Weaver Lodge, a 20-bedded mental health rehabilitation unit, was rated Requires improvement overall following its March 2019 inspection, driven by two regulatory breaches: the absence of an exclusively female day lounge and the failure to provide evidence-based psychological therapies. Across caring, responsive and well-led domains the service performed well, with strong staffing compliance, medicines management, patient involvement and leadership.
Concerns (2)
criticalPerson-centred care: “The service did not offer suitable psychological therapies as part of the service user treatment in line with national guidance on best practice. This was a breach of regulation 9 (3)(b)”
criticalSafeguarding: “There was no dedicated female only lounge day space that was not accessed by male patients. The female lounge was used by male patients at times. This was a breach of regulation 10(2)(a)”
Strengths
· 100% compliance with mandatory training; electronic rota system prevented allocation of staff not up to date with training.
· Staff compliance with supervision at Weaver Lodge was at 100%.
· In the 12 months before the inspection there had been no incidents of restraint.
· Staff followed good practice in medicines management in line with national guidance, including Liverpool University Neuroleptic Side-Effect Rating Scale.
· Patients treated with kindness, dignity and respect; all patients spoken with stated staff were very supportive.
Weaver Lodge improved from requires improvement to good across all five key questions, with previous breaches around female-only facilities and clinical psychology input fully met. Minor concerns remained around audit completion, Mental Health Act administration shortfalls, and recording of best interest decisions.
Concerns (5)
moderateGovernance: “a small number of audits had not been fully completed and did not always clearly record what action had been taken to show that shortfalls had been fully addressed”
moderateRecord keeping: “one recent monthly audit of Mental Health Act paperwork was not completed fully as it did not check detention renewal dates fully even though there had been an incident of a lapsed detention”
minorConsent / capacity: “best interest considerations for certain decisions about patients who lacked capacity were not always fully recorded on the provider's own recording systems”
minorStaffing levels: “There were two nurse vacancies (one of which was maternity leave cover) and four health care assistants.”
minorLeadership: “Some staff felt that a recently introduced rota system did not fully work to enable them to have a good work/life balance.”
Strengths
· Safe, clean ward environment with appropriate risk assessments and ligature mitigation
· Holistic, recovery-oriented care plans using the mental health recovery star
· Access to a full range of specialists including psychological input now provided
· Compassionate staff who respected patients' privacy and dignity
· Well-managed discharge planning and effective multidisciplinary working
Quality-Statement breakdown (5)
safe: Long stay or rehabilitation mental health wards for working age adultsGood
effective: Long stay or rehabilitation mental health wards for working age adultsGood
caring: Long stay or rehabilitation mental health wards for working age adultsGood
responsive: Long stay or rehabilitation mental health wards for working age adultsGood
well-led: Long stay or rehabilitation mental health wards for working age adultsGood