The Care Quality Commission
  • Mental Health
  • Independent mental health service

Thornford Park

Overall: Requires improvement read more about inspection ratings

Crookham Hill, Thatcham, Berkshire, RG19 8ET (01635) 860072

Provided and run by:
Elysium Healthcare No.2 Limited

All Inspections

14 & 15 September 2021

During a routine inspection

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.

23 June and 3 July 2020

During an inspection looking at part of the service

Thornford Park Hospital provides forensic inpatient services across ten wards and two shared flats within the secure perimeter of the hospital.

We undertook an unannounced focussed inspection following concerns received through the CQC website about poor infection control measures relating to Covid 19 procedures across the hospital.

We visited Currdige and Tadley wards due to concerns raised about 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.

This inspection was a focussed inspection so therefore did not provide a change to the existing rating.

During this inspection we found:

  • Records lacked detailed guidance for staff on how to manage patient risks and on how to manage incidents that placed patients and others at risk of harm.

  • The provider had not developed or implemented a procedure on when to administer medicines prescribed to be taken “when required” (PRN). This meant there were inconsistencies between staff on when to administer PRN medicines. Patients were not having these medicines consistently as prescribed.

  • The staff we spoke with as part of this inspection including feedback prior to the inspection expressed a lack of confidence with the organisation which had an impact on their performance. For example, lack of experienced staff, delays in introducing COVID procedures and specialist training. A clinician said that in “Curridge morale has been low but Tadley has varied.”

However:

  • Overall, there were effective system to provide safe care and treatment to patients. The provider had improved communication and introduced measures to prevent the spread of infection.
  • The wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose.

21-23 November 2017

During a routine inspection

We rated Thornford Park as good because:

  • Risk assessments and risk management plans were detailed, thorough and up to date and patients had been involved in the development of the plans. The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery. Physical healthcare assessments and associated plans of care were thorough and consistently delivered to a high standard. Care plans had either a National Institute for Health and Care Excellence (NICE) guidance reference to an identified intervention or another nationally recognised intervention such as from the Quality Network for Forensic Mental Health led by the Royal College of Psychiatrists.
  • There were enough suitably qualified and trained staff to provide care to a safe standard. We consistently saw respectful, patient, responsive and kind interactions between staff and patients. Staff displayed a high level of understanding of the individual needs of patients. There were innovative practices used consistently across the service to engage and involve patients in the care and treatment they received, for example, the recovery star. There was a confident and thorough understanding of relational security among all of the staff. Relational security is how staff use their knowledge and understanding of their patients to ensure the ward environment is kept calm and any conflict is kept to a minimum.
  • Bed management processes were effective and there was a clear care pathway through the service from medium secure wards to the least restrictive environments, such as the shared flats. The service model optimised patients’ recovery, comfort and dignity. The needs of patients were considered at all times.
  • The service had clear guidance in place to report incidents and we saw evidence that staff learnt from when things had gone wrong. The service was responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that when staff where able to, these ideas were taken on board and implemented.
  • Staff monitored patients’ physical healthcare and they could access specialist physical health services when needed. A GP provided regular physical health monitoring. Patients attended a well-man clinic.
  • We observed many positive engagement and interaction between staff and patients. Staff demonstrated a clear understanding of individual patient’s needs.

However:

  • Staff were not always available to facilitate section 17 leave on the forensic wards and leave was often cancelled.
  • The number of staff having access to regular supervision was below the provider’s target of 90%.
  • Not all patients were always reminded of their rights when their circumstances changed, such as on renewal of detention.
  • The seclusion room did not have a two-way intercom to ease communication between staff and patients.  Gym equipment was worn . All of these facility issues had been identified for refurbishment and upgrade in 2018
  • The recording of seclusion was documented differently across the wards. Staff made the required checks however, some was recorded electronically and some in paper form.

