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Riverdale Grange Clinic Good

Reports


Inspection carried out on 14 and 15 August 2018

During a routine inspection

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 carried out on 9 August 2017

During an inspection to make sure that the improvements required had been made

We found the following areas the hospital needs to improve;

  • The provider had installed a new training database but it was not fully functional at the time of our inspection. This meant they could not provide us with compliance data for all the mandatory training staff were required to undertake.
  • We could not see from care records when and what information staff had provided to patients receiving naso-gastric treatment about independent mental health advocacy. We could therefore not be sure that staff had acted in line with the Mental Health Act code of practice when treating detained patients.
  • Not all staff had been trained in the requirements of the Mental Capacity Act, 2005.

However, we also found the following areas of good practice;

  • The provider had ensured appropriate training requirements were in place for different job roles and they encouraged staff to place high importance on participating in mandatory and essential training.

  • Staff had been trained in appropriate levels of life support depending on their job role and the provider planned to train future staff in-house by adopting a train the trainer model.
  • Managers provided staff with regular line management and clinical supervision. They provided relevant training for supervisory staff and made sure staff recorded the frequency of supervision sessions.
  • Patients described effective communication between support workers, nursing staff and the therapy team in ensuring coordinated care.
  • The hospital provided staff with training in the Mental Health Act and the associated code of practice.
  • The provider carried out checks on directors to ensure they were fit and proper to carry out their role.
  • The provider’s adult service had been accredited by the Royal College of Psychiatrists’ quality network for eating disorders.

Inspection carried out on 9th & 10th May 2016

During a routine inspection

We rated Riverdale Grange Clinic as requires improvement because:

  • As of May 2016, average compliance for mandatory training for the child and adolescent unit was 74%. Average compliance for mandatory training on the adult unit was 77%.
  • The service had high vacancy rates for qualified nurses and nursing assistants. The child and adolescent unit had a staff turnover rate of 45% and the adult unit had a staff turnover rate of 23%. This had impacted on training compliance.
  • Not all staff working on both the adult unit and the children’s unit were trained in safeguarding level three.
  • Compliance rates with basic life support training was 46% for all non-clinical staff and 50% for clinical staff on the child and adolescent unit. Compliance rates for the adult unit were not clear from the training matrix provided.
  • The Mental Health Act policy was not dated, nor did it have a date for review listed. The changes in the code of practice which came into place in April 2015 had not been incorporated into the policy.
  • Checks to ensure directors meet the fit and proper person regulation had not been completed.

However

  • The provider ensured that there were sufficient staff available. A professional judgement tool was used to calculate staffing establishments. Staffing levels were adjusted to ensure safety at all times and took into account bed occupancy, new admissions and periods of one to one observations.
  • We saw that physical health monitoring was in place and carried out in accordance with care plans written for the individual. Physical health checks and monitoring were overseen by two general practitioners who visited the units weekly or daily during the first 72 hours of any admission.
  • Care planning showed the involvement of patients, family members where appropriate and members of the multidisciplinary team. They covered all aspects of care and were reviewed on a regular basis. All patients were given copies of their care plan.
  • There was a wide range of professionals within the multidisciplinary team. These professions are recommended within guidance issued by the National Institute for Health and Care Excellence.
  • Both ward managers felt supported in their roles and had the autonomy to make decisions in the absence of the service managers. The ward managers also participated in the on call rota.
  • Both units were participating in the Royal College of Psychiatrists’ accreditation scheme through which good practice and high quality care are recognised and services are supported to address any areas for improvement

Inspection carried out on 29 April 2013

During a routine inspection

People that we spoke with that were using the service told us that overall they were happy staying at the clinic and were satisfied with the care and support they were receiving. Their comments included, "I know that the staff have my best interests at heart," "it's fine here," "we all get on well together and that helps with our recovery" and "the staff are very good and they're there when you need them."

We found that care and support was offered appropriately to people. We found that staff were skilled, in recognising the diversity, values and human rights of people who used the service.

Each person staying at the clinic had a care plan. We found that the information in these was sufficient and up to date. This meant that the delivery of care to people was safe, effective and appropriate.

Since our last inspection a new system for the safe administration of medicines had been introduced. We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

Staff that we spoke with said they were very well supported by the registered manager to carry out their role. Staff said they were up to date with all mandatory training and we saw confirmation of this.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.

Inspection carried out on 7 January 2013

During a routine inspection

We spoke with several patients, on both the adult side and the adolescent side, who were receiving treatment at Riverdale Grange Clinic. They mostly spoke positively about their experience. Patients told us that they found the regime within the hospital to be "difficult at first", but several patients said to us "we understand that the rules are put in place so that we can get better". One patient that we spoke with told us that they found the complementary therapies within the hospital to be "excellent". Other patients told us that they felt all the staff team were very supportive and that they all had "very good" relationships with their named nurse and named support worker.

We found that patient's needs were identified in care plans. Patients had been involved in writing their care plans. Patients told us that following consultation with "key staff" they were able to make changes to their care plan at any time.

We saw that medication was not always recorded at the time it was administered. This meant it was not clear if patients always received medication as prescribed. We found that although this had been identified as an issue, following medication monitoring checks, appropriate action had not been taken to rectify this.

Staff that we spoke with said they felt "well supported" by their line manager and received regular training, supervision and appraisal.

Patients told us they were aware of how to make a complaint if they wished to do so.

During an inspection to make sure that the improvements required had been made

We did not carry out a site visit to the clinic and therefore do not have any comments from people using the service. Following the last inspection, the provider sent an action plan telling us what they had done to resolve the concerns raised at the inspection in December 2011.

Inspection carried out on 17 November 2011

During a routine inspection

We spoke with several people who were receiving treatment at Riverdale Grange Clinic. They mostly spoke positively about their experience. Some patients told us that they found the regime within the hospital to be challenging, but one patient said to us �it�s challenging for a reason, it�s to get me better�. One patient that we spoke with told us that they found the activities within the hospital to be �brilliant�, and another told us that she felt all the staff team had been very supportive to her.

Reports under our old system of regulation (including those from before CQC was created)