Archived: Calderstones Partnership NHS Foundation Trust

Updated 9 February 2016

Calderstones Partnership NHS Foundation Trust provides care and treatment for people aged between 18 and 65 with learning disabilities or autism.

The trust provides low and medium secure forensic services over nine sites:

• Maplewood 1 is a 24-bed female-only low secure ward. It is split into four flats
• Maplewood 2 is a 16-bed male-only low secure ward
• Maplewood 3 is a 16-bed male-only low secure ward. It is split into two flats
• Gisburn Lodge is a 16-bed male-only medium secure unit.
• 1 Woodview is a 12 bed medium secure unit split into two flats; 6 bed female only and 6 bed male (unoccupied)
• 2 Woodview is a 12-bed male-only medium secure unit. It is split into two flats
• 3 Woodview is a 12-bed unit that is split into two flats. The unit provides services to male patients
• 1 West Drive is a pre-discharge ward that provides enhanced support for up to 12 male patients
• 4 West Drive is a 15 bed facility is split into three flats and is a service for male patients being transferred from the low secure service
• 5 West Drive is a 16 bed facility made up of two services split over five flats. The first service is a relapse prevention and sex offenders treatment programme. The second service is for patients with autism

The trust has had one comprehensive inspection under the new approach. The inspection took place on the 8th July 2014 to 11th July 2014. There were compliance actions for the trust following the inspection:

Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010

The registered person had not taken proper steps to ensure that people were protected against the risk of receiving inappropriate or unsafe care.

Regulation 10 HSCA 2008 (Regulated Activities) Regulations 2010

The registered person had not protected service users and others who may be at risk, against the risks inappropriate or unsafe care and treatment, by means of effective operation of systems designed to enable the registered person to regularly assess and monitor the quality of service.

Regulation 12 HSCA 2008 (Regulated Activities) Regulations 2010

The registered person had not maintained appropriate standards of cleanliness and hygiene in relation to the premises and equipment in the forensic services.

Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010

The registered person had not protected people against the risks associated with medicines because there was not a sufficient system in place to manage medicines in the forensic services.

Updated 9 February 2016

We found that the trust was performing at a level that led to a rating of ‘Good’ because:

• Since our last inspection of the trust in July 2014, the trust had made significant improvements in the care and treatment that staff provided to patients and the environments in which this was delivered. The trust had developed an action plan following our last inspection and worked with external stakeholders to address the issues we had raised.

• The executive team had reviewed and strengthened the trust's governance structure. The trust had implemented reports which provided ‘real time’ information about a number of clinical key performance indicators which could impact on the quality of care provided. These included staffing issues, incidents, complaints and episodes of restraint and seclusion. This allowed the service managers and the board to monitor trends and possible gaps in service provision to enable them to take timely action.

• The trust’s vision and values were fully embedded throughout the organisation and all of the staff we met with were aware of these and explained how the values underpinned their work. Staff were satisfied with the support they had from their managers and were proud of the work that they were doing.

• The trust had implemented a new model of working called ‘safe wards’ which focussed on reducing restrictive practices and improving patient outcomes. All staff had been trained in the new way of working and were committed to improving the care they provided to patients. All patients had a comprehensive risk assessment, positive behavioural support plan (PBS) and ‘moving on’ plan in place. The quality of the PBS plans was exceptional and there was evidence of patient involvement in the formulation of these.

• The implementation of the new model had significantly changed the culture within the trust and enabled staff to reflect on their practices to identify areas of improvement. The board was the driving force behind the changes and they had supported staff whilst maintaining good oversight regarding the monitoring and implementation of the changes.

• The most significant improvements noted was the reduction in the number of episodes of restraint, seclusion, the use of rapid tranquillisation and the eradication of the use of emergency response belts within the trust.

• This had been achieved despite the uncertainty regarding the future of the service. NHS England had recently announced that Calderstones Hospital would close as part of the Government’s transforming care agenda. This uncertainty had led to the trust experiencing some challenging staffing issues over the previous year. The trust had managed the staffing issues proactively and we were satisfied that there were sufficient numbers of staff to deliver the care and treatment that patients needed safely and effectively with the appropriate use of bank and agency staff.

