On 1 and 2 November 2011 Whipton Hospital was part of a targeted inspection that covered a range of services that cared for people with learning disabilities. At that inspection we found that the two units at Whipton Hospital known as The Additional Support Unit (ASU) and Knightshayes were not compliant with outcome 4: Care and welfare of people who use services, or outcome 7: Safeguarding people who use services from abuse. Following our inspection the Trust sent us their action plan to show us how they planned to address the areas of non-compliance that we identified.

This inspection was carried out by two inspectors who visited the locations on 26 April 2012 to check on compliance with the above outcomes. We also checked on the actions taken to improve the outcomes for people identified at the previous inspection of the service in February 2011. These related to an improvement action for outcome 1: Respecting and involving people who use services, and a compliance action for outcome 21: Records. On the day of our inspection there were four people accommodated in Knightshayes and five people accommodated in the Additional Support Unit.

We chose four people (two who were staying at the Adult Support Unit and two who were staying at Knightshayes) to look at the care and treatment they had received since they were admitted. We looked at the records of care held in each location, talked to staff who were on duty at the time of our visit, and talked to the Modern Matron who was responsible for managing the services. We either talked to each person, or, if they had limited verbal communication skills, we observed the support they received. We found out how they spent their time and whether this was a positive experience for them.

People told us they were happy with the services they were receiving. They felt safe, and said they would talk to one of the staff if they were worried or unhappy about anything.

We talked to each person about their care plans. They told us they had been consulted, and they had agreed the support and treatment set out in the plans. Each person had a care plan that had been drawn up in a format they understood, and they held their own copy. People told us that they were confident that their care plans were being followed, and the treatment and support was helping them to work towards either returning successfully to their previous homes, or to work towards finding suitable new homes. A person who was nearing discharge told us “my psychiatrist comes every Thursday, we talk about medicines and stuff”. The person commented “I think they listened to me”, so felt respected and in charge of their life when speaking about what they had wanted to do regarding having an overnight stay away from the unit.

One person had drawn up their own Wellness and Recovery Plan, and other people had worked with a member of the staff team to draw up and agree their plan. They all had a Health Action Plan in place. We saw evidence to show that the plans had resulted in improvements in people’s health.

People had been involved in improving the quality of the service. For example, one person told us “we have a meeting with staff about once or twice a week”. We saw a ‘learning log’ displayed on the notice board in an easy read/picture format that documented issues people had raised and the actions taken to resolve these.

Since our last inspection significant improvements had been made to the way the staff team used the computerised care planning system. Care plans contained greater detailed information on every aspect of each person’s health and personal care need. The systems for monitoring and reviewing the care plans had improved and this had resulted in staff having a greater awareness of how problems in one area of a person’s needs might affect them in other areas.

Staff told us that the morale of the staff team had improved significantly in recent months. They said the level of training on topics relevant to people’s care needs had increased, and they had regular staff meetings where they were able to discuss issues and felt they were listened to and respected for their ideas and opinions. They said the improvements to the care planning systems had resulted in better outcomes for people, and this made their jobs more rewarding.

There were six people using services when we carried out an unannounced visit to Whipton Hospital. We had a conversation with two people. We obtained most information about people’s experiences through observation.

People told us that they are invited to attend meetings where their care, treatment and support are discussed. If they choose not to attend staff spend time explaining to them what happened at the meeting. People are involved in their own care as much as they are able and information is available to them in formats suitable to their needs. Where a person is unable to weigh up information and make sound decisions best interest decisions are made on their behalf. Consent to care and treatment is sought and recorded.

We saw that staff treat people respectfully. However, observation windows into people’s bedrooms were left open and any person could look in. One person told us that staff are “OK”. People appeared relaxed around the staff. Staff spoke of their commitment to improving people’s health. There is a genuine desire by staff to ensure safe and seamless care for people. People are protected from abuse through staff knowledge, training and supervision, the ethos of the unit and a commitment to ensuring people’s human rights are respected and upheld.

People appeared comfortable on the units, which were warm, fresh and very clean. The environment was safe and well maintained. One person told us the food was nice.

Records did not provide sufficient information of people’s individual needs. Staff we met knew people’s needs well but the inadequacy of record keeping might affect the outcome for people should staff on duty be less knowledgeable.

Whipton Hospital is located on the outskirts of Exeter. Devon Partnership Trust has a specialist service on this site called the Additional Support Unit which is an inpatient assessment and treatment service for up to five patients who have a learning disability. When we visited, there were five patients on the unit and four patients were detained under the Mental Health Act 1983.

We found many good areas of practice at Whipton Hospital. Staff felt confident to raise concerns about the practice of other staff and that action would be taken as a result. This meant that patients were safeguarded from harm and abuse. Staff had an understanding of what they needed to do to make improvements to benefit patients.

Staff received the training and support they needed to meet patients’ individual needs to ensure their wellbeing. There were just below two whole time equivalent band five staff vacancies out of a total resource of nearly 37 staff working at the hospital. In addition, the service had significant numbers of staff on maternity and long-term sick leave. Established and consistent agency personnel were used to cover these vacancies.

Patients had detailed and comprehensive care plans that showed staff how to support them and patients were involved in these. We saw that patients were supported to have regular health checks to ensure their wellbeing. Overall, records where well-maintained, comprehensive, up to date and regularly reviewed. We looked at records which showed that patients had their rights under the Mental Health Act 1983 respected and that access to Independent Mental Health Advocates was supported and encouraged.

Staff worked with the team of professionals involved in each patient’s care to ensure that all the patients’ needs were met. Staff worked with other providers so that when each patient was discharged they received the support they needed.                                       

The environment was well maintained and the majority of procedures and processes in place ensured that patients were kept safe from risk and hazards.

We spoke with three relatives and three patients who were very pleased with the service. Staff were described as “absolutely magnificent”, “extremely caring, understanding and are sensitive to patients’ needs”. One person said that that the short notice cancellation of some meetings was frustrating and inconvenient but that the staff were brilliant. One patient told us, “The staff get me all the meals and drinks I need”.

There were three areas for improvement identified. These were to ensure that blanket restrictions such preventing people from accessing the kitchen are reviewed to check they are still needed. Supporting people to promote their independence through the development of daily living skills should be explored. Fridge and freezer temperatures should be monitored at the appropriate frequency to ensure food is safely stored.