Riverdale Grange Clinic

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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 inspection we rated this key question Good. At this inspection the rating has remained Good.

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.

The service treated people with kindness, empathy and compassion and respected their privacy and dignity. The service treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We observed warm and friendly exchanges between staff and patients, and patients being helped with requests and care needs. Staff discussed patients in meetings conveying respect, kindness, understanding, and compassion.

Patients and families consistently described most staff as kind, approachable and respectful. Feedback included that staff were ‘calm and comforting’, that staff greeted people daily which made them feel cared for, and that staff were ‘amazing, smiley and kind’.

We received feedback from 2 young people who raised concerns about staff attitudes. The provider had already taken appropriate action to address one of the issues raised and responded immediately at the time of inspection to review a further concern.

Stakeholder feedback included comments about the ‘firm but fair’ approach taken by staff and that patients were involved in discussions about their care. We were told that staff explained care and treatment clearly and in detail, and that they communicated the reasons for difficult decisions with sincerity and compassion.

Staff maintained patient confidentiality, with patient records filed securely or stored electronically. Staff mostly respected patient privacy, for example, information on the young people’s ward was displayed appropriately, and patient information on the board in the nurses’ office was covered to maintain confidentiality. However, we received 2 comments that staff on the young people’s ward did not always wait long enough after knocking before entering patients’ bedrooms. Young people told us they had raised this with the provider and that staff had been reminded about the importance of waiting before entering bedrooms. We reviewed community ward meeting minutes where this issue had been recorded, and staff meeting minutes where staff were reminded to knock first. The provider also took immediate action when we fed this back during the inspection. Newly designed posters were placed on all bedroom doors to prompt staff to knock and wait, and we saw evidence that this was reinforced in staff meetings.

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.

Staff made reasonable adjustments for disabled patients. This included ensuring access to and movement within the premises and meeting patients’ individual communication needs. The provider showed us examples of individualised communication plans that had been used for previous patients.

Staff ensured information was available for patients, on treatments, local services, patients’ rights, how to complain and so on. For example, patients told us they were provided with information about prescribed medicines. They also reported that information was explained, and their preferences and opinions were asked for.

Patients told us they were able to personalise their bedrooms with posters, photographs and artwork, and could have personal items from home, such as duvet covers and soft toys. We saw further examples of personalised support, including a patient being provided with a desk to enable them to continue their self‑employed work and another patient being able to bring a television from home.

Staff made information leaflets available in languages spoken by patients.

Managers ensured staff and patients had access to information about interpreters and signers. The provider used 2 translation services when required. Patient and carer handbooks stated that where English was not a person’s first language, interpreter services, including British Sign Language, were available on request.

Patients had a choice of food that met the dietary requirements of religious and ethnic groups and took account of allergies and intolerances. While the provider operated a single menu for each meal, individual preferences and dietary needs were considered. There were 2 weekly rolling menus, including meat and vegetarian options. The provider used a daily form to record dietary needs, such as halal, pescatarian, gluten‑free requirements, and dietary needs for neurodivergent patients. This also captured individual food preferences and requested substitutions.

The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Staff described how they supported patients to have choice and control over their care, treatment, and wellbeing. Patients confirmed they were involved in their care by attending meetings and contributing their views.

Patients told us they were supported to maintain contact with their employers or continue with their self-employment business where this was possible for them to do so. Education staff supported young people to keep in contact with their schools to continue learning opportunities during their inpatient admission for care and treatment.

Patients and carers told us they could keep in contact and that they were able to have visits, either in patient bedrooms or in one of the garden rooms that could be booked for visits. Patients had access to mobile phones. Restrictions on mobile phone use for young people was detailed in the patient handbook. The provider had an acceptable use of technology policy to guide access and use and had involved young people in the policy development.

We observed a weekly ward community meeting at which patients were able to make requests or raise issues. For example, young people agreed on a code word that could be used by individuals to indicate if they were finding situations or conversations difficult, and a peer support group was planned to enable patients to discuss issues they wanted to raise.

The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and managed specific risk issues. For example, we observed handover meetings where staff adjusted patient observation levels in response to changes in need, and where leave arrangements were restricted due to increased risks associated with nutritional intake.

We observed staff responding to individual patients, showing flexibility and respect for preferences and wishes. For example, education staff offered different options when a young person was reluctant to attend the hospital classroom. Staff and patients told us how patients requiring nasogastric feeds were supported to identify different ways they wished to have this process managed in the moment.

We received mixed feedback from patients about the use of restraint when it was required to support nasogastric feeding. One patient told us that, where restraint formed part of their care plan, staff attempted to use alternative approaches to help them calm before applying restraint techniques. However, another patient told us they felt staff were sometimes too quick to use restraint and did not always talk to them beforehand.

Stakeholders told us they had observed staff behaviours that consistently prioritised patient safety and risk awareness. They also described staff interactions with patients as kind, compassionate and respectful. Stakeholders told us that management were responsive and that the service adapted to meet changing patient needs.

The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care.

Staff felt respected, supported and valued. Staff described the service as a really nice workplace, and that they felt comfortable at work. They told us they felt supported, and that the service was very open to hearing staff views.

Staff told us they felt positive and proud to work for the provider and within their teams. Staff mostly described teams as happy. However, staff on the young people’s ward told us that a lack of strong leadership had impacted team cohesion and consistency. A new ward appointment had been made for the young people’s ward at the time of the inspection, with a start date for the following month.

Stresses of work were acknowledged, however staff told us that these were variable and that they were supported when these arose. Staff described having a good work-life balance.

Managers considered the wellbeing of staff and facilitated flexible working arrangements, for example for staff needing these due to personal or family circumstances.

Staff told us they felt able to raise concerns and described the service as having a no-blame culture. Most staff knew the provider’s freedom to speak up champion.

Staff were supported with their own physical and emotional health needs, for example returning to work after a period of sick leave and attending health appointments.

Staff appraisals recognised what had gone well for staff and had a focus on accomplishments. Appraisal discussions also included consideration of support needs, health and wellbeing, and staff development and career progression.