All inspections: Willows Green Hospital

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

The provider had failed to provide a stable multi-disciplinary team and since the last inspection did not have a psychologist or occupational therapist in post. There was now a locum psychiatrist.
A new electronic care record system was in place, but staff were not aware of the functionality that when searching for care plans, only those created within the date range requested were available, so they did not always see all the historic care plans when using the system.
The provider was unable to provide copies of hospital induction training and observation competency checks for all staff. This meant we were not assured that staff had been inducted to their role.
At the time of inspection, the service did not have an agreed safeguarding policy with the local safeguarding board.
The provider had an occupational therapy kitchen however, it was not used as such and was used by staff for their own purposes.

However:

After the last inspection extra members of nursing staff had been employed and only two agency nursing staff were used permanently.
There was now limited use of bank or agency staff, as the provider had employed new health care assistants.
The management team had been increased to include a deputy manager and a clinical lead nurse.
All staff now received face to face safeguarding training.
The ward environments were safe and clean.
Managers ensured that staff received supervision.

This comprehensive unannounced inspection took place to follow up enforcement action from the last inspection.

Our rating of this location stayed the same. We rated it as inadequate because:

The provider had failed to provide a stable management team with four managers in less than a year as well as a changing multi-disciplinary team which had resulted in no continuity of improvement from the last inspection.
The service did not provide safe care. The service did not have enough, appropriately skilled staff to meet people’s needs and keep them safe. There was only one full time nurse employed by the service and the service was overly reliant on bank and agency staff. Incidents that occurred during our inspection all took place when the nurse in charge was agency staff.
Staff did not assess and regularly review patient risks. We saw risk records were not updated after incidents. Managers did not complete investigations into incidents in a timely manner.
The service did not provide trained staff to care, support and meet patient’s needs. Occupational therapy staff did not have systems in place to ensure patients did not conceal prohibited items after sessions.
The service was not well led, and governance processes did not ensure incidents were not repeated. Incidents were not immediately reported to safeguarding or the Care Quality Commission.
The service was not well led, managers allowed a member of staff to come into contact and conduct observations of a patient whilst they were being investigated for a safeguarding allegation.
Governance processes did not identify that care plans and risk assessments were not up to date and were inaccurate.
The provider appointed a new hospital manager and they were awaiting their arrival. The deputy manager resigned leaving just one manager in post. Managerial tasks were not being completed in a timely way.

However:

After the last inspection an extra member of staff had been added to the roster to allow staff to have a break from observations every two hours.
After the last inspection staff now received face to face safeguarding training.
The hospital introduced the use of a smart speaker so a patient could control their smart television without the need of a remote control.
The ward environments were safe and clean.
There was a full range of specialists required to meet the needs of patients on the wards.
Managers ensured that staff received supervision.

We rated it as inadequate because:

The service did not provide safe care. The service did not have enough, appropriately skilled staff to meet people’s needs and keep them safe. There were insufficient staff to provide breaks while conducting one to one observation. There were insufficient female staff to support the patients.
Patients did not always receive kind and compassionate care from staff and patient’s privacy and dignity was not always observed. Two male members of staff supervised female patients for long periods of time. On our observations staff attempted no therapeutic activity whilst conducting observations.
People’s risks were not assessed and reviewed regularly. We saw risk records had not been updated after incidents. Managers did not complete investigations into incidents in a timely manner.
The service did not provide care, support and treatment from trained staff able to meet people’s needs. We were not satisfied mandatory training records of staff were accurate. Staff had not received the correct safeguarding training and were not qualified to conduct high level safeguarding investigations.
The service was not well led, and the governance processes did not ensure incidents were reported and investigated appropriately. Duty of candour processes were not followed. There was no evidence that staff were held accountable for their actions and that managers took disciplinary action where inappropriate holds were used. Routine audits such as food safety were not completed resulting in out of date food being kept in the kitchen.

However:

The ward environments were safe and clean.
There was a full range of specialists required to meet the needs of patients on the wards.
Managers ensured that staff received supervision.

Willows Green Hospital

All Inspections

27 and 28 June 2023

During an inspection looking at part of the service

1, 2 and 9 March 2023

During a routine inspection

15 and 16 August 2022

During a routine inspection