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Inspection Summary


Overall summary & rating

Good

Updated 30 August 2019

We rated Combat Stress/Audley Court, Specialist community-based mental health services for adults of working age as good because:

  • The provider had a high standard of managerial, medical and clinical leadership and made effective use of multi-disciplinary team working.

  • Clinical governance at Combat Stress/Audley Court was well established and linked to local and national quality improvement initiatives, research and audit.

  • Risk assessment and care planning were of a high standard and helped clinicians and therapists provide safe care.

  • The services provided were responsive to the needs of patients and based on the existing and emerging evidence for effective treatment.

  • Combat Stress/Audley Court had been through a successful period of organisational change and redesign and developed a model of service that patients told them they found helpful and of high quality.

However;

  • Patient feedback indicated that patients needed more help managing their physical health and accessing community activities

  • Some staff thought that the provider had not effectively communicated the implications of organisational change for themselves and the service.
Inspection areas

Safe

Good

Updated 30 August 2019

We rated Safe as good because:

  • Combat Stress/Audley Court provided a safe and clean environment for its community patients. All clinical areas were clean and the building itself was very well maintained.

  • Therapeutic services were provided to patients by a qualified staff team, experienced in the issues faced by combat veterans and allied service personnel experienced in civilian life. A consultant psychiatrist led the team of psychologists, community mental health nurses, occupational therapists and cognitive behavioural therapists.

  • Clinical managers supported staff to manage their caseloads and ensured patient safety over a large geographical area. All staff participated in a mandatory training in safeguarding and basic life support to ensure the care and safety of patients.

  • Staff completed detailed risk assessments for patients and these were up to date. Staff made safeguarding referrals and knew how to recognise forms of abuse their patients might be experiencing.

  • Serious incidents were investigated thoroughly, and staff were transparent in their discussions with patients when something went wrong.

Effective

Good

Updated 30 August 2019

We rated Effective as good because:

  • Staff made holistic assessments of patients that focussed on the specific mental health problems patients faced when dealing with trauma. Patients’ were effectively triaged to ensure they had the capacity to participate in the provider’s therapeutic program.

  • Care records we reviewed on the organisations electronic patient record system identified the needs of patients. These records provided detailed information on the care being planned for patients and staff were working hard to improve these further by using redesigned forms.

  • All therapeutic interventions provided by staff at Combat Stress/Audley Court was evidence based and complied with National Institute for Health and Care Excellence guidance. Staff also participated in a comprehensive audit program.

  • Combat Stress/Audley Court staff had the necessary skills to do their job and were regularly supervised, appraised and supported in their continued professional development. This ensured staff maintained and updated their skills to care for patients safely.

  • All staff worked well as a multidisciplinary team to ensure the delivery of care was tailored to the individual needs of patients.

Caring

Good

Updated 30 August 2019

We rated caring as good because:

  • Service user feedback from patient satisfaction surveys confirmed the inspection team’s finding that staff were caring and compassionate towards their patients. Patients also fed back that they felt involved in their care

  • The organisation made good use of local peer support and carer organisations and supported staff in their dealings with other health and social care providers.

  • The individual needs of patients were paramount in delivering care and staff were always mindful of the specific issues and challenges facing patients.

  • Care records demonstrated patient involvement in their care and encouragement to engage with wider civilian society.

  • Patient satisfaction surveys confirmed that patients were satisfied with the service they received. The provider was committed to building on this feedback to ensure the continuing improvement of services for veterans.

However;

  • Patients said that they needed more support in managing their physical health and for taking part in community activities.

Responsive

Good

Updated 30 August 2019

We rated Responsive as good because:

  • After a period of consultation and redesign the service was clear about its treatment program aims and offered clear criteria for those patients wishing to access the service. Where patients required interventions to help them prepare for treatment at Combat Stress/Audley court, staff liaised with other mental health agencies to ensure patients received the help they needed.

  • The facilities provided at Combat Stress/Audley Court promoted recovery, comfort, dignity and confidentiality and included spacious and pleasant clinical and non-clinical areas.

  • Staff focused on linking patients and their loved ones with support groups as an important part of the therapeutic program and ensured that patients had access to a range of specialist information.

  • The provider managed complaints about its service efficiently and made sure that lessons were learned after the complaints were investigated fully by senior staff. Staff also received feedback on the outcome of the investigation of complaints through regular staff bulletins.

Well-led

Good

Updated 30 August 2019

We rated Well-led as good because:

  • Leaders at Combat Stress/Audley Court had the skills, knowledge and experience to perform their roles and articulated a good understanding of the challenges their patients faced and those of the organisation.

  • Following extensive organisational change, services provided by Combat Stress/Audley court were delivered with a clear vision and a strong emphasis on all staff working to a common set of shared values. Managers had also implemented effective contingency plans through a period of disruption over the winter of 2018/9 and staff reflected positively on the way protests against the service were managed.

  • Senior leaders consulted staff and patients regularly and staff said they felt supported in their work. They also told us they felt confident to raise concerns with senior colleagues if they felt it was necessary and without fear of retribution.

  • The provider was fully engaged in quality improvement and involved staff wherever possible with service developments through regular local clinical governance meetings and communications.

  • A risk register was held centrally, and risks identified by staff were included on this. Managers had access to information to support them with their management role. The organisation had a full range of policies and procedures which all staff followed.

  • Leadership encouraged and facilitated feedback from staff and patients and instigated improvements after analysing this feedback. Combat Stress/Audley Court was also committed to research into the problems of veterans coping in civilian life.

However;

  • Staff said that organisational change had not always been communicated effectively.

Checks on specific services

Community-based mental health services for adults of working age

Good

Updated 30 August 2019