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Vision MH - Cornerstone House Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 20 December 2017

We rated Vision MH – Cornerstone House as Outstanding because:

  • The service had robust, detailed and comprehensive environmental and ligature risk assessments in place. Managers updated these regularly.
  • The service had a range of rooms and equipment to support treatment and care. This included a clinic, treatment room, therapy kitchen, gym, art room and a group therapy room.The service had achieved a five star food hygiene rating. Patients could make hot and cold drinks when they wanted. Snacks were available throughout the day.
  • All staff assessed risks to patients who used the service on a daily basis. This included physical health, mental health and behaviours that challenged.
  • There was good medications management, which included regular audits of equipment and records.
  • Staff reported all incidents in line with policy. The senior management team reviewed every incident. Openness and transparency in relation to safety was encouraged. Staff understood and fulfilled their responsibilities to raise concerns. Senior staff discussed lessons learnt with the staff and patients in different forums, to minimise a re-occurrence. 
  • All staff had a holistic approach to assessing, planning and delivering care and treatment to patients. Every patient had a comprehensive assessment upon admission to the service. Staff placed real emphasis upon the physical healthcare of patients. Nursing and medical staff monitored the physical health of all patients from the point of admission. 
  • All staff undertook a comprehensive induction to the service. Staff received annual appraisals. Staff received supervision in line with policy. Senior managers encouraged the continuing development of staff skills, competence and knowledge. Managers recognised that this was integral to ensuring high quality care.
  • All staff had a good working knowledge of the Mental Health Act. Where patients were subject to Mental Health Act detention, their rights were protected. Staff complied with the Mental Health Act Code of Practice. All staff had a good working knowledge of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Senior staff regularly monitored consent practices and records. Staff completed capacity assessments for patients who might have had impaired capacity in relation to specific decisions.
  • Staff who were exceptionally caring, extremely compassionate and very kind supported patients. Staff demonstrated considerable pride in their work and supported patients in the most appropriate manner to meet their needs. Patients and families shared with us their positive experiences of the care they received at the service. Staff consistently empowered patients to have a voice and realise their potential through different forums.
  • Information on treatments, local services, advocacy and patients’ rights were visible in communal areas. Interpreters and signers were accessible as and when required.
  • The service was led well by the senior management team. Staff, patients and carers told us that they were visible and accessible.
  • A sufficient number of staff of the right grades and experience covered shifts.
  • There was an open and transparent culture across the service. Staff were honest with patients when things went wrong.
  • The service was proactive in capturing and responding to patients concerns and complaints. Patients and families knew how to make a complaint. Managers investigated all complaints fully in line with their policy and responded in a timely way.

However:

  • We observed one ligature risk in the new building, which had not been identified. The manager took immediate action when we highlighted this.
  • Some portable electrical equipment testing was just outside of the time frame for expected annual checks. These had been booked to be undertaken.
Inspection areas

Safe

Outstanding

Updated 20 December 2017

We rated safe as Outstanding because:

  • The service had robust, detailed and thorough environmental and ligature risk assessments in place. Staff updated these regularly.
  • There was good medications management, which included detailed regular audits of equipment and records.
  • Staffing levels and skill mix were well planned, implemented and reviewed to keep patients safe. Staffing shortages rarely happened.
  • All staff received and were up to date with mandatory training.
  • All staff proactively assessed risks to patients who used the service, regularly monitored these and managed them effectively. This included physical health, mental health and behaviours that challenged. The whole team took responsibility for monitoring risks and recognised their responsibility to do so.
  • Staff consistently reported all incidents in line with policy. The senior management team reviewed every incident within the service. Openness and transparency in relation to safety was encouraged. Staff fully understood and fulfilled their responsibilities to raise concerns.
  • Senior staff communicated lessons learnt from incidents with the staff and patients at every opportunity in different forums, to minimise a re-occurrence. Staff genuinely wanted to improve after incidents and learning from events was integral to team meetings and patient forums.
  • When something went wrong, patients received a sincere apology from the manager. Staff shared actions and learning points through different forums, to improve processes to prevent the same happening again.

However:

  • We observed one ligature risk in the new building, which had not been identified. The manager took immediate action when informed of this.
  • Some portable electrical equipment testing was just outside of the time frame for expected annual checks. These had been booked to be undertaken.

