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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Good: This meant people were supported and treated with dignity and respect; and involved as partners in their care. Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. We observed that staff were kind and compassionate when interacting with patients.

Staff attitudes and behaviours when interacting with patients showed that they were discreet and respectful of patients and provided advice when patients requested it. Staff supported patients to understand and manage their care, treatment or condition. One patient told us staff had spoken to them about their medication and helped them get the medication they preferred.

Staff directed patients to other services when appropriate and, if required, supported them to access those services. A patient told us staff were helping them prepare for the next place they were moving to. Patients said staff treated them well and behaved appropriately towards them.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. Staff maintained the confidentiality of information about patients.

However, 10 patients said that staff were generally poor at providing emotional support, stating “they were not the kind of people to do that” and that staff were “too busy” to spend time with them and didn’t know them as individuals.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. We observed staff address all patients by their first name. Patients were encouraged to personalise their bedrooms.

The service made adjustments for disabled patients, for example all rooms and corridors were large enough for wheelchairs and carers. Worktops in kitchens and the garden areas were suitable for wheelchair users. Hoists were available for use in bedrooms and bathrooms and handrails were provided. All entry points to the service had ramps to ensure disabled people’s access to the premises.

Staff ensured that patients could obtain information on treatments, patients’ rights and how to complain. Wards had accessible and relevant information displayed for patients. Some staff discuss care plans with patients, and these were available in easy read format. Information for safeguarding and the mental health act was also in easy read format.

Patients said the staff listen to them during ward rounds, remain professional and explain their medication to them. Two patients said they had not received information about local services, for instance the location of Costa, or information in other languages, but one patient had used an interpreter.

Staff ensured that patients had access to appropriate spiritual support. Each ward had a multifaith room that patients could access. The chaplain was known to all patients and visited regularly. Resources were available in easy read format across a range of faiths, including a large print bible for patients with sight problems.

The service could cater to patient’s individual dietary preferences upon request. Patients said the food was “really good” with plenty of choice. There were 4 to 6 items on the daily menu and the service catered for patients’ specific dietary requirements, including gluten free and vegan to account for allergies and intolerances and religious requirements.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. The occupational therapy team had adapted shower chairs for improved patient independence when showering and installed a profiling chair for another patient to assist standing.

Patients felt supported to have choice and control over certain aspects of their care and support, like what activities they participated in, what they wore, when they bathe and whether they ate in their rooms or in the social hub. Patients had their own kitchens to make food and drinks and were supported to do their own laundry. Patients however did not feel they had control over their medication and treatment.

There was a sensory room with a range of equipment and a sensory gym. Patients said staff support them with equipment or technology to support their independence, for example one patient had an iPad that played the music they liked to listen to. Wards had a private room for patients to make phone calls.

Patients could have visits from friends or relatives whenever they chose. Visitors were not permitted on wards, but the hospital had a dedicated family room off the ward for family and carers to visit patients. We saw family visiting patients and going for walks during the inspection.

The service had a range of activities are available to patients including breakfast club, arts and crafts, education, community walks and access to city shopping, swimming, badminton, table tennis and gyms, pamper sessions and animal interaction opportunities. Patients acknowledged these activities were happening and spoke favourably about gym access and the horses, but 10 patients told us the weekends were very boring.

The service tracks patient responses to activities, including ‘feeling after’ scores and engagement levels. The key findings of the last survey showed some groups were popular with up to 8 patients attending, and 75% of patients reported improved mental state after activity attendance. Average attendance across activities each month was low depending on the acuity of patients and the number of patients declining engagement.

We scored the service as 2. The evidence showed some shortfalls. The service did not always listen to and understand people’s needs, views and wishes. Staff responded to people’s physical health needs in the moment and acted to minimize any discomfort or distress but were criticized by patients as being “too busy” to accommodate patients’ routine requests around comfort or concern.

Staff were aware of and dealt with any specific risk issues, such as falls or pressure ulcers and care planned for these accordingly. One patient described staff as quick to respond to alarms or emergencies, but slow on everything else, including requests for PRN. Patients said “everything takes a long time [we are] always waiting for staff.” Patients agreed everything was very slow because staff were busy. One patient, put it “everything takes forever and I mean forever – 20 minutes for a hair dryer”.

Patients told us staff spent a lot of time in the office and patients felt they spent a lot of time knocking on the door asking for things. We observed activity on both wards during the inspection and found patients were waiting for staff to respond to their requests. Staff were not always responsive in a timely manner and staff did not always intervene promptly when patients needed support.

Staff used de-escalation techniques to reduce the need for physical interventions when patients’ behaviours became heightened. One patient told us, “staff do let us run around to get rid of all the adrenaline”. Patients told us doctors, and other staff do listen to their views and wishes during ward rounds, but “then do whatever they were going to do anyway”. Outside of ward rounds or specific care tasks for individuals, staff spent very little time interacting with patients. Patients believed staff knew them as diagnoses and tasks to be completed, not as the individuals they were. All patients had access to psychological and occupational therapy.

We scored the service as 4. The evidence showed an exceptional standard. The service always cared about and promoted the wellbeing of their staff and was exceptional at supporting and enabling staff to always deliver person-centred care.

Staff felt respected, supported and valued and staff morale appeared good. There was no negative feedback from any staff spoken to. Staff felt positive and proud about working for the provider and their team. Staff told us they had supportive and inclusive leaders. Staff spoke highly of managerial flexibility, citing the reasonable adjustments that had been made for them and support for their own physical and emotional health needs through an occupational health service. The service’s staff sickness and absence were very low at 1.5 per cent average for the last year.

The provider recognised staff success within the service – for example, through staff awards. Staff valued ‘kite awards’ which are QR code operated and coordinated through the regional office. Patients have their own star of the week. Staff could be nominated and receive their award along with vouchers and small gifts such as chocolate. Staff told us they were mentioned in service wide literature, and they felt proud of the recognition of their efforts.

Wards also had an employee of the month award and a £250 award for any staff member with 100% compliance with staff training. There were several 'living the values' awards presented each December by the onsite wellbeing team.