encouraged patients to be at the heart of planning their care and treatment. We found comprehensive care plans and risk assessments which considered patients’ physical, psychological, emotional and social wellbeing.

Records were completed for incidents of seclusion but there was no seclusion log or register and so it was not possible to check that all incidents of seclusion had been recorded appropriately. Incidents of seclusion are reviewed locally by Ward Managers and Senior Nurses both at team and directorate level. The current recording does not ensure all the necessary details are available to enable effective monitoring of trends on a trust wide level.

Out of hours there were some delays in patients in seclusion being reviewed by a doctor. This was because the on-call doctor covered several inpatient sites which affected their availability.

We found incidents of patients being nursed in, and prevented from leaving, the extra care areas of Avon House and Chichester House. Whilst staff were in the room with the patients, as they were unable to leave this is seclusion. These had not been recorded as seclusion episodes by staff and there was a lack of clarity from some staff as to the definition of seclusion.

Improved local governance arrangements were still being embedded so they were meaningful to staff. There were a range of measures in place including the audit processes, meetings relating to governance processes and improvement plans.