Riverdale Grange Clinic

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

We have not awarded this service a score for Effective.

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

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed 5 electronic care records during the inspection.

We observed a multi‑disciplinary bed management meeting where each patient referred for admission was discussed prior to a decision being made. During the meeting, we noted that individuals’ mental and physical health needs, background, and previous treatment were reviewed. For those identified for admission, staff made arrangements for assessment to ensure needs could be met in a timely and safe way.

We found that staff completed a comprehensive mental health assessment for each person on admission. We saw evidence that risk assessments were completed within 24 hours of admission and were updated regularly.

The clinical team completed autism spectrum disorder diagnostic assessments in line with national guidance for patients who required them. We reviewed assessment reports that showed outcomes from comprehensive psychologist led assessments.

Staff assessed individuals’ physical health needs in a timely way after admission. A physical health assessment was completed by the covering sessional GP on the day of admission, and we saw evidence in care records of a thorough initial 72‑hour monitoring care plan in place to support safe observation and early identification of physical health concerns. We saw evidence of crisis plans in the event of physical health deterioration. Staff ensured that patients had good access to physical healthcare, including access to specialists, general medical hospital treatment, and emergency care when needed.

We found that continued physical health monitoring was evident. A weekly designated physical health clinic took place, during which staff completed individuals’ weight checks and any required blood tests. A monthly physical health clinic was held by the sessional GP, and staff could access additional advice when needed outside of the monthly clinic. Nursing staff were allocated to attend and support this clinic, which provided consistency in patient care. Staff ensure patients had access to specialist, hospital and emergency care when needed.

We also noted the use of physical health outcome measures, including the Waterlow assessment tool and the Health of the Nation Outcome Scales (HoNOS), to support monitoring and review of individuals’ health needs.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

The service provided a range of care and treatment interventions suitable for both adult and young people’s patient groups. These interventions were in line with guidance and recommendations from the National Institute for Health and Care Excellence. For example, we saw evidence that treatment interventions included medication, psychological therapies, therapeutic activities, psychoeducation, and opportunities for education and work, which supported individuals to maintain and develop daily living skills.

Assessment, care and treatment were delivered by a multidisciplinary team to meet patients’ psychological, medical, and physical health needs. The team included a full range of specialists, which comprised registered nurses, support workers, doctors, consultant and assistant psychologists, occupational therapists and occupational therapy assistants, family therapists, cognitive behaviour therapists, dietitians and dietitian assistants, and education and activities staff. The provider also had a sessional speech and language therapist to support autism assessments. A social work vacancy had recently been interviewed for.

The service was a current accredited member of the Royal College of Psychiatrists Quality Network for Eating Disorders (QED). Members of QED have undergone a comprehensive process of review that identifies high-quality standards of patient care and service organisation. This process includes the involvement of patients and carers with experience of using eating disorder services. The service was previously an accredited member of the Quality Network for Inpatient CAMHS (Child and Adolescent Mental Health Services) (QNIC) and was undergoing reaccreditation at the time of inspection.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff received eating disorder training, and this included administrative staff. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. For example, clinical psychology staff were training in Eye Movement Desensitization and Reprocessing (EMDR) therapy, support workers had been supported to complete nursing associates training, staff from different disciplines undertook Quality Network for Inpatient CAMHS accreditation training, and the service was due to host Autism Diagnostic Observation Schedule (ADOS) training in the coming month. Over 80% of staff responding to the staff annual survey said they received the training and development they needed.

Managers provided appraisal of staff performance. All service staff compliance with appraisal was 87%.

Mental Health Act

The provider reported that staff had received training in the Mental Health Act (MHA); however, compliance was low at 78%.

Staff had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had easy access to onsite administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance. An electronic database recorded due dates for reading patients their rights, dates of MHA appeals, and a check for patients requesting to speak with an advocate.