30 June, 7-9 and 23 July 2015

During a routine inspection

We rated Thornford Park as good because:

  • The wards were kept clean and well maintained and patients told us that they felt safe.
  • There were enough, suitably qualified and trained staff to provide care to a good standard.
  • Patients’ risk assessments were robust and person-centred.
  • The service had clear mechanisms to report incidents of harm or risk of harm and we saw evidence that the service learnt from when things had gone wrong.
  • The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery.
  • We found evidence of best practice and that all staff had a good understanding of the Mental Health Act 1983 (MHA), the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
  • Throughout all of the wards the multidisciplinary teams were consistently and proactively involved in patient care and that everyone’s’ contribution was considered of equal value.
  • Staff were caring and motivated and we saw good, professional and respectful interactions between staff and patients during our inspection. We saw evidence of initiatives to involve patients in their care and treatment. These included the ‘my shared pathway’ recovery approach to care planning and daily ward briefings with all patients and staff.
  • Staff had a confident and thorough understanding of how good relationships between patients and staff can support a secure environment.
  • Bed management processes were robust and effective. The service model optimised patients’ recovery, comfort and dignity. There was a clear care pathway through the service from medium secure wards to the least restrictive environments, such as the shared flats.
  • The needs of patients were considered at all times. There was a varied, strong and recovery orientated programme of therapeutic activities available over seven days, every week.
  • The service was particularly good at listening to concerns or ideas from patients and their relatives to improve services, with the exception of their feedback about the inconsistent quality of the food. When staff where able to; these ideas were implemented.
  • Staff morale was good and staff felt well supported and engaged with a highly visible and strong leadership team, which included both clinicians and managers. Governance structures were clear, well documented, adhered to by all of the wards and reported accurately. This meant that the hospital had clear controls in place to know that the service was being delivered to a good standard.

However

  • The use of plastic bin liners was inconsistent across the wards and no clear rationale was given as to why this was. (Plastic bin liners could be used as a means of suffocation if used to self-harm.)
  • We received mixed comments from patients about how kind the staff were towards them.
  • The quality of food remained inconsistent despite patient feedback about this.

24, 25 February 2014

During a routine inspection

We inspected three of the eight wards at the hospital. Chievely ward, a medium secure unit; Theale ward an acute unit; and Highclere a low secure ward for men with physical health problems who tended to be older.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Patients had been supported to make advance directives for their future care should they lose capacity to make decisions. Wherever possible patients' consent to their care and treatment was sought and their choices respected. Where necessary a second opinion appointed doctor was involved.

Patients had individualised care plans and we saw that some patients had a high level of input into their plans whilst other patients had refused to participate. Each patient had been asked for their views and these had been recorded. Patients had access to physical healthcare both within the hospital and could also access community health services, dependent upon risk.

The provider cooperated with other providers in order to manage patients' health, safety and welfare.

The premises were safe, secure and fit for purpose. we saw that a program of refurbishment was taking place.

Staff felt supported by management and there was an effective system of supervision and training in place. Following incidents staff had the opportunity to attend debriefs.

The provider had an effective quality monitoring system and demonstrated learning from incidents

6 February 2013

During a routine inspection

We conducted this inspection on Bucklebury Ward. We found that staff respected people's rights, involved them in their care where possible and were thoughtful about the care provided. Staff we spoke with demonstrated a good understanding of people's needs and the ethical issues involved in treating people who were detained. However, one person told us “They don't speak to me with respect”. Other records and information looked at did not support this view.

There was a programme of activities which took place daily that people could choose to participate in. One person said “The activities are OK, and you can stay on the ward and play games”. Information was displayed at several points around the ward to inform people about a range of topics. Some of this information was out of date. Meetings were held with people three times a week to discuss how the ward operated. One person told us “I leave the meetings because it's a one-way conversation”. However records seen did not support this view.

Staff felt supported in their role and had access to regular recorded one to one supervision meetings. There were regular team meetings, role specific meetings, debriefing sessions and reflective practice discussions.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.