- NHS mental health service
Langdon Hospital
All Inspections
17-18 April 2019
During an inspection looking at part of the service
During this focused inspection we inspected the safe and well led domains at Owen House and Avon House at Langdon hospital.
The service already has an outstanding rating and on this occasion we did not re-rate it.
We inspected the service due to concerns that had been raised through safeguarding and through information shared with us.
Prior to the inspection, the trust had been responding to safeguarding concerns that had been raised. Owen House had seen a high turnover of staff over the previous year. Staff at Owen House had not been identifying and reporting safeguarding previously but were now using a matrix to support this process. A new manager and a new consultant were in place at Owen House. Efforts had been made to improve training and supervision compliance. Concerns had also been raised about communication from Owen ward with care coordinators and community providers and efficiency of discharge planning. Owen House had an action plan in place to address the following areas: discharge planning, leave planning, quality reporting, absent without leave (AWOL) processes, care records, staffing, skill mix, training, safeguarding and actions to address leadership and organisation of the ward.
We had received information about staffing shortages including sickness and vacancies at Avon House. These included vacancies for a substantive consultant, ward manager, social worker and occupational therapist. Although these were being covered by bank and agency staffing, we were concerned that staff were regularly being redeployed to medium secure wards at Langdon and that this was leaving Avon House with minimum staffing levels. This meant patients could not always take escorted leave they were entitled to. We understood that, in response to these concerns, the ward was holding regular team meetings and patient forums to reinforce a supportive culture.
We had asked the trust for information about the concerns raised and learned that there had been recruitment issues on both wards and the trust was addressing these with an ongoing recruitment programme. The trust told us that the senior management team were spending more time on site at Langdon hospital and holding staff engagement events to seek views from staff and patients.
During our inspection visit, we found:
- The service provided safe care. Wards were working towards improving recruitment and retention and safe staffing levels were being maintained. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
- 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 treated patients with compassion and kindness and understood the individual needs of patients.
- Staff planned and managed discharge well and liaised with services that would provide aftercare.
- The service was well led, and the governance processes ensured that ward procedures ran smoothly.
However
- There were blind spots on the stairwells at Avon House that had not been mitigated and there were delays in completing repairs to patient toilets, showers and telephones.
- There were staffing challenges on both wards although these had improved. There were two vacant nurse posts at Owen House and there had been a high turnover of staff over the previous 12 months. Staff from both wards were regularly redeployed to other wards and this left both wards with minimum staffing levels. Staff told us they struggled to provide a good level of service at the minimum staffing level.
- Staff did not routinely record when patients section 17 leave had been cancelled and this meant there was a lack of oversight of the extent of the issue.
- Ward and senior managers did not know that safeguarding referrals were reviewed by the trust’s safeguarding department and that not all referrals were sent to the local authority.
- Patients and staff had raised concerns about the replacement of metal cutlery and china crockery on all wards with plastic cutlery and crockery. Staff considered this to be an unnecessary blanket restriction.
24 March 2015
During an inspection looking at part of the service
We visited three inpatient areas on the hospital site, spoke with a variety of staff and spoke to six of the patients on the wards. We were provided with an internal audit report completed by Audit South West who are part of a group of NHS internal audit providers. This had detailed all the actions which the Trust had taken following the previous CQC inspection. At this inspection and after reviewing all the information we had gathered, we found the Trust had made sufficient improvements to meet the compliance action.
4 February 2014
During an inspection
4, 5 and 6 February 2014
During a routine inspection
Langdon Hospital is an NHS forensic hospital based in Dawlish in Devon and run by Devon Partnership NHS Trust.
We inspected the Dewnans Centre which has four medium secure wards with a total of 60 beds. The four wards are Ashcombe, Holcombe, Warren and Cofton. The Dewnans Centre supports people on a treatment pathway from acute forensic emergency admissions through to longer-term medium secure services and step down care as people's health and wellbeing improves. Ashcombe is an admissions assessment ward providing care to people with acute mental health conditions. Holcombe Ward is a treatment ward for people with complex mental health needs, including people with personality disorders. Warren and Cofton provide services to people whose mental health is stable with the care and treatment provided by the hospital. People can and have moved to low secure services from these wards.
We visited Avon House, a 14-bed longer stay low secure ward; Chichester House, a 15-bed shorter stay low secure ward; Owen House, a 16-bed open ward for men with complex mental health needs and Connelly house, a 6-bed rehabilitation unit.
There were many positive aspects to the care provided to people using the services at Langdon Hospital. Physical health assessments had been carried out and reviewed for all patients. Where appropriate, physical health needs were addressed as part of the patient’s care plan. Patients had good access to primary health care.
Improvements had been made in care planning since our last visit. Care plans were comprehensive and specific to the needs of the patient, with the patient involved in their development. Care plans were re-evaluated and updated regularly. Plans to discharge the patient or move them towards less secure environments were included as part of the care planning process.
Robust arrangements were in place to ensure that leave under section 17 of the Mental Health Act was appropriate and authorised. Risk assessments were consistently completed for patients. Case records demonstrated that comprehensive risk assessments were completed, regularly reviewed and updated when needs or risks changed. These assessments were reflected in the care plans with measures identified to manage or mitigate the risks.