Effective

Good

Updated 20 December 2017

We rated effective as good because:

  • All staff had a holistic approach to assessing, planning and delivering care and treatment to patients. Every patient had a comprehensive assessment upon admission to the service.
  • Staff placed real emphasis upon the physical healthcare of patients. Nursing and medical staff monitored the physical health of all patients from the point of admission. The service employed a consultant in emergency medicine who attended the service regularly. Advice was offered to staff concerning patients’ physical health. The consultant had carried out minor procedures on site. This had prevented patients being transferred to the local general hospital for treatment on several occasions.
  • Staff carried out regular comprehensive audits, which had identified actions and time-scales to improve practice and outcomes for patients.
  • The service offered a range of psychological therapies as recommended by the National Institute for Health and Care Excellence.  Patients were admitted from various different units, including acute units, for further assessment of need and rehabilitation. Some patients who had been discharged from the service attended as day patients, which enabled the continuation of therapy.
  • All staff undertook a comprehensive induction to the service. Staff received annual appraisals. All staff received regular supervision in line with policy. Senior managers encouraged the continuing development of staff skills, competence and knowledge. Managers recognised this as being integral to ensuring high quality care. All staff were proactively supported to acquire new skills and share best practice.
  • All staff had a good working knowledge and understanding of the Mental Health Act. Where patients were subject to detention under the Mental Health Act, their rights were protected. Staff complied with the Mental Health Act Code of Practice.
  • All staff had a good working knowledge and understanding of the Mental Capacity Act and the Deprivation of Liberty Safeguards. Senior staff regularly monitored consent practices and records. Staff completed capacity assessments for patients who might have had impaired capacity in relation to specific decisions.

Caring

Outstanding

Updated 20 December 2017

We rated caring as outstanding because:

  • Patients were supported by staff who were highly motivated, caring, very compassionate and kind. Staff demonstrated considerable pride in their work and supported patients in the most appropriate manner to meet their needs. Staff were committed to their roles and were determined to deliver the best care for patients, carers and families.
  • Patients and families shared with us their positive experiences of the care they received at the service.
  • There was a strong, visible person centred culture, which staff had embedded into practice. Care plans were consistently holistic, individual and recovery focused. Managers promoted and demonstrated person centred care and this was reflected throughout the service.
  • Patients were active partners in their care and were respected and valued as individuals to be involved in care planning and treatment reviews. Staff invited families to be involved in care and treatment, if the patient had consented. Patients’ individual preferences and needs were consistently reflected in how staff delivered care.
  • Staff empowered patients to have a voice and realise their potential through different forums, to include daily community meetings, monthly patient forum meetings, and lessons learnt meetings. Co-production work between patients and staff was evident. Patients told us that they were really listened too, and their ideas and contribution valued.
  • Patients and staff held regular discussions around advance decisions and how the staff could help them should their health deteriorate.
  • Patients had the opportunity to be involved with the recruitment of staff.

Responsive

Good

Updated 20 December 2017

We rated responsive as good because:

  • Bed occupancy was well managed across the service by the senior management team.
  • Discharge from the service was not delayed for non - clinical reasons.
  • The service communicated regularly with referring NHS services and invited these to review meetings. Attendance from external professionals proved difficult on occasions. In these instances the staff provided an update verbally and in writng. Commissioners told us that they were happy with the care and treatment the service provided for patients.
  • The service had a range of rooms and equipment to support treatment and care. This included a clinic, treatment room, therapy kitchen, gym, art room and a group therapy room.
  • The service had achieved a five star food hygiene rating. Patients could make hot and cold drinks when they wanted. Snacks were available throughout the day.
  • Information on treatments, local services, advocacy and patient’s rights were visible in communal areas. Interpreters and signers were accessible as and when required.
  • Patients and families knew how to make a complaint. Managers investigated all complaints fully in line with their policy and responded in a timely way.

However:

  • The service did not provide full access to people requiring disabled access, as there was no lift within the building. If a patient could not access upper floors, a bedroom was allocated on the ground floor. This bedroom had access to the garden via a ramp. The provider told us the ramp met building regulations for gradient, but it did not have a non-slip surface.

Well-led

Outstanding

Updated 20 December 2017

We rated well-led as outstanding because :

  • The service was led well by the senior management team. Staff, patients and families told us that they were visible and accessible. Managers inspired staff to do their best to support patients, work collaboratively, and strived to deliver the best possible care.
  • All staff received regular supervision and had annual appraisals.
  • Staff of the right grades and experience covered shifts and rarely were shifts under staffed.
  • There was a great commitment towards continual improvement and innovation. The senior managers worked with a local provider to innovate and improve, took examples of outstanding practice, and applied them to this service.
  • Staff were proud to work at the service.
  • There was clear and thorough learning from incidents and investigations, which was embedded into forums and meetings.
  • The staff were very responsive to feedback from patients.
  • Staff were given the opportunity and encouragement to develop further.
  • There was an open and transparent culture across the service. Staff were honest with patients when things went wrong.
  • Governance systems were robust and effective. Managers actively reviewed every area of service provision and shared visions with staff. Leadership was strong and had emphasis on high quality service delivery.
  • The service was proactive in capturing and responding to patients’ concerns and complaints.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 20 December 2017