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Archived provider: Calderstones Partnership NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 9 February 2016

We found that the trust was performing at a level that led to a rating of ‘Good’ because:

  • Since our last inspection of the trust in July 2014, the trust had made significant improvements in the care and treatment that staff provided to patients and the environments in which this was delivered. The trust had developed an action plan following our last inspection and worked with external stakeholders to address the issues we had raised.

  • The executive team had reviewed and strengthened the trust's governance structure. The trust had implemented reports which provided ‘real time’ information about a number of clinical key performance indicators which could impact on the quality of care provided. These included staffing issues, incidents, complaints and episodes of restraint and seclusion. This allowed the service managers and the board to monitor trends and possible gaps in service provision to enable them to take timely action.

  • The trust’s vision and values were fully embedded throughout the organisation and all of the staff we met with were aware of these and explained how the values underpinned their work. Staff were satisfied with the support they had from their managers and were proud of the work that they were doing.

  • The trust had implemented a new model of working called ‘safe wards’ which focussed on reducing restrictive practices and improving patient outcomes. All staff had been trained in the new way of working and were committed to improving the care they provided to patients. All patients had a comprehensive risk assessment, positive behavioural support plan (PBS) and ‘moving on’ plan in place. The quality of the PBS plans was exceptional and there was evidence of patient involvement in the formulation of these.

  • The implementation of the new model had significantly changed the culture within the trust and enabled staff to reflect on their practices to identify areas of improvement. The board was the driving force behind the changes and they had supported staff whilst maintaining good oversight regarding the monitoring and implementation of the changes.

  • The most significant improvements noted was the reduction in the number of episodes of restraint, seclusion, the use of rapid tranquillisation and the eradication of the use of emergency response belts within the trust.

  • This had been achieved despite the uncertainty regarding the future of the service. NHS England had recently announced that Calderstones Hospital would close as part of the Government’s transforming care agenda. This uncertainty had led to the trust experiencing some challenging staffing issues over the previous year. The trust had managed the staffing issues proactively and we were satisfied that there were sufficient numbers of staff to deliver the care and treatment that patients needed safely and effectively with the appropriate use of bank and agency staff.

  • Within the learning disability service, we saw some outstanding examples of staff adapting their interactions with patients based on their individual needs. The staff accepted and embraced the unique communication methods of patients who did not use speech to communicate, including individual sounds and gestures. All of the care plans we reviewed were person centred, and patients all had their own copy and reported their involvement in the care planning process where their capacity allowed. These plans clearly demonstrated that staff had a good understanding of patients’ needs, their hobbies and interests, likes and dislikes. The patients who were able could describe their discharge plans and were animated about their future opportunities. We also found numerous examples of how the trust and staff engaged with patients and their carers and provided opportunities for them to be involved in service development initiatives.

However:

  • We identified some inconsistencies across services in relation to staff training, supervision, de-briefs and staff understanding around the Mental Capacity Act.

  • The number of staff trained in basic life skills was low within the learning disability services which could expose patients to a preventable risk within these services.
Inspection areas

Safe

Good

Updated 9 February 2016

We rated safe as ‘good’ because:

  • All wards were clean, tidy and in a good state of repair. There were systems in place for maintaining hygiene and managing infection prevention.

  • The trust had effective systems in place to ensure that there were enough staff on duty. Where there were vacancies, the trust employed temporary staff to ensure shifts were covered.

  • Since the implementation of the ‘safe wards’ model of care throughout the trust, the number of incidents of restraint, seclusion and the use of rapid tranquillisation used during restraint had significantly reduced. The use of emergency response belts had also been eradicated.

  • The trust was a high reporter of incidents, practices were reviewed and changed as a result of lessons’ learnt. This demonstrated an open and transparent approach to incidents.

  • There was an effective system in place to provide assurance from ward to board that risks were being managed safely. The trust ensured that each clinical area had assessed the risks presented by both the environment and individuals and ensured that active management was in place to reduce the potential of harm.

  • The trust had effective safeguarding procedures in place which staff followed.

  • The majority of staff we spoke with understood the underlying principles of the Duty of Candour requirements and the relevance of this in their work.

  • The overall trust performance figure for mandatory training was 95%.

However;

  • In some of the learning disability services we found that staff were not always being debriefed after being involved in an incident.

  • In the learning disability service, areas for concern and risks were not a standard agenda item for handovers meaning these could be overlooked or missed.

  • On Maplewood 1 and 2 there was no system to allocate staff to respond to activated alarms in an emergency.

  • Compliance with basic life skills training was below the trusts’ target of 80%.

