Ashwood Court Supportive Pathways

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. • 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. • 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 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 understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. • 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 well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason. • The service worked to a recognised model of mental health rehabilitation. It was well led, and the governance processes ensured ward procedures ran smoothly. • Due to the improvements noted at this inspection the service is no longer in special measures.

2 Ashwood Court Nursing Unit Inspection report

Summary of findings

Our judgements about each of the main services

Service Rating Summary of each main service Long stay or Good ––– rehabilitation mental health wards for working age adults

3 Ashwood Court Nursing Unit Inspection report

Summary of findings

Contents

Summary of this inspection Page Background to Ashwood Court Nursing Unit 5 Information about Ashwood Court Nursing Unit 6

Our findings from this inspection Overview of ratings 8 Our findings by main service 9

4 Ashwood Court Nursing Unit Inspection report

Summary of this inspection

Background to Ashwood Court Nursing Unit Ashwood Court Nursing Unit is an independent mental health hospital for people aged from 18 to 65 years. It is a community rehabilitation unit for people who require rehabilitation and support with a severe and enduring mental illness. It has 10 beds and can admit up to five men and five women. Patients may be admitted informally or detained under the Mental Health Act.

Ashwood Court Nursing Unit is provided by Making Space. Making Space is a registered charity that provides services across the country. Ashwood Court Nursing Unit is adjacent to Ashwood Court – Unit 1 which is a residential home. The registered manager for the independent mental health hospital is only registered for that service and not the residential unit. Both services share facilities such as catering and cleaning.

All 10 beds in the unit are commissioned on behalf of the NHS Wigan Integrated Care Board. The service 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. Ashwood Court Nursing Unit has been registered with the Care Quality Commission since 23 November 2010. There is a registered manager in post.

The service was inspected in May 2022 where the service was rated as inadequate overall. The key questions safe and well-led were rated as inadequate. The key questions effective, caring, and responsive were rated as requires improvement. Following the May 2022 inspection, we took enforcement action and issued two Section 29 warning notices. These were issued in relation to a lack of adequate risk management and systems and processes for effective audit. The warning notices were served for a breach of Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment and Regulation 17 HSCA (RA) Regulations 2014 Good governance.

We also took urgent enforcement action and issued a notice of decision imposing conditions on the provider’s registration. This meant the provider was unable to admit any new patients and was subject to additional oversight by the Care Quality Commission. We also issued three requirement notices relating to breaches of the following regulations:

• Regulation 9 HSCA (RA) Regulations 2014 Person-centred care

• Regulation 18 HSCA (RA) Regulations 2014 Staffing

• Regulation 10 HSCA (RA) Regulations 2014 Dignity and respect

In September 2022, a focused inspection of the service took place of the safe and well-led domains. The service was not rated at the September 2022 inspection. We found policies, processes, and other documents were not considered robust enough to provide safe and consistent care, as well as poor mandatory training compliance, restraint training did not include all required areas. It was also noted admission criteria and pre-assessment documents were not screening possible violent or aggressive patients to ensure they were not admitted to the service. However, there had been improvements made regarding risk assessments, care plans, audits, new policies, incident reporting, a physical intervention policy, incident response, and a risk assessment and care plan policy.

5 Ashwood Court Nursing Unit Inspection report

Summary of this inspection This inspection and report focused on checking whether improvements had been made in relation to the Section 29 warning notices only. We found the Section 29 warning notices had been complied with. The removal of the notice of decision conditions is a separate process outside of this report. It was noted the requirement notices regarding policies and procedures had been successfully acted upon, and the physical intervention process had been improved upon.

What people who use the service say

We spoke with 3 patients during the inspection. All patients told us staff were respectful and there for them. We were told all requested support was given, and staff were always available. Patients told us they were involved in their treatment and took an active role in care plan preparation. One patient spoke of how staff would talk with them about medicine issues if raised during medicine rounds.

Each patient we spoke with, felt they were in the right place and were receiving the right treatment. During the inspection, we saw evidence of patients being involved in developing their care plans and good interaction between patients and staff.

How we carried out this inspection The inspection team comprised two CQC inspectors and a specialist advisor.

Prior to and following the inspection visit, we reviewed information that we held about the location and asked a range of other organisations for information including commissioners.

During the inspection visit, the inspection team;

• visited the service, looked at the quality of the environment and observed how staff were caring for people, • reviewed the medicines management and prescribing arrangements, • observed a group session, visited the needle exchange and observed interactions between staff and clients, • spoke with 11 clients and one carer, • observed a risk pod meeting, • spoke with the deputy service manager and the no