Riverdale Grange Clinic

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

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

Staff managed beds well.. The provider operated a waiting list at times. Patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy, and dignity. Staff supported patients with activities outside the service, such as work, education, and family relationships. The service met the needs of all patients – including those with protected characteristics. Staff helped patients with communication, advocacy, and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them, and learned lessons from the result.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff based patient care on individual needs and preferences, placing people at the centre of their care. This was evident in care plans, which included people’s wishes and preferences. For example, we saw that a person’s preferred language and the terms they used in relation to their eating disorder were recorded to support their communication needs. Patients' views were evident in care plans and were person-centred, with the exception of one patient record on the young people’s ward that lacked details of a personalised plan and patient involvement.

Staff empowered patients to make their own decisions about their care and treatment. Stakeholders reported that they had attended care planning meetings at which patients chaired their meeting. Young people told us, and we saw evidence in records, that they were involved in identifying personalised strategies to help them manage high distress times, for example for nasogastric feeds.

We saw evidence of detailed communication passports that included personalised preferences for communication style, sensory preferences, suggestions of sentences staff could use to engage with the patient, and patient preferences for how they were communicated with about treatment.

Within a limited daily menu, we saw evidence that people received requested changes or preferred substitutions to some meals. This meant meals could be personalised to meet individual dietary requirements and preferences.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Staff ensured that young people had access to education. The service had dedicated classroom facilities and an onsite staff team, which were accessible to all young people and supported their education. Education staff liaised with young peoples’ schools, ensuring consistency and support to continue their educational development while in hospital.

Staff told us they supported people to access their chosen place of worship within the community. This had included accompanying people to a local Mosque, which demonstrated consideration of individual religious and cultural needs.

Where appropriate, staff supported people to maintain existing work arrangements. For example, one person told us they were provided with a desk in their bedroom, and the service was supportive of them joining video calls, which supported the patient to continue with their self-employment.

Staff supported people to maintain contact with their families and carers. Staff also held coffee and cake evenings, which provided opportunities for relatives and carers to meet the staff team. In addition, a 10‑week carers’ programme was offered to provide psychoeducation and ongoing support.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff made notifications to external bodies when required. Records showed the provider made appropriate and timely CQC regulatory notifications.

Staff ensured carers, families, and commissioners were provided with updates about patients’ progress. Stakeholders told us they received updates about patient care and progress. Feedback from parents was mixed. Two of 3 parents said they were well informed, kept up to date with changes, and received minutes of ward round meetings. One parent told us it could be difficult to contact staff and that email had been more effective. They also told us updates from the provider had not always been consistent and that they relied on information shared by the patient following ward round meetings.

Information governance systems supported the confidentiality of patient records through the use of electronic systems and password-protected equipment. We also observed that patient confidentiality was respected in practice. For example, patient information displayed on boards in the nurses’ office was covered to maintain confidentiality.

Staff ensured patients could access information about treatments, local services, patients’ rights, and how to raise concerns or make complaints. The provider displayed information on notice boards and in dedicated areas throughout the hospital building, including on each ward and at the main reception area. Information was up to date and clearly presented.

The provider told us translated information leaflets were available in languages spoken by patients when required. At the time of our visit, there were no patients who required translated materials.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had received no complaints in the preceding 12 months.

Patients and family members knew how to complain or raise concerns. They were provided with information on admission, information on how to complain was clearly displayed in the ward and reception areas, with anonymous post boxes, and carers told us they were provided with feedback forms.

The provider had introduced The Triangle of Care model as a framework to guide its inclusion of carers, through recognising them as partners in care.

Complaints and compliments were discussed through clinical governance processes. An action log was in place for complaints, which was reviewed and discussed at action plan meetings. We also saw staff team meeting agendas included standard items for discussing patient feedback.

Staff we spoke with understood how patients could provide feedback about their care and the service, and they were aware of how to manage complaints appropriately.

Patient satisfaction feedback was gathered in 3-monthly patient workshops. Weekly community meetings were held on both wards where patients could raise any issues relating to the ward. Records showed that young people had documented notes from some of these meetings.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Staff mandatory training included equality and diversity training, with training compliance at 95%. Staff were also required to complete mandatory human rights training, which had a compliance rate of 78%.

Staff ensured the needs of patients with mobility needs were met. For example, there was lift access for wheelchair users and a ground-floor bedroom on the young people’s ward. The hospital main entrance was accessed via several steps; however, disabled access was available at the front of the building and was located next to a designated disabled parking space. The service had an outside garden space that patients could access easily, which was available to both wards. However, the garden was not wheelchair accessible. Young people had exclusive access to an outside, enclosed yard area with seating and planted areas.

The service supported patients with their gender identity, and we saw evidence of the use of preferred pronouns.

Patients had access to independent advocacy services. Advocates told us they were welcomed into the hospital and were appropriately involved in supporting patients.

At the time of our inspection, there were no patients with specific communication needs. However, the provider shared examples of communication plans that had been used for previous patients, which demonstrated how individual communication needs had been identified and supported.

There was adequate medical cover day and night, with an on-call doctor rota and a hospital accident and emergency department within 5 miles of the service.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Staff were required to complete training in diversity and inclusion, and human rights training.

The service admitted patients from a range of religious and cultural backgrounds. Staff were able to describe patients’ religious and cultural needs. Staff told us they supported patients to access their chosen place of worship within the community, and this had included accompanying patients to a local mosque. Prayer for Muslim patients was facilitated in one of the garden rooms, and flexible arrangements were in place to support Friday prayers.

We saw evidence that the provider promoted inclusion through a large, brightly coloured notice board on the young people’s ward. This displayed Lesbian, Gay, Bisexual, Transgender, Queer plus (LGBTQ+) positive messaging, images of public figures with a range of diverse identities, information about discriminatory experiences related to gender, and telephone numbers for relevant support organisations.

Psychologists within the service provided autism assessments and staff told us they were aiming to develop a neurodevelopmental pathway of care.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff supported patients to make decisions about their care and treatment, and their future. We reviewed care records that showed evidence of discharge planning from the start of treatment. Care pathways for young people included a transition and independence care pathway, that identified steps to discharge. This included early support and interventions with family and carers.

Members of the multidisciplinary team liaised with external organisations, including commissioners, local authority teams and community health services, to plan and support patient transitions and placements.

The provider had introduced a transition service, known as Stepping Stones, to support patients following discharge to continue working towards identified aims and goals. The service offered psychoeducation, provided support to families, and worked with schools. Staff told us the service had developed good working relationships with NHS community teams and local eating disorder organisations. At the time of the inspection, the adult provision within this service was in the process of being decommissioned while the service for young people continued to operate.