Thornford Park

Updated 8 December 2021

Thornford Park is a 129 bedded hospital providing inpatient medium and low secure forensic mental health services including a ward for people with learning disabilities and a ward for people with autism. It also has two psychiatric intensive care units and three rehabilitation flats which can accommodate up to eight patients. A full breakdown of the wards is provided below:

• Bucklebury, 12 bedded male acute medium secure unit
• Tadley, 10 bedded male medium secure unit for people with a learning disability
• Hermitage, 14 bedded male rehabilitation medium secure unit
• Kingsclere, 13 bedded male rehabilitation low secure unit
• Donnington, 14 bedded male low secure unit for people with autism
• Headley, 11 bedded male acute low secure unit
• Highclere, 17 bedded male low secure unit for older people
• Theale, Nine bedded male enhanced low secure unit
• Crookham, 11 bedded male psychiatric intensive care unit
• Curridge, 10 bedded female psychiatric intensive care unit
• Midgam, Two bedded male low secure flat
• Ashford, Five bedded male low secure flat
• Donnington Flat, One bed male low secure flat for people with autism

Thornford Park is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the MHA
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury

There was a registered manager in post at the time of the inspection.

We had previously inspected the service in November 2017. Following this inspection the service was rated good overall, with the responsive key question rated as requires improvement. Following this inspection in 2017 we told the provider it must make the following improvements: The provider must ensure that there are sufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of the patients as patients did not always have facilitated escorted leave or access to enough therapeutic activities to meet their needs and support their recovery journey.

We found that this issue remained at this inspection.

In June 2020 we carried out a focused inspection of Curridge (female PICU) and Tadley (male medium secure unit for people with a learning disability). This was due to concerns raised about the quality of care delivered to patients and about the increasing number of incidents that the provider had sent us notifications about alleged abuse and significant injuries. We did not re-rate this service following this inspection. However, we told the hospital it must take action to:

• Ensure records were up to date and accurate so staff could mitigate risk and meet the changing needs of patients.

We found that this issue remained at this inspection.

What people who use the service say

Patients on the forensic wards told us that staff treated them well and that the wards were clean. All of the patients we spoke with told us that there are not enough staff on the wards and that they sometimes have their leave or planned activities cancelled as a result of this. However, patients told us that while there are not enough staff, the staff who are there are kind, attentive and respectful. Patients we spoke with on Kingsclere ward told us they felt safe at the hospital, however patients on Hermitage and Bucklebury wards said they did not always feel safe due to patients assaulting other patients.

Patients on the PICUs told us that there were limited daily activities offered and the timetable that was provided did not meet their needs in terms of the limited range of activities available and the lack of structured activities in the evenings and at weekends. Patients understood that the recent Covid-19 pandemic had affected their ability to attend occupational therapy led group work and were looking forward to new opportunities becoming available.

Patients on the learning disability and autism wards told us their rights were respected and they understood their rights of appeal. They told us the ward manager was on the ward most of the time. They said they had daily meetings with staff and their comments were taken seriously and action taken on issues they requested. Patients stated they felt safe, and although incidents occurred, staff responded quickly to these and they felt safe.

Some concerns were raised about there not being enough staff all the time, but most of the time there were staff they knew, just sometimes they didn’t feel too confident with the agency staff as it takes time to get to know them and trust them.

The people we spoke to said they were happy with their environment and were allowed to personalise their rooms. They also said they were given easy read paperwork if they needed or asked for it and that they felt involved in their care.

Patients on Donnington ward said that they didn’t like it when staff shone a torch in their room at night but understood why it was done. They have discussed this at a meeting with staff and this is now being looked into to find an alternative approach to checking patients at night.

Updated 8 December 2021

Thornford Park is a 129 bedded hospital providing inpatient medium and low secure forensic mental health services including a ward for people with learning disabilities and a ward for people with autism. It also has two psychiatric intensive care units (PICUs) and three rehabilitation flats.

Our rating of this location went down. We rated it as requires improvement because:

• There were high nursing vacancy rates at the service. The hospital utilised agency staff to fill these gaps, however this was not always possible. This meant that the wards were sometimes short-staffed and on the forensic wards this had an impact on patients being able to take leave. This had an impact on patient’s wellbeing and could impact on their recovery. At our previous comprehensive inspection in 2017 we told the hospital it must make improvements to ensure it always has enough appropriate staff to meet patients’ needs; this was, and remains a breach of the Health and Social Care Act regulations.
• Governance and oversight processes at the hospital required improvement. The quality of care records on the forensic and PICU wards was variable. Kingsclere ward had very thorough and comprehensive records, while records on Bucklebury ward were less personalised and did not include adequate mitigation plans for identified risks. Care records did also not reflect the patient voice.
• The forensic wards looked very tired and required refurbishment. These were due to be renovated, with a programme of works due to commence in 2022.
• Staff utilised the National Early Warning System (NEWS 2) to monitor the physical health of patients. However, on the forensic and PICU wards it was not always documented what action had been taken when indicated which meant that the physical health needs of patients may not have been acted upon, placing them at risk.
• Some patients on Bucklebury and Hermitage wards told us they did not feel safe due to the risk of violence from other patients. Violence and aggression was the most common incident type reported on the wards.
• On Headley ward a patient had two T2 forms signed by two different approved clinicians in place authorising different medicines (a T2 form confirms that a patient is capable of understanding the nature, purpose and likely effects of a treatment and that they have consented to receiving this). This could have led to a patient receiving the wrong medicine, or not receiving medicine they should have.
• On Curridge ward we found that a defibrillator wasn’t working. This had not been identified because the relevant audits of emergency equipment had not been carried out.
• Patients on the PICUs told us that there were not enough activities to occupy them during evenings and weekends.
• Staff on the PICUs did not always receive regular individual supervision. Compliance rates for individual supervision in the quarter prior to the inspection were 68%.

