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Riverdale Grange Clinic Good

Inspection Summary


Overall summary & rating

Good

Updated 16 October 2018

We rated Riverdale Grange Clinic as good because:

  • Patients had access to a wide range of therapies and professionals within an effective multi-disciplinary team. Patients and carers told us that therapy was personalised and specific to individual need. Families and carers were encouraged to be actively involved in patient care, and were offered support and education programmes.
  • Staff morale was high and staff told us they felt well supported and valued in their roles. Staff supervision and appraisal rates were above 80% across both units.
  • Patients had access to a timetable of activities on both units and were encouraged to complete individual weekly planners detailing activities they intended to attend. Patients were also involved in a social enterprise which encouraged them to try new activities whilst raising awareness of eating disorders in the local community.
  • Robust physical health monitoring was in place throughout patients’ admission, overseen by two general practitioners. There was an on-call rota for managers and consultant psychiatrists for support and advice out of hours in order to maintain the safety of staff and patients.
  • Adolescent patients could access an on-site education provision during term-time, with school staff maintaining contact with the patient’s education provider outside the hospital.
  • Staff at the hospital were involved in peer review of other eating disorder services; allowing them to share knowledge and engage in learning opportunities.

However:

  • Staff did not consistently complete patient medication cards following the administration of medication. Fridge temperatures in the adolescent clinic room regularly exceeded the recommended range. It was not clear that emergency medication, namely EpiPen’s, were stored in line with manufacturer’s guidance, and one of the emergency bags did not contain the correct equipment identified on the equipment check-list.
  • Mandatory training compliance for eating disorders awareness and therapeutic observation training modules was low. This meant that staff may not have been aware of the specific risks and complications associated with eating disorders in order for them to safely care for patients.
  • Adolescent patients had not been individually risk assessed to establish whether they required supervision whilst accessing the hospital garden. Patients’ rights under the Mental Health Act were not clearly displayed on the adolescent unit.
  • Staff could not identify where consent to share information was stored within patient notes and we could not see evidence of a clearly documented assessment of capacity for a patient who had been deemed not to have the capacity to make a specific decision.
  • Governance structures in place at the hospital did not effectively manage all of the concerns identified.
Inspection areas

Safe

Requires improvement

Updated 16 October 2018

We rated safe as requires improvement because:

  • Staff did not consistently complete patient medication cards following the administration of medication.

  • Mandatory training compliance for eating disorders awareness and therapeutic observation training modules was low. Due to the specialist nature of the service there was a concern that without having undertaken eating disorder awareness training staff may not be aware of the specific risks and complications associated with eating disorders in order for them to safely care for patients.

  • Adolescent patients had not been individually risk assessed to establish whether they required supervision whilst accessing the hospital garden.

  • Fridge temperatures in the adolescent clinic room regularly exceeded the recommended range.

  • Emergency medication, namely EpiPen’s, were not stored in line with manufacturer’s guidance, and not all equipment listed as contained within one of the emergency bags was present.

  • Patients’ rights under the Mental Health Act were not clearly displayed on the adolescent unit.

However:

  • Both units, including clinic rooms, were clean and well-maintained.

  • The hospital ran an on-call rota for consultant psychiatrists and ward and senior managers to ensure staff on the units had support out of hours.

  • Staff were trained in safeguarding and had a good understanding of how to report safeguarding concerns and incidents.

  • We observed staff to respond promptly and safely to a patient alarm activated during our inspection and found that nurse call alarms were located in all rooms within the hospital.

Effective

Good

Updated 16 October 2018

We rated effective as good because:

  • Physical health monitoring was in place with patients receiving a physical examination on admission and an appointment with a general practitioner within four hours, as well as ongoing monitoring throughout admission.
  • Patients had access to a wide range of professionals within an effective multi-disciplinary team.
  • Patients had access to a range of therapies recommended by the National Institute for Health and Care Excellence (NICE).
  • Patients saw a dietician within 12 hours of admission. Dieticians worked with patients to create personalised meal plans which would be reviewed regularly at ward rounds.
  • The hospital used recognised rating scales to assess and record severity and outcomes.
  • Staff supervision rates were above 90% and staff appraisal rates were above 80% across both units.

However:

  • Staff did not follow the Mental Capacity Act code of practice process when assessing for and documenting capacity. Some staff lacked understanding of the Mental Capacity Act.
  • Staff printed and stored patient care plans within a paper-based folder on the adult unit for bank and agency staff to refer to for information about patient care, but many plans were not up-to-date a number were missing entirely.
  • Staff could not always identify where consent to share information was stored within patient notes.

Caring

Good

Updated 16 October 2018

We rated caring as good because:

  • We observed positive interactions between staff and patients and saw staff to be respectful and supportive. Patients and carers were largely positive about staff.
  • Families and carers were invited to attend a carer’s group aimed at providing education around eating disorders as well as peer support.
  • Prior to admission patients received a handbook detailing what they should expect during their stay, therapies and activities available, details of staff at the hospital and information on advocacy and complaints. Patients were also invited to tour the hospital prior to admission.
  • Patients and carers were actively involved in regular ward round and care programme approach meetings.
  • Patients were involved in creating an interview pack for prospective employees, with questions based on domains they felt were important.

However:

  • One patient spoken with told us that they had asked for a copy of their care plan a number of times before it was provided.
  • Two patients told us that they did not feel that staff listened to them when deciding on their care and treatment.

Responsive

Good

Updated 16 October 2018

We rated responsive as good because:

  • Patients and carers told us they knew how to complain and would feel comfortable doing so if required.

  • Patients had access to a timetable of activities on both units and were encouraged to complete individual weekly planners detailing activities they intended to attend.

  • There was disabled access to the hospital and lifts were available to access other floors within the building.

  • There was on-site education provision available to adolescent patients during term-time. School staff maintained contact with patient’s education provider outside the hospital to ensure work was of an appropriate nature, as well as to support transition once discharged.

However:

  • Activities were not scheduled on weekends and two patients from the adult unit told us that they felt there were not enough activities available off the unit.

Well-led

Good

Updated 16 October 2018

We rated well-led as good because:

  • Staff told us that senior managers were visible on both units and that they could approach them for support.

  • Staff morale was high and staff told us they felt valued.

  • Staff and patients were engaged in a number of projects aimed at improving quality and raising awareness of eating disorders in the local community, including a social enterprise called ‘by Riverdale’ which encouraged patients to engage in a range of activities.

  • Staff at the hospital were involved in peer review of other eating disorder services through accreditation with the Royal College of Psychiatrists Quality Network for Eating Disorders (QED).

However:

  • Governance structures in place at the hospital were not effective in managing all the concerns identified in relation to medication management and staff training. 
Checks on specific services

Specialist eating disorder services

Good

Updated 16 October 2018