Weaver Lodge

We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

During our inspection we toured the environment of the service, including the clinic room. We observed multidisciplinary meetings, staff meetings, and a patients morning meeting. We reviewed prescription charts and 9 care records, spoke with 4 patients and 7 members of staff, which included psychiatry, occupational therapy, support workers and nurses, as well as the registered manager.

We previously inspected the service in April 2022. We rated safe, effective, caring, responsive and well led as good, the overall rating of the service was good.  At this inspection we rated caring, responsive and well led as good, and safe and effective as requires improvement. Our overall rating of the service was requires improvement.

During this inspection we found breaches of regulation in relation to safe care and treatment. The electronic care record system lacked consistency and was difficult to navigate. There was a lack of crisis planning in place, in one care record a risk assessment had not been completed, and patient voice was not consistently present in care records. This meant that staff could not be quickly assured of patient risk, or the involvement of patients in developing care and treatment.

The Oliver McGowan tier 2 training (nationally recommended training on meeting the needs of people with a learning disability and autistic people) was at 54%. This meant we were not assured that staff had the appropriate training, skilling and culture to ensure the needs of patients with learning disabilities and autism.

The service did not have a psychologist as part of the MDT, which is against national standards and NICE guidance for a rehabilitation service. Although the service told us they did not admit people who needed increased psychology input, however this was not clear in their admission criteria.

However, the service was focused on quality improvement and had a quality improvement project in place to ensure that care records were more robust. The service responded to serious incidents well and acted when learning was identified. Staff spoke positively about the service, and the change to the culture of the service which new management had facilitated. Staff in the service worked well together, and with external teams to ensure continuity of care between services.

Mental Health Act

The service admitted patients detained under the Mental Health Act 1983. Staff received training on the Mental Health Act as part of their mandatory training, the compliance rate at the time of inspection was 100%. They had a good understanding of the Mental Health Act, the Code of Practice and its guiding principles. The service had access to administrative support through the provider, this included legal advice on implementation of the Mental Health Act and its Code of Practice, and relevant policies and procedures that reflected the most recent guidance.

Staff explained to each patient their rights under the Mental Health Act, and this was recorded by the Mental Health Act administrator and evidenced within care records. Patients we spoke with understood whether they were detained under the Mental Health Act but some patients where not sure if their rights had been explained to them. Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted. Escorted leave was rarely cancelled and always re-arranged as soon as possible if unable to go ahead.

At the entrance of the service there was an information board, which included how to access Independent Mental Health Advocacy (IMHA). During our inspection some patients were informal (not detained under the Mental Health Act), we raised with staff that there was not a notice informing informal patients that they were able to leave. This was addressed by staff and raised in the staff meeting to ensure awareness.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act, had a good understanding of the five principles and were able to give examples of when capacity had been assessed. Staff received mandatory training on the Mental Capacity Act and Deprivation of Liberty Safeguards, and the compliance rate was 100%.

Staff took all practical steps to enable patients to make their own decisions. There was evidence in care records that staff had involved patients in decision making and supported them to understand their care and treatment. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The provider had a policy on the Mental Capacity Act, including Deprivation of Liberty Safeguards. Staff were aware of the policy and had access to it.