Waterloo Manor Independent Hospital

Updated 16 June 2022

Waterloo Manor Independent Hospital is an independent hospital for up to 54 women who have a mental illness and/or personality disorder. At the time of our inspection 49 beds were in use. Some of the women may have a learning disability in addition to a mental illness. All patients are detained under the Mental Health Act.

There are 25 forensic/low secure beds across two wards:

• Cedar - 12 bed low secure ward primarily for women with a diagnosis of personality disorder

• Maple - 13 bed low secure ward primarily for women with a mental illness

There are 22 rehabilitation beds across two wards:

• Larch – eight bed high-dependency rehabilitation ward primarily for women with a diagnosis of personality disorder

• Hazel – 14 bed locked rehabilitation ward for patients with a diagnosis of personality disorder and/or mental illness. 2 of the beds were not in use at the time of this inspection.

There are seven further beds that offer less restrictions and semi-independent living:

• Lilac – four beds

• Holly – three beds (annexed to Hazel ward)

15 secure beds are commissioned by the West Yorkshire collaborative, the remaining 10 are for spot purchase by any appropriate commissioning teams country wide. Patients are admitted to the rehabilitation wards from across the country, by individual clinical commissioning groups.

Waterloo Manor Independent Hospital has been registered with the Care Quality Commission since 2011. It is provided by Waterloo Manor Limited, which are part of the Inmind Healthcare Group.

It is registered to provide the regulated activities: assessment or medical treatment for persons detained under the Mental Health Act 1983; treatment of disease disorder or injury; and diagnostic and screening procedures.

The service had a registered manager at the time of our inspection.

We have previously inspected Waterloo Manor Independent Hospital nine times since its current registration began. The service was last inspected by the Care Quality Commission in April 2021. It was rated as requires improvement overall; requires improvement in the safe and well lead domains, and was unrated in effective, responsive and caring domains.

At the last inspection we found that the hospital was not meeting all the Health and Social Care Act (Regulated Activities) Regulations 2014. We issued the provider with a requirement notices under regulation 13 HSCA (RA) Regulations 2014 Safeguarding service users from abuse and improper treatment and regulation 17 HSCA (RA) Regulations 2014 good governance.

We carried out this unannounced comprehensive inspection because we had not carried out a comprehensive inspection since 2018.

What people who use the service say

We spoke to 19 patients who were using the service.

Seven patients on the rehabilitation wards told us that permanent staff in general were caring and compassionate, three patients said staff were the most compassionate they had ever encountered. However, all patients told us that there were too many agency staff and this impacted on continuity of care.

Patients on the rehabilitation wards said there was a good range of activities available and they said that section 17 leave was only ever cancelled due to changes in risks, never because of staff shortages.

Patients on the rehabilitation wards told us that they thought the furniture and décor on the wards needed to be updated. They also told us that there was a lack of quiet and private space. Some patients said the wards were not very clean.

Seven patients on the low secure wards told us that staff were supportive, and that staff would sit with them when they needed support. Two patients felt that staff were uncaring, and one patient said they did not feel safe on the ward.

Most patients on the low secure ward told us the ward was unkempt and several patients told us the shower made the toilet seat wet, and that they needed a bigger fridge.

Patients on the low secure ward provided a mixed response to activities available on the ward.

We spoke to five families or carers of patients who were using the service.

Families and carers told us that they were offered the opportunity to be involved in patients care where it was appropriate, however, one person told us that they had not been invited to take part in MDT meetings.

Families and carers that had visited the hospital said it was clean and tidy. They told us that generally staff were friendly and helpful and responsive to patient's needs, but one person told us that staff did not communicate well with them.

Updated 16 June 2022

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

• The ward environments were not always safe or clean and staff were not always following guidance in relation to infection control.
• The premises did not always promote privacy and dignity for all patients.
• Staff on Cedar and Maple wards did not consistently assess and manage risk well.
• Although staff engaged in clinical audit to evaluate the quality of care they provided, audits were not always effective in identifying issues.
• Not all checks following rapid tranquilisation were accurately recorded on Cedar ward.
• Not all care plans on Maple ward were comprehensive.
• Care plans did not accurately reflect the assessed physical health needs of all patients
• Staff did not always understand and discharge their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Not all staff had received up to date supervision or had access to regular team meetings.
• Our findings from the other key questions demonstrated that governance processes did not always operate effectively at team level and that performance and risk were not always managed well.
• Staff did not always feel respected or valued.

However:

• The wards had enough nurses and doctors. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• In the main staff developed recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• 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 and appraisals.
• 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, discharge was rarely delayed for other than a clinical reason.

Updated 16 June 2022

Our rating of this service stayed the same. We rated it as requires improvement because:

• The ward environments were not always safe or clean and staff were not always following guidance in relation to infection control.
• The premises did not always promote privacy and dignity for all patients.
• Staff did not consistently assess and managed risk well.
• Not all checks following rapid tranquilisation were accurately recorded on Cedar ward.
• Although staff engaged in clinical audit to evaluate the quality of care they provided audits were not always effective in identifying issues.
• Not all care plans were comprehensive.
• Staff did not always understand and discharge their roles and responsibilities under the Mental Capacity Act 2005.
• Not all staff had received up to date supervision or had access to regular team meetings.
• Our findings from the other key questions demonstrated that governance processes did not always operate effectively at team level and that performance and risk were not always managed well.
• Staff did not always feel respected or valued.

However:

• The wards had enough nurses and doctors. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• Staff developed recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• 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 and appraisals.
• 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 mainly 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, discharge was rarely delayed for other than a clinical reason.

Updated 16 June 2022

Our rating of this service stayed the same. We rated it as requires improvement because:

• Not all wards were safe, clean well equipped, well furnished, well maintained and fit for purpose.
• Staff were not always following guidance in relation to infection control.
• The premises did not always promote privacy and dignity for all patients.
• Not all staff had received regular supervision or had access to regular team meetings.
• Our findings from the other key questions demonstrated that governance processes did not always operate effectively at team level and that performance and risk were not always managed well.
• Staff did not always feel respected or valued.

However:

• The wards had enough nurses and doctors. 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 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 developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.