• Within the learning disability service, we saw some outstanding examples of staff adapting their interactions with patients based on their individual needs. The staff accepted and embraced the unique communication methods of patients who did not use speech to communicate, including individual sounds and gestures. All of the care plans we reviewed were person centred, and patients all had their own copy and reported their involvement in the care planning process where their capacity allowed. These plans clearly demonstrated that staff had a good understanding of patients’ needs, their hobbies and interests, likes and dislikes. The patients who were able could describe their discharge plans and were animated about their future opportunities. We also found numerous examples of how the trust and staff engaged with patients and their carers and provided opportunities for them to be involved in service development initiatives.

However:

• We identified some inconsistencies across services in relation to staff training, supervision, de-briefs and staff understanding around the Mental Capacity Act.

• The number of staff trained in basic life skills was low within the learning disability services which could expose patients to a preventable risk within these services.

Updated 9 February 2016

We rated wards for people with learning disabilities or autism as good overall because:

• the wards were clean and well kept and had up-to-date environmental risk assessments

• patients told us they felt safe on the wards and that staff handled incidents well

• the wards managed staffing pressures and it was unusual for them to be below their required number of nurses on duty

• risk assessments and care plans were recovery focused and person centred, patients all had their own copy of their care plan and reported their involvement in the care planning process where their capacity allowed

• some of the wards were located within residential houses that were well integrated in the local community and complemented the step-down philosophy of the services

• patients had ‘moving-on’ plans and there were discharge plans in progress

• there was good multidisciplinary working, in particular occupational therapists and psychologists worked in each of the inpatient wards

• there were good examples of staff working hard to enhance communication and understanding of patients’ needs and individual communication methods

• patients reported that staff were friendly, caring and respectful

• staff had a good knowledge of the individual needs and preferences of patients, and were highly responsive to patients with complex needs who did not use speech to communicate

• we observed caring, respectful and professional interactions between the staff and patients on the wards

• family members told us they felt included in the care of their relative, were asked to share their views and opinions, and felt these were taken into account by the service

• information for patients was available in a range of formats including easy read and pictorial

• there was a wide range of activities for patients, which were appropriate to their needs

• staff spoke positively about the teams they worked in and there was good communication between the wards and senior managers.

However:

• staff did not always receive a debrief after incidents

• staff at 2 and 3 West Drive did not receive regular supervision

• staff had limited understanding of the Mental Capacity Act and how this related to their role

• staff could not describe the key performance indicators that were monitored to drive improvements

• staff training attendance for life support and prevention and management of violence and aggression was below the trust target of 80%.

Updated 9 February 2016

We rated Forensic inpatient/secure wards as good because:

All of the wards were clean, tidy and well maintained. Staff completed regular checks on the ward resuscitation equipment. These checks were recorded.

Staff managed physical, relational and procedural security well. The outdoor areas met the secure service standards set out by the Department of Health in its Environmental Design Guide (2011). The wards had airlock systems at their entrances and a central office managed keys and alarms so that staff collected these on their way in and left them on their way out. Staff used the ‘see think act relational security explorer’ during handovers. Staff knew how to access the security policies that were available on the trust intranet. These were all in date.

Care plans focused on recovery. Ward staff understood the principles of positive behavioural support and applied these when developing care plans.

All of the care records we reviewed showed that staff checked the physical health of patients regularly. The trust ensured that patients had good access to a range of physical healthcare services including GP services, opticians, dentists, dieticians and podiatrists.

The staff worked well together as multi-disciplinary teams.

Staff at all levels were kind and respectful when speaking to patients. They respected patient privacy and dignity and maintained confidentiality. Staff involved patients in all aspects of care planning, including in the development of positive behavioural support plans.

The trust ensured that advocacy services were available and present on the wards. Patients told us that they had good relationships with advocates.

The trust made a wide range of therapeutic and social activities available to patients on all of the wards. Patients could use the outdoor areas at any time. There were good facilities for children to visit away from the ward areas.

The care was discharge-oriented. Staff actively planned for discharge to appropriate alternative placements, taking account of patient needs and risks. The ward teams worked collaboratively with community teams mental health and learning disability teams that would support patients post-discharge, and with commissioners.

Staff at all levels understood and supported the trust’s vision for the service. Ward staff knew who the members of the trust board were and told us that they saw them regularly. The trust ensured that there were systems in place to monitor quality and to give feedback on performance to staff throughout the organisation.

However:

Managers had not undertaken an appraisal of all ward staff in the previous 12 months.

On Maplewood 1 and 2, the managers had not put in place a system that allocated staff to respond when an alarm was activated.