Waterloo Manor Independent Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. The hospital now ensured that care plans reflect the assessed physical health needs of all patients

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients did not raise concerns about their assessments. One patient told us that they were frustrated by the process of transferring to another ward, but we saw that the provider was working hard to facilitate this.

Staff could tell us about patients' assessed needs, knew where to find information to support them and could use system effectively.

There were effective processes in operation that supported staff to assess patient’s needs effectively. For example, care plans, MDT meetings, discussions at handovers. Leaders carried out audits of these processes to ensure that they were effective.

Some patients told us that treatment was in line with what matters to them. There was some evidence that patients had been involved in planning of care and patients mostly told us they were offered copies of their care plans. Families were invited to ward rounds and care review meetings where appropriate. Patients told us their physical health needs were met and that they had no concerns around their medicines. However, patients told us they did not like the food or menu choices.

Managers and staff were able to tell us about the type of service the wards delivered, what treatment was being offered and the overall model of care for each ward. They told us how being a forensic ward impacted on the patient group, and how this differed from the other wards at the hospital. For example, they described how restrictions differed across the wards. There were various treatment options available to patients including psychology sessions and occupational therapy.

There were effective processes to ensure that work staff carried out met the needs of patients. For example, checks and audits were completed and there were regular meetings such as multidisciplinary team meetings where patients could discuss treatment plans and ways forward. We reviewed care records on each ward and did not find any concerns with staff adhering to evidence based good practice and standards. The hospital used a collaborative care planning system to ensure that care plans now reflected the full range of patient needs, including the assessed physical health needs of all patients. Staff received training in a range of physical health conditions including diabetes, epilepsy and wound management. Compliance for these training sessions was above 85% for all courses.

Some patients said that staff worked together to support them. Some patient’s attended MDT meetings to take part in conversations about their care and treatment.

Staff had access to the information they need to appropriately assess, plan and deliver patient’s care, treatment and support. Staff generally said they worked well together. They told us about ways that they did so to support people using services. For example, they told us about reflective practice sessions, handovers, and MDT meetings, as places they would come together to communicate about patients' needs.

We observed staff working well together during handover meetings and MDT meetings. We also observed staff on the wards, they were communicating with each other to make sure patient’s needs were met.

There were processes in place to ensure that staff were exchanging information about patients, such as incident reporting, safeguarding reporting and the use of the electronic care records.

Some patients told us about ways that staff were supporting them to live healthier lives. However, others told us that they did not have access to a dietitian.

Staff understood how to support patients to live healthier, more independent lives. Staff encouraged patients to make healthier choices to help promote and maintain their health and wellbeing.

All patients were registered with the GP. However, there were challenges with regards to NHS dentist registrations. Patients were supported emergency dental treatment through 111. This was recorded on the hospital risk register. Opticians are offered annually. We observed patients being supported to attend healthcare appointments during our assessment visit. A practice nurse visited the service a minimum of once a quarter, depending on the needs of the patients. The practice nurse offered advice and support with care plans and management of long-term conditions such as diabetes and asthma. Patients were offered an annual physical health review, and the service ran a weekly well woman clinic. The hospital employed a dietician privately when needed, usually with relation to eating disorders. The use of this service was monitored through the monthly clinical governance meetings. However, our review of care records identified that a patient had a care plan for obesity, but there was no structured approach to weight monitoring.

Patients did not give us feedback about how their outcomes were monitored. However, we saw evidence that suggested patients were involved in discussion about their treatment and progress.

Staff and leaders told us about ways in which they monitored and helped to improve outcomes.

There were effective processes that supported the monitoring of outcomes. The collaborative care planning system used by the hospital ensured that clinical outcomes were recorded in patient’s care records. Outcomes were discussed in governance meetings and plans made to support patients in different ways.

All patients were detained under the Mental Health Act 1983 (MHA 1983). Most patients understood their rights under the Act and told us advocates visited the wards regularly.

Not all staff had a good understanding of the Mental Capacity Act 2005 (MCA 2005). Some staff could not explain how the Act applied to their role or describe the 5 key principles. However, Staff had access to support and advice on implementing the MHA 1983 and its Code of Practice from the MHA administration team.

During our time on the wards, we observed staff treating patients with respect and ensuring they had choices.

Staff completed MCA training every 2 years. At the time of the assessment, the compliance rate was 98.1% across the hospital. Staff also completed MHA awareness training, and the compliance rate was 91%. There was a MHA administration team in place who monitored compliance with the MHA/MCA. We reviewed a sample of MHA records and found these were in order. Care records showed that patients had their rights under the MHA explained in a way that they could understand regularly. The service now ensured that staff carry out mental capacity assessments with patients where required. Care records demonstrated that capacity to consent was reviewed regularly.