All patients were legally detained under the Mental Health Act 1983. All treatment had been given under an appropriate legal authority. Patients were informed of their rights under the Mental Health Act 1983 and were supported in exercising those rights.
Improvements had been made to the seclusion facilities in the Dewnans Centre since our last visit. Improvements were needed in the seclusion environments in Avon House.
Records were completed for incidents of seclusion but there was no seclusion log or register and so it was not possible to check that all incidents of seclusion had been recorded appropriately. Incidents of seclusion are reviewed locally by Ward Managers and Senior Nurses both at team and directorate level. The current recording does not ensure all the necessary details are available to enable effective monitoring of trends on a trust wide level.
Out of hours there were some delays in patients in seclusion being reviewed by a doctor. This was because the on-call doctor covered several inpatient sites which affected their availability.
We found incidents of patients being nursed in, and prevented from leaving, the extra care areas of Avon House and Chichester House. Whilst staff were in the room with the patients, as they were unable to leave this is seclusion. These had not been recorded as seclusion episodes by staff and there was a lack of clarity from some staff as to the definition of seclusion.
Staff found it hard to describe clearly the areas for improvement and action taking place at Langdon Hospital. There were a range of governance measures in place including the audit processes, meetings relating to governance processes and improvement plans, but these need to become embedded so they are meaningful to staff working in the hospital.
9, 10, 11, 12, 13 September 2013
During a routine inspection
We inspected with two specialist advisors, both trained mental health nurses who worked in and had managed forensic services. We talked to 30 of 108 patients, two carers and 21 of 348 staff. Most patients said they felt involved with reviews and had met their named nurse. Staff were respectful. One patient said 'Yeah (X) is very good. We have regular chats.'
Two patients said they had not seen their care plans. Records corroborated this. Care plans were basic and did not provide clear evidence based interventions or rationale for their use.
Patients said food quality was poor. There was limited choice for people with special diets. Patients had raised concerns in the comments books. There was no evidence that these had been dealt with.
Patients told us they felt safe. Staff received safeguarding training. Most patients were cared for in a clean environment. One area of the hospital was assessed as requiring safety improvements. One area of the hospital was identified as requiring maintenance improvements.
Staff received regular supervision and most staff had received an annual appraisal. Most staff had completed mandatory training.
The hospital did not have consistent systems in place to monitor the quality of care.
18 April 2012
During an inspection looking at part of the service
Everyone we spoke with said that they thought that their privacy was respected and that they were treated with dignity. We observed that staff interacted with people in a friendly manner and continually offered choices to people.
One person said 'Even though I don't want to be here, they're still good to me. They're good to all of us'. Another person told us that 'Things have improved lately. It's great that the doors are left open for longer in the evenings now'. When asked if they were asked to be involved in making choices and decisions one person told us 'I am always being asked to look at my care plans; I get fed up with it sometimes, but it's good really'.
People we spoke with told us that staff provide them with information about their care and treatment and make sure that people give consent before and treatment is carried out.
All of the people we spoke with knew that they had care plans and said that they received the care that they needed. People confirmed that arrangements were made for them to see health and social care professionals according to their individual needs.
19 October 2011
During a themed inspection looking at Learning Disability Services
Owen House has a member of staff that is responsible for organising sports and leisure. When speaking to a member of the team they explained they arrange activities like attending the gym, cycling and walking. They explained that during the evening they organise competitions in the games room and this appears to calm patients down. The sports coordinator was clear about their approach saying that they will encourage patients to take part, but no more than that.
Through examining patients' daily progress notes and from our conversations with them it was clear that they are involved in a range of these activities.
As part of our inspection of Owen House we asked the ward manager to supply us with the contact details of patients' relatives. We attempted to contact all of the people on the list, three patients' relatives spoke with us. Their comments about the service were positive; they spoke about patients being treated with respect, being treated well, good communication from the service about their relatives needs and progress, the nursing staff being very good and people being safe.
15 December 2010 and 9 January 2011
During a routine inspection
People told us that they are invited to attend meetings where their care, treatment and support are discussed. If they choose not to attend staff spend time explaining to them what happened at the meeting.
People are treated with respect. One person told us their dignity was not upheld by some staff.
People's opinion is regularly sought. They are given information verbally and in written formats suitable to their needs. They are offered choices and where a person is unable to understand the information to make sound decisions best interest decisions are made on their behalf. Consent to care and treatment is sought but not recorded.
People receive care, treatment and support by a staff committed to improving people's health. Assessment records include information on the person as an individual.
Nutritious and tasty food is provided and there is choice of menu. People's nutritional needs are taken into account as part of their health care planning but none of the people using the service on Cabot ward may have 'second' and one person told us they had been hungry on several occasions when they were o the unit .
People receive care, treatment and support which is coordinated with other providers of services they receive.
People are protected from abuse through staff knowledge, training and supervision.
People commented on the cleanliness of the units. They also said they felt secure, safe and comfortable.