We rated Whorlton Hall as requires improvement because:

• The provider had not taken sufficient action to address the requirement notice we issued following our inspection in March 2016. Although resuscitation equipment was clean and in date an essential stock item for anaphylaxis which we identified at our March 2016 inspection was not available at the time of our inspection.
• There were gaps in cleaning records and domestic staff vacancies meant that some days there was not a domestic on duty.
• Some minutes from governance meetings were brief and there had been gaps in monthly internal service reports. This had the potential to affect the organisations ability to effectively monitor performance and quality.
• The provider had not completed all the requirements for a patient being cared for away from other patient who was in long term segregation as defined by the Mental Health Act code of practice.
• A patient who had been given as required high-dose antipsychotic medication regularly refused physical health monitoring. The patient’s refusal was not always recorded.
• It was difficult to locate items in some paper care records.

However:

• The service had been proactive in addressing significant staffing and management issues which had occurred between June and August 2016. Senior managers in the organisation had put safeguards in place to support new managers. Active recruitment to vacant posts was continuing and a new post of deputy manager had been created.
• The provider was making good progress in addressing actions highlighted in recent audits and internal reviews. We saw improvements had taken place with regard to the environment, staff training and record keeping.
• Staff completed risk assessments of patients at admission and on an ongoing basis.
• Low morale amongst staff had been recognised and the service had worked actively with staff to respond to their concerns and make changes that would benefit them. Staff reported things had improved and they enjoyed their jobs.
• Senior manager support was continuing to maintain the improvements which had been made. An action plan was in place to ensure improvement was maintained and outstanding actions were monitored.

Whorlton Hall is an independent hospital in Barnard Castle, County Durham, which cares for people living with a learning disability or autism and complex needs, and for people who have additional physical or mental health needs and behaviours that challenge.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so, we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

We inspected Whorlton Hall in March 2016 and published our report in June. We rated the hospital as good overall but as requires improvement for safe.

This inspection was prompted by concerns about the quality of care that were brought to our attention since June.

We did not rate the safe domain for Whorlton Hall during this inspection because we did not carry out a full inspection. However, our findings during this inspection meant that we did rate the provider in the effective domain.

We found the following:

• We saw one patient who we considered to meet the Mental Health Act definition of long term segregation but were not identified as such by the provider.
• The hospital had had recent changes in management. A newly appointed registered manager had left at short notice resulting in temporary management arrangements needing to be put in place. An interim manager was in place and a permanent manager had been recruited. Staffing levels had not always been sufficient to keep staff and patients safe. This had resulted in concerns regarding the care of patients. At the time of our visit we saw that the provider had taken positive steps to ensure there were sufficient numbers of staff on duty to keep patients and staff safe.
• Some areas in the hospital were unclean despite the hospital having domestic staff. The provider had an improvement action plan which included a review of cleaning rotas.
• Care plans identified risks but did not always describe how to manage these risks.

We did not rate Whorlton Hall at this focused inspection.

We found the following issues that the service needs to improve:

• There were no processes in place to assess and monitor the impact of staff working excessive hours. Managers knew that staff were working up to 24 hour shifts and had no system in place to assess and mitigate the risk and impact of this on patients or staff
• The service relied heavily on the use of bank and agency staff. Not all agency staff were up to date with mandatory training, and there was no internal system in place to review the training compliance of agency staff
• Individual staff supervision was not taking place in line with Danshell’s policy and supervisory bodies

We also found the following areas of good practice:

• Staff were supported after incidents took place and de briefing sessions were carried out after incidents
• Care plans were holistic and contained the patient voice