However:

• The learning disability and autism wards were rated as good overall. Staff demonstrated a commitment to providing person-centred care for patients and we saw some excellent use of communication methods.
• Staff had handled the COVID-19 pandemic very well. None of the patients at the hospital had tested positive since April 2020.
• The senior leadership team had a good understanding of the key challenges the service faced. The hospital director was a visible presence throughout the hospital and approachable for patients and staff.
• The provider had worked with a local university to develop an adapted Sexual Offender Treatment Programme (SOTP).
• Patients we spoke with gave excellent feedback about the way staff treated them. They said they were always kind and compassionate.
• Patients were involved in their care and developments in the hospital. There was a patient council made up of representatives from each ward and patients also attended ward-based and hospital-wide clinical governance meetings.
• Staff were supported to develop in their roles. For example, all ward managers were able to complete level five leadership training.
• The hospital had robust safeguarding procedures in place. Staff had good knowledge of these procedures and the provider had supported 11 staff members to complete level four safeguarding training.
• Patients had good access to physical healthcare and were supported to make healthy lifestyle choices, e.g. offered nicotine replacement therapy and weight management programmes. The hospital also had an onsite gym and ran exercise classes to encourage patients to exercise.
• Staff had recently begun hosting a monthly online carers’ forum which provided an opportunity for carers to learn more about the hospital.

Updated 8 December 2021

This was the first time we rated this service. We rated it as good because:

• The care provided to patients was of a very high standard.
• Ward managers had an excellent understanding of their services and of patients’ needs. They were visible and approachable for patients and staff.
• Care plans, risk assessments and Positive Behavioural Support (PBS) plans were clear and informative.
• Individual needs were met and staff demonstrated skill and kindness. Patients said that they were listened to, could ask for help, were able to participate in their care plans and planning their future. Staff helped them achieve their goals and supported them to make decisions.
• Patients stated they were happy with their care and treatment and the support offered.
• Staff were confident in being able to express their thoughts and on the whole felt really well supported by the ward managers. They felt they were given opportunities to improve their skills and develop.
• The provider had worked with a local university to develop an adapted Sexual Offender Treatment Programme (SOTP).
• Staff ensured physical health was well monitored and documented.
• Discharge plans were discussed and documented as achievable goals for individuals’ needs.
• Staff used verbal de-escalation to manage patient incidents and there was low use of restrictive interventions.

However:

• Some staff on Tadley ward felt that they were not supported by senior staff following incidents, that there were no senior management staff at the debriefing sessions to discuss the management and outcomes of incidents.
• Staff on Tadley ward were unable to locate the ligature audit for the ward.
• High fridge temperatures had been recorded on Tadley ward, however no action had been taken to address this.

Updated 8 December 2021

Our rating of this service went down. We rated it requires improvement because:

• The wards looked very tired and required refurbishment. A programme of works was due to begin in 2022.
• There was generally enough staff on the wards to keep people safe, but not enough staff to ensure that patients could always take planned leave from the ward. All of the patients we spoke with told us they had leave cancelled.
• The quality of care plans was variable across the wards and some care plans were generic and not reflective of individual patient needs.
• We found that governance processes required improvement – we found issues with treatment authorisation forms and ligature audits that had not been picked up by the provider’s own quality assurance processes.

However:

• Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Ward managers had a good understanding of patients’ needs. They knew the patients well.
• 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 understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, patients rarely had their discharge delayed for other than a clinical reason.

Updated 8 December 2021

Our rating of this service went down. We rated it as requires improvement because:

• The environment on Curridge ward was stark and the layout of the communal area was untherapeutic, with furniture all pushed to the sides.
• There were two lead nurses which were shared across the forensic and PICU wards, however we found a number of inconsistencies in how things were done on the PICU wards. Leaders had recognised this and a PICU lead nurse was due to start in post shortly after the inspection. Their focus would be on improving standards on these wards.
• Staff were unaware of the provider’s restrictive practice policy and did not understand why some behaviours would be perceived as restrictive practice.
• Staff did not always follow the procedures that were in place to ensure that medicines were safely prescribed, administered, recorded and stored.
• Care plans on the wards were generic and did not reflect the involvement of patients in the development of their plans.
• There were insufficient activities on the wards to provide meaningful, therapeutic engagement for patients to support their path to recovery.
• Staff on the PICUs did not always receive regular individual supervision. Compliance rates for individual supervision in the quarter prior to the inspection were 68%.
• Governance processes did not operate effectively at ward level.

However:

• Staff assessed and managed risk well.
• Staff had a good understanding and knowledge of safeguarding procedures.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.