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Inspection Summary


Overall summary & rating

Good

Updated 8 August 2019

Our rating of this service improved. We rated it as good because:

  • The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However;

  • Not all staff were trained in the use of physical intervention.
  • Staff did not keep records of seclusion in line with the Code of Practice.
  • The mobile phone and mail management policy was not in line with the Code of Practice.
  • Not all patients with long term conditions received regular review by an appropriate clinician.
  • Staff did not always record the reason for the use of prone restraint in incident records.
  • Staff did not always record when patients and staff received a de-brief following an incident.
  • The hospital policy for patients with transgender needs was not written in plain English and did not reference any national sources of information.
  • Information about transgender support groups was not available on the wards.
Inspection areas

Safe

Requires improvement

Updated 8 August 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Although we found the service largely performed well, it did not meet the legal requirements relating to staff training and maintaining accurate and complete records for those patients in seclusion.
  • Not all staff were trained in the use of physical intervention.
  • Staff did not keep records of seclusion in line with the Code of Practice. Not all records included documentation of 15 minute observations, timely medical review, multi-disciplinary reviews including professionals other than the nurse and doctor and a care plans that identified what was required to end a period of seclusion.
  • The mobile phone and mail management policy was not in line with the Mental Health Act Code of Practice.
  • Not all patients with long term conditions received regular review by an appropriate clinician.
  • Staff did not always record the reason for the use of prone restraint in incident records.
  • Staff did not always record when patients and staff received a de-brief following an incident.

However;

  • All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose.
  • The service had enough nursing and medical staff, who knew the patients.
  • Staff assessed and managed risks to patients and themselves well and achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery. Staff had the skills required to develop and implement positive behaviour support plans and followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s physical health.
  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Effective

Good

Updated 8 August 2019

Our rating of this service improved. We rated it as good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented. They included specific safety and security arrangements and a positive behavioural support plan.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • The ward team(s) included or had access to the full range of specialists required to meet the needs of patients on the ward(s). Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward team(s) had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation and engaged with them early on in the patient’s admission to plan discharge.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

Caring

Good

Updated 8 August 2019

Our rating of this service stayed the same. We rated it as good because:

  • 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. They ensured that patients had easy access to independent advocates.

  • Staff informed and involved families and carers appropriately.

    However;

  • The hospital policy for patients with transgender needs was not written in plain English and did not reference any national sources of information.

  •  Information about transgender support groups was not available on the wards. 

Responsive

Good

Updated 8 August 2019

Our rating of this service stayed the same. We rated it as good because:

  • Staff planned and managed discharge well. They liaised with services that would provide aftercare. Discharge was rarely delayed for other than clinical reasons.

  • The design, layout, and furnishings of the ward/service supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • The food was of a good quality and patients could make hot drinks and snacks at any time.

  • Staff helped patients with communication, advocacy, cultural and spiritual support.

  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider service.

    However;

  • The service did not meet the needs of all patients who used the service – including those with a protected characteristic.

Well-led

Good

Updated 8 August 2019

Our rating of this service improved. We rated it as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated that performance and risk were managed well.

  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff engaged actively in local and national quality improvement activities.

However;

  • Our findings from the other key questions demonstrated that governance processes did not always operate effectively at ward level in relation to the application of the Mental Health Act 1983 and the Mental Health Act Code of Practice.

Checks on specific services

Forensic inpatient or secure wards

Good

Updated 8 August 2019