Riverdale Grange Clinic

Updated 16 October 2018

Riverdale Grange Clinic is an independent hospital providing treatment and care to people with an eating disorder. It is located in an extensively refurbished Edwardian building with landscaped gardens, not far from the centre of Sheffield. The hospital has 18 in-patient beds in two separate units; one treating up to nine adult patients and the other treating up to nine young people. The hospital provides treatment mostly for female patients, however, there is appropriate space available to treat one male patient. At the time of our inspection, all the patients in the hospital were female.

The hospital currently has two registered managers, one primarily for the adult unit and one for the adolescent unit. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Registered managers have a legal responsibility for meeting the requirements of the Health and Social Care Act, 2008 and associated Regulations about the running of the service. The registered manager for the adult unit also acts as the hospital’s accountable officer for controlled drugs. Riverdale Grange Clinic has been registered with the CQC since 19 January 2011. It is registered to carry out three regulated activities:

• assessment or medical treatment for persons detained under the Mental Health Act, 1983, (child and adolescent unit only)
• diagnostic and screening procedures
• treatment of disease, disorder or injury

There has been a total of six inspections carried out at Riverdale Grange. The last one was a focussed follow-up inspection in August 2017. At that inspection, we identified the following breaches of the regulations:

• Regulation 17 HSCA (RA) Regulations 2014 Good governance
• Regulation 9 HSCA (RA) Regulations 2014 Person-centred care
• Regulation 18 HSCA (RA) Regulations 2014 Staffing

We told the provider they must take the following action:

• The provider must ensure they monitor compliance with staff mandatory and essential training.
• The provider must ensure that staff take sufficient steps to inform patients receiving naso-gastric treatment of their rights regarding mental health advocacy in treatment reviews.
• The provider must ensure all staff receive training in the Mental Capacity Act, 2005.

In addition, we told the provider they should take the following actions:

• The provider should ensure procedures for fit and proper persons checks are clearly documented in the relevant policy.
• The provider should ensure there is a robust procedure for ensuring policies are reviewed in line with stated review dates.

Following inspection the provider created action plans relevant to the above requirements and suggestions which were reviewed through engagement and during the current inspection it was found that these actions had been completed.

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.

Updated 16 October 2018