Adarna House

Updated 14 July 2022

Adarna House is a rehabilitation service for up to nine adult men with mental illness and a secondary diagnosis of autism spectrum disorder. People are admitted formally under the Mental Health Act, under a Deprivation of Liberty Safeguards or informally with their informed consent. At the time of our inspection there were five people on the ward. Four people were detained under the Mental Health Act and one person was informal. It is run by Caireach limited which is part of the Cygnet Health Care group, a national provider of health and social care services.

The hospital was registered with the Care Quality Commission in July 2011 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.

The hospital had a service manager and a registered manager in post. The registered manager, along with the registered provider, is legally responsible and accountable for compliance with the requirements of the Health and Social Care Act 2008 and associated regulations.

Adarna House has been inspected on eight previous occasions when it was called Cygnet Woodside. We last inspected the hospital in March 2021 where we rated Cygnet Woodside as ‘inadequate’. We rated the safe, effective, responsive, and well-led key questions as ‘inadequate’ and caring as ‘requires improvement’.

We took enforcement action including the service being retained in special measures following this inspection. After our inspection in March 2021, the provider closed the hospital temporarily for refurbishment in May 2021 after all the people using the service were transferred or discharged.

The service re-opened in January 2022 after extensive changes at the service, these included a change of management, refurbishment of the building, and a change of service name. The service continues to be a ward for people with a learning disability and/or autism with a focus on providing a service to autistic people.

What people who use the service say

There were five people who used the service. Two people declined to speak to us, but three people told us they felt safe at the service and that staff were very supportive and available when needed. They all liked how quiet the service was and two people regularly attended the weekly service community meetings where they could raise concerns. All three people said there were not enough activities, and one person was concerned about the upcoming change in menu that they had not been consulted on and believed would provide less choice. The people we spoke to all knew who the independent health advocate was.

We asked the service for contact numbers of carers and one person we talked to was not aware that their relative had been moved to this service. We raised this with the service who called the relative directly that day and informed them of their relative’s admission to the service. The persons next of kin and nearest relative as named on the Mental Health Act detention papers were not the same and this may have been the reason for the confusion.

We spoke to four carers including the carer who was not aware of their relative’s placement at the service. Two of the carers said they were happy with the service and that they were regularly kept updated on their relatives care and treatment whilst another carer said they were not kept up to date on their relatives care and treatment and that their relative was bored as there were no activities.

Updated 14 July 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

• Staff did everything they could to avoid restraining people and there had been no restraint used since opening on 10 January 2022.
• The service gave people care and support in a safe, clean, well equipped, well-furnished, and well-maintained environment that met their sensory and physical needs.
• Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
• Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. However, there was no access to activities linked to work or education and all the people we spoke to who used the service said there were not enough activities.

Right care

• Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
• People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
• Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

• People received good quality care, support, and treatment because trained staff and specialists could meet their needs and wishes.
• People were supported by staff who understood best practice in relation to the wide range of strengths, impairments, or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs.
• Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.
• Carers and relatives were not always included in the planning of people’s care. Two relatives told us they were not informed about the care their relative received.

Updated 14 July 2022

Our rating of this service improved. We rated it as good because:

• People were cared for in a ward that was safe, clean, well equipped, well furnished, well maintained and fit for purpose.
• Staff assessed and managed risks to people and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible to support peoples’ recovery.
• The service had no instances of restraint, seclusion, long term segregation or rapid tranquilisation (medicine given to manage aggression or agitation) since the service re-opened in January 2022.
• The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each person’s mental and physical health. They knew about and worked towards achieving the aims of STOMP (stopping over-medication of people with a learning disability, autism, or both).
• Staff undertook functional assessments when assessing the needs of people who used the service. Care plans reflected the assessed needs, were personalised, holistic and strengths based.
• Staff provided a range of treatment and care for people based on national guidance and best practice. Staff used recognised rating scales to assess and record severity and outcomes.
• The team included or had access to the full range of specialists required to meet the needs of people at the service. Managers made sure they had staff with the range of skills needed to provide high quality care. They supported staff with appraisals, supervision, and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
• Staff treated people with compassion and kindness. They respected people’s privacy and dignity. They understood the individual needs of people and supported people to understand and manage their care, treatment, or condition.
• The design, layout, and furnishings of the ward supported peoples’ treatment, privacy, and dignity. Each person had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.

However,

• Staff did not always inform and involve families and carers appropriately.
• Staff did not always support people with activities outside the service, such as work and education.
• The service had not ensured all actions listed on their ‘right support, right care, right culture’ plan had been completed.