Effective

Good

Updated 9 February 2016

We rated effective as ‘good’ because:

  • Patients were involved in the planning of their own care and attended meetings to discuss this. Patients had an assessment by a doctor and nurse on admission which covered all their physical and mental health needs. Each patient had a comprehensive, detailed risk assessment in place.

  • Each patient had a Positive Behavioural Support (PBS)plan in place. The quality of the PBS plans was exceptional. These had been co produced with patients and or their family members where possible.

  • Patients had been involved in making a DVD about the PBS model for staff as a practical training tool and numerous health promotion DVDs through the trusts patient led media group which were available for patients.

  • The trust had implemented a range of evidenced based practices and initiatives to improve patient outcomes.

  • All staff had participated in a training programme called creative intervention training in response to untoward situations (CITRUS).

  • Staff worked collaboratively with others to formulate ‘moving on’ plans for each patient.

  • The trust had been leading a national piece of work on behalf of the National Offender Management Service to improve outcomes for offenders with leaning disability.

  • Compliance with the requirements of the Mental Health Act and Mental Capacity Act was good.

However;

  • There were inconsistencies regarding the recording of the responsible clinician’s (RC) assessment of a patient’s capacity to consent to treatment.
  • Within the learning disability service, supervision of staff was not in line with the trust’s policy.
  • Some staff were uncertain around the principles of the Mental Capacity Act.

Caring

Good

Updated 9 February 2016

We rated caring as ‘good’ because:

  • On the learning disability wards, the staff clearly understood the needs of the patients including those with no speech. We saw some excellent examples of staff adapting their interactions with patients based on their individual needs. The staff accepted and embraced the unique communication methods of patients who did not use speech to communicate, including individual sounds and gestures. Members of the staff team ensured that the specific communication needs of the individual were taken into account and ensured that information was provided to them in a format they could understand
  • All of the care plans we reviewed were person centred, and patients all had their own copy and reported their involvement in the care planning process where their capacity allowed. These plans clearly demonstrated that staff had a good understanding of patients’ needs, their hobbies and interests, likes and dislikes. The patients who were able could describe their discharge plans and were animated about their future opportunities.
  • On all of the wards we visited staff ensured that patients received care that was supportive and treated them with dignity and respect at all times.
  • Staff actively worked with individuals to plan care and there was shared decision-making about care and treatment. Patients were involved as partners in their care.
  • During the inspection, we saw several patients experiencing times of challenge and without exception the staff present at the time were compassionate and supportive.
  • Staff had invested time in developing positive behavioural support plans with all patients within the trust which were formulated around their specific needs’.
  • The trust had signed up to the ‘triangle of care’ initiative in 2010.
  • Patient meetings were patient led with the support of staff.
  • All patients had access to advocacy services and there were posters displayed to promote this services.
  • Patients were fully trained and involved with the recruitment of staff.

Responsive

Good

Updated 9 February 2016

We rated responsive as ‘good’ because:

  • The trust had planned and delivered services in a way to meet the needs of the patients. The specific needs of patients had been taken into account when planning and delivering services.
  • All patients had a moving on plan which the individual and other stakeholders had developed collaboratively. However; some patients were not able to move on as there was a shortage of accommodation and support to meet their needs available within community settings
  • Care and treatment was coordinated with other services and providers to ensure that where possible patients were admitted and discharged in a timely manner.
  • The trust had ‘Our Shared College’ on site and in 2014, patients took 322 courses on subjects including money management, maths, upholstery, curriculum vitae skills and horticulture. 126 accredited certificates, including nationally recognised qualifications were awarded to patients through the college.
  • Facilities and premises were appropriate for the services delivered in them. The trust had designed services around the specific needs of the individual patients using then at the time.
  • Staff had provided information in a variety of formats to ensure that it was easy for patients to complain or raise a concern.
  • The trust had a Lesbian, Gay, Bisexual, Transgender (LGBT) forum called The Avenue. This had been developed after a request from a patient and was patient led.

However;

  • Some staff within the learning disability service were not aware of the chaplaincy and spiritual support available to patients.

Well-led

Good

Updated 9 February 2016

We rated well led as ‘good’ because:

  • There was good leadership at board level with a visible executive team. The leadership team recognised the importance of strong engagement with patients, relatives, staff and external stakeholders. The trust had a number of established initiatives in place to promote engagement and had systems in place to develop this further. The trust were working with other health providers to improve care outcomes for the patient group.
  • The trust leadership has implemented and overseen significant changes across all of its services these have had a direct impact on improving the care and treatment of the patients in the service. This had had a direct impact on the number of incidents, episodes of restraint, use of rapid tranquillisation, use of emergency response belts and seclusion.
  • The ward managers, senior managers and the trust board used the data set information and heat maps to monitor performance and identify any trends which could impact on the quality of service provision.
  • Staff and patients told us that the hands on, supportive approach of the executive team had empowered them to take a person centred approach to the care being delivered.
  • The governance structure from senior manager level to ward level monitored performance outcomes for patients. There were risk registers in place in all services and there were plans in place to mitigate these risks. There was board oversight and monitoring of these risks.
  • The trust vision and values were fully embedded across the trust all of the staff we met with were aware of these and explained how the values underpinned their work. Staff were satisfied with the support they had from their managers and were proud of the work that they were doing.
  • The organisation was working with other stakeholders to identify the current and future risks and to put systems in place to monitor and address these.
  • The forensic units had successfully completed the self and peer review parts of the quality network for forensic mental health services annual review cycle.

