Moorlands Neurological Centre

Updated 31 May 2023

Moorlands Neurological Centre, previously The Woodhouse Independent Hospital, is an independent mental health hospital provided by Elysium Healthcare (Acorn Care) Limited. As The Woodhouse Independent Hospital, it provided services for people with a learning disability or autistic people. The service specialised in providing care for autistic people and people with forensic histories including; sexual offending, highly complex and severe challenging behaviour.

We previously inspected the service in February 2022. This inspection was carried out to follow-up concerns from our June 2021 inspection that gave The Woodhouse Independent Hospital an overall rating of ‘requires improvement’ and rated the safe domain as ‘inadequate’. Our findings were as follows:

We found that staff did not always use recognised interventions and approved physical intervention techniques to manage incidents and behaviour that challenged with people who used the service.

We found that staff present but not directly involved in incidents where colleagues illtreated people in their care, had failed to identify and escalate concern in what they had observed.

We found that not all governance systems were sufficiently robust or always worked effectively to ensure safety and quality in the service. Staff did not report all incidents in the service and not all incidents reported were an accurate and true account of what had happened. Arrangements to use CCTV to support safety and quality in the service were not sufficiently robust or established.

Due to the seriousness of the concerns identified during our February 2022 inspection, we used our powers under Section 29 of the Health and Social Care Act 2008 to issue a warning notice to the provider notifying them they failed to comply with Regulation 12, 12 (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.We gave the service an overall rating of ‘Inadequate’ and applied Special Measures.

You can read our findings from our all of our previous inspections by selecting the ‘all reports’ link for Moorlands Neurological Centre on our website at www.cqc.org.uk.

At this inspection we focused only on the issues raised in the warning notice and have assessed if significant improvement has been made.

The hospital is located on a rural site in Cheadle, Staffordshire. The service had up to 8 units and could accommodate up to 39 males and females under 65 years old who had a learning disability or autism. However, when we inspected only 2 units remained in operation and each accommodated just 1 person per unit. Both people were detained under the Mental Health Act 1983. We found 2 units were being renovated to meet the needs of the new service model for patients with an acquired brain injury.

There was a CQC registered manager in post. Moorlands Neurological Centre is registered to provide the following regulated activities:

Assessment or medical treatment for persons detained under the Mental Health Act 1983.

Treatment of disease, disorder or injury.

At this inspection, we visited:

Kingsley - a secure unit for up to four males with autism and complex or challenging behaviours. Accommodation is provided in single occupancy self-contained apartments. There was one person in this unit at the time of our inspection.

Highcroft - a secure unit for up to four males with autism. Accommodation is provided in single occupancy rooms with en-suite facilities. There was one person in this unit at the time of our inspection.

Updated 31 May 2023

The Woodhouse Independent Hospital provides services for people with a learning disability or autism in a range of small, bespoke units and cottages. The service offers assessment, treatment and rehabilitation placements, individualised and intensive packages of care and step down to community-based services. The service specialises in providing care for autistic people and people with forensic histories.

The CQC expects health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

This inspection, which commenced on 28 February 2022, was an unannounced, focussed inspection to see what improvements the provider had made. Our inspection focussed on the concerns we raised to the provider following our previous inspection. We did not look at all of the key lines of enquiry.

Due to the seriousness of our concerns following our 1 March 2022 site visit, we wrote to the provider to inform them we were considering urgent enforcement action under Section 31 of the Health and Social Act 2008. The letter identified our significant concerns with staff conduct towards people using the service, inappropriate and disproportionate use of restraint and the investigation of incidents. We invited the provider to urgently complete and send an action plan detailing how they had already addressed or planned to immediately address our concerns. The provider responded with an action plan of sufficient assurance and we did not pursue urgent enforcement action. We returned to the hospital on 8 March 2022, and our findings provided us with further assurance to the immediate actions and the plan in place to protect people using the service from the risk of avoidable harm.

Despite improvements seen in some areas of the service since our previous inspection, we remain concerned about the way some staff have treated people who use the service and the robustness of governance arrangements in the service to always protect people. We have rated the service inadequate and placed it in special measures. Prior to the publication of this report, we issued the provider with a Warning Notice served under Section 29 of the Health and Social Care Act 2008. This notified them that they were failing to comply with Regulation 12 (1), Safe care and treatment, of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and must demonstrate compliance by 11 November 2022. Details of the notice can be found at the end of the report.

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

• The service did not always provide safe care. Staff did not always follow plans or use approved physical intervention techniques with people who used the service. We saw staff tormenting, goading, lifting and dragging people when responding to incidents or behaviour that challenged.
• Staff did not always manage safety incidents well. Staff did not recognise all incidents that needed to be reported and some incidents continued to be reported inaccurately. Existing processes to use closed circuit television camera footage in the investigation of incidents had not been sufficiently robust to protect all people who used the service from avoidable harm.
• The provider’s action to assess for the presence of a closed culture had not identified similar concerns to those we observed during our inspection. Staff did not always treat people who used the service well during incidents and staff failed to identify or report practice or conduct of colleagues that was inappropriate or abusive.
• Not all governance processes appeared sufficiently robust or established to ensure safety and quality for all people who used the service and particularly those most vulnerable.
• The service continued to experience staffing challenges during the COVID-19 pandemic. Staff absences as a result of COVID-19 and the provider’s use of temporary staff during the pandemic had sometimes negatively impacted on the care and treatment of people who used the service.
• Environmental improvements to Moneystone had not sufficiently softened or reduced noise on the unit.
• There were concerns about excessive weight gain for some people who used the service. It was not always clear how effective the provider’s actions were to support people to remain healthy.

However,

• The provider’s response to the concerns raised to them following the inspection was immediate, robust and provided us with assurance risks to people who used the service would be mitigated.
• Many of areas of the service had improved to meet the requirement notices issued following our previous inspection. This included equipment to meet the sensory needs of people on Moneystone unit and improved medicines management practices.
• The provider had supported the hospital manager’s decisions to support safety and quality at the service as the COVID-19 pandemic progressed. There was additional leadership in the service. People who used the service and staff spoke positively about the visibility and approachability of the service managers.
• Many units provided people who used the service with their own apartment. Staff supported people to be independent and personalise their accommodation. The provider had invested in new furniture that was suitable for people who used the service and maintained communal and outdoor areas well.

As this service has been rated inadequate it will be placed into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Updated 22 June 2022