Patients told us, and we saw in care records, that staff had read patients’ Mental Health Act rights to them. Patients had easy access to information about independent mental health advocacy, including a noticeboard that provided details and how to contact the advocate.

Staff ensured that patients were able to take Section 17 leave (permission for patients detained under the MHA to leave hospital) when this had been granted.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them. An electronic record of Section 17 leave papers stored authorisation centrally, and paper copies were made available for staff on the wards.

An external auditor completed annual audits to ensure the Mental Health Act was applied correctly and provided reports of their findings. Staff were able to describe learning points from these audits.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. We observed comprehensive handover and patient safety meetings. In handovers, staff shared information to those coming onto shift, including patient risk and enhanced observations, diet, meal and activity information, and any agreed leave arrangements.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation (for example, care co-ordinators, community mental health teams, and the crisis team).

Teams had effective working relationships with external organisations. Practitioners and managers from outside organisations told us they received regular updates and invitations to attend meetings about patients, and that care was collaborative, considered and patient‑focused. Other external organisations told us that care was regularly reviewed, that staff took account of feedback and that patients’ views were included in these processes. We were told that the provider supported effective transitions between services, promoted collaborative working and encouraged innovative approaches that kept patients at the centre of the service.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives with a key element focusing on body positivity, self-care and compassion. Group activity sessions included healthy ways with food, and movement and meditation. The provider had a large, maintained garden that patients could access for relaxation or group games.

Ward activities helped promote a healthy lifestyle for patients, for example baking groups, individual 1:1 sessions to plan, prepare and cook healthy and balanced meals, and walks off the ward.

Physical and nutritional health needs were assessed in relation to activity, and colour coded activities were designed for patients requiring more sedentary opportunities. These included quizzes, karaoke, board games, pamper and craft activities.

Patients had access to on‑site laundry facilities, which supported the development of independent living skills. This enabled patients to manage their own clothing and personal items, promoted autonomy and prepared them for greater independence when moving on from the service.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes, these included: the Eating Disorder Quality of Life (EDQoL) to understand how an eating disorder affected a person’s day‑to‑day quality of life; the Eating Disorder Examination Questionnaire (EDE-Q) to assess the severity and frequency of eating disorder thoughts and behaviours; the Strengths and Difficulties Questionnaire (SDQ) to screen young people’s emotional wellbeing and behaviour; and the Children's Global Assessment Scale (CGAS) to provide an overall picture of a young person’s mental health and daily functioning. The service provided a report of individual outcome measures to patients and their community teams following admission.

We reviewed provider records that showed service improvements were identified and monitored at regular clinical governance meetings. An action log set out timeframes and recorded progress updates. Areas for improvement identified at these meetings included care plan quality and consistency, increased patient involvement, new treatment pathways and reducing restrictive practice.

The provider ensured people could feed into improvement through surveys and other opportunities for feedback, e.g. questionnaires, suggestion boxes, weekly community meetings on each ward. Carers were invited to complete the care programme approach feedback form prior to patient meetings to share their views on progress, hopes, and what could be done better for their relative.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

We reviewed care records and saw that patients’ consent to treatment was recorded on admission. Patient consent information was also displayed on ward office notice boards, and we observed consent being checked with patients and discussed verbally at ward round meetings.

At the time of inspection, there were no patients who had been assessed as having limited capacity in areas of care or treatment. We saw that staff received training in the Mental Capacity Act. Staff demonstrated knowledge of the principles of the Act and knew how to access relevant policies, guidance and senior staff support when required.

Patients had easy access to information about independent mental health advocacy services, which was clearly displayed on noticeboards in ward corridors. Patients told us they had spoken with an advocate, knew how to contact the advocacy service and that advocates were visible through regular ward visits. Advocacy services told us that hospital staff proactively encouraged advocacy involvement and ensured new patients were offered an introductory visit if they wanted one. Advocates could attend individual patient ward round meetings to provide support, and community meetings which they had done when engagement was low, to provide information and introductions.