However;

  • Within the learning disability wards staff could not describe the key performance indicators that were monitored to drive improvements.

  • Formal team meetings were not taking place regularly on all wards within the learning disability service.
Checks on specific services

Forensic inpatient/secure wards

Good

Updated 9 February 2016

We rated Forensic inpatient/secure wards as good because:

All of the wards were clean, tidy and well maintained. Staff completed regular checks on the ward resuscitation equipment. These checks were recorded.

Staff managed physical, relational and procedural security well. The outdoor areas met the secure service standards set out by the Department of Health in its Environmental Design Guide (2011). The wards had airlock systems at their entrances and a central office managed keys and alarms so that staff collected these on their way in and left them on their way out. Staff used the ‘see think act relational security explorer’ during handovers. Staff knew how to access the security policies that were available on the trust intranet. These were all in date.

Care plans focused on recovery. Ward staff understood the principles of positive behavioural support and applied these when developing care plans.

All of the care records we reviewed showed that staff checked the physical health of patients regularly. The trust ensured that patients had good access to a range of physical healthcare services including GP services, opticians, dentists, dieticians and podiatrists.

The staff worked well together as multi-disciplinary teams.

Staff at all levels were kind and respectful when speaking to patients. They respected patient privacy and dignity and maintained confidentiality. Staff involved patients in all aspects of care planning, including in the development of positive behavioural support plans.

The trust ensured that advocacy services were available and present on the wards. Patients told us that they had good relationships with advocates.

The trust made a wide range of therapeutic and social activities available to patients on all of the wards. Patients could use the outdoor areas at any time. There were good facilities for children to visit away from the ward areas.

The care was discharge-oriented. Staff actively planned for discharge to appropriate alternative placements, taking account of patient needs and risks. The ward teams worked collaboratively with community teams mental health and learning disability teams that would support patients post-discharge, and with commissioners.

Staff at all levels understood and supported the trust’s vision for the service. Ward staff knew who the members of the trust board were and told us that they saw them regularly. The trust ensured that there were systems in place to monitor quality and to give feedback on performance to staff throughout the organisation.

However:

Managers had not undertaken an appraisal of all ward staff in the previous 12 months.

On Maplewood 1 and 2, the managers had not put in place a system that allocated staff to respond when an alarm was activated.

Wards for people with learning disabilities or autism

Good

Updated 9 February 2016

We rated wards for people with learning disabilities or autism as good overall because:

  • the wards were clean and well kept and had up-to-date environmental risk assessments

  • patients told us they felt safe on the wards and that staff handled incidents well

  • the wards managed staffing pressures and it was unusual for them to be below their required number of nurses on duty

  • risk assessments and care plans were recovery focused and person centred, patients all had their own copy of their care plan and reported their involvement in the care planning process where their capacity allowed

  • some of the wards were located within residential houses that were well integrated in the local community and complemented the step-down philosophy of the services

  • patients had ‘moving-on’ plans and there were discharge plans in progress

  • there was good multidisciplinary working, in particular occupational therapists and psychologists worked in each of the inpatient wards

  • there were good examples of staff working hard to enhance communication and understanding of patients’ needs and individual communication methods

  • patients reported that staff were friendly, caring and respectful

  • staff had a good knowledge of the individual needs and preferences of patients, and were highly responsive to patients with complex needs who did not use speech to communicate

  • we observed caring, respectful and professional interactions between the staff and patients on the wards

  • family members told us they felt included in the care of their relative, were asked to share their views and opinions, and felt these were taken into account by the service

  • information for patients was available in a range of formats including easy read and pictorial

  • there was a wide range of activities for patients, which were appropriate to their needs

  • staff spoke positively about the teams they worked in and there was good communication between the wards and senior managers.

However:

  • staff did not always receive a debrief after incidents

  • staff at 2 and 3 West Drive did not receive regular supervision

  • staff had limited understanding of the Mental Capacity Act and how this related to their role

  • staff could not describe the key performance indicators that were monitored to drive improvements

  • staff training attendance for life support and prevention and management of violence and aggression was below the trust target of 80%.