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Inspection Summary


Overall summary & rating

Outstanding

Updated 1 August 2018

We rated Newbridge House as outstanding because:

  • Newbridge House was committed to research and innovation within the eating disorders field. They took part in local, national and international research. Staff published papers, facilitated public health education and continuously evaluated current treatments and piloted new interventions with the aim of developing an evidence base for eating disorder treatment in young people and becoming a centre of research excellence.

  • Staff provided high quality treatment and care. Different professionals worked well together to assess and plan for the needs of patients. Staff were skilled and experienced. The provider supported ongoing training to develop specialist skills.

  • Staff undertook regular safety checks of the environment, ensuring ligature points and blind spots were kept to a minimum. The building was undergoing a programme of refurbishment and the furniture and fittings were well maintained, comfortable and clean.

  • Patients had up to date risk assessments and management plans which covered by physical and mental health needs.

  • Patients had up-to-date care plans. These focused-on treatment plans, recovery and rehabilitation. Staff involved patients and their families and or carers in developing care plans, risk assessments and within clinical review meetings. All patients had copies of their care plan.

  • Staff had a good understanding of Gillick competence, the Mental Capacity Act and the Mental Health Act. They routinely advised detained patients of their rights under the Mental Health Act.

  • Staff worked towards discharge with patients and parents/ carers. The pathway toward discharge was open and clear for patients and their families to understand. They ensured that the patients community teams were kept fully updated of care needs and completed home and school visits prior to discharge. Patients and parents told us this led to a smooth transition back to home life.

  • Staff used a wide variety specialist tools to assess the severity of the patients’ eating disorder and measure the outcomes of treatment interventions. They carried out regular clinical audits to monitor the effectiveness of interventions and adapt where necessary.

  • Staff provided interventions following national guidance such as Junior MARSIPAN, National Institute for Health and Care Excellence guidance for eating disorders and Autistic Spectrum disorders.

  • Newbridge House staff offered second opinion assessments free of charge to ensure the patient could access the most appropriate treatment interventions.

However:

  • Not all eligible staff had undertaken the appropriate level of children’s safeguarding training as recommended by the Royal College of Paediatrics and Child Health.
  • Newbridge House had not notified the CQC of all safeguarding alerts. However, the manager had submitted safeguarding alerts to the local authority safeguarding team. We were satisfied that patients were safeguarded by staff raising alerts.
  • Staff did not always follow the medicines policy when disposing of medicines.
  • One patient told us that agency and bank staff sometimes used their personal mobiles whilst on the unit and they did not have such a good understanding of their support needs around mealtimes.
  • Medication charts for three detained patients did not show the Mental Health Act status of patients.

Inspection areas

Safe

Good

Updated 1 August 2018

We rated safe as good because:

  • Newbridge House had effective processes to ensure the environment was compliant with infection control standards and reviewed the environment regularly for hazards. The provider had sought to limit the number of ligature anchor points by installing anti-ligature fixtures and fittings.
  • Newbridge House had had enough staff with the right qualifications, skills and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
  • Staff used physical restraint only when verbal de-escalation was not effective or where this was part of the naso-gastric feeding plan.
  • Staff completed detailed risk assessments for patients and updated them after incidents. Risk management plans contained information specific to patients’ physical and mental health needs.
  • There was adequate medical cover out of hours in an emergency
  • Staff knew how to protect vulnerable adults and children from abuse, and discussed concerns with the local safeguarding team.
  • The service provided mandatory training in key skills to all staff and monitored staff compliance.
  • Staff reported incidents and there was an effective system in place to report and learn from incidents.

However:

  • Medication charts for three detained patients did not show the Mental Health Act status of patients.

Effective

Outstanding

Updated 1 August 2018

We rated effective as outstanding because:

  • Staff completed comprehensive assessments for each patient and created detailed, personalised care plans.

  • Staff assessed and supported patients with physical health needs.

  • The service followed national guidance when prescribing medication and offered nationally recommended psychological therapies.

  • Staff at Newbridge House were committed to assessing, understanding and publishing their outcome data. Staff monitored the effectiveness of care and treatment and used the findings to improve them.

  • The continuing development of staff skills, competence and knowledge was fully supported and recognised as a significant factor in ensuring high quality care. Staff were proactively supported to share best practice, skills and acquire additional specialist training.

  • Staff of different roles worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care through sharing good practice, training and effective meetings and handovers of care.

  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

  • Staff worked collaboratively with patients community teams and school to support a smooth discharge.

Caring

Good

Updated 1 August 2018

We rated caring as good because:

  • Patients said most staff were kind and caring.
  • Parents gave very positive feedback about the service and described staff as dedicated. They said staff identified the individual needs of their child and supported them well.
  • Patients had access to advocacy services.
  • Staff involved families in care.
  • Patients attended weekly community meetings where they could give feedback about the service.
  • Staff involved patients in their care and treatment. This included involving patients in their care plans, risk assessments and ward rounds.

However:

  • Patients told us that some staff occasionally used their personal mobile phones whilst on the unit and that some staff were impatient and inconsistent with rules. Patients told us this was mainly the bank and agency staff.

...

Responsive

Outstanding

Updated 1 August 2018

We rated responsive as outstanding because:

  • There were clear admission criteria and staff worked well with community teams, families and patients towards discharge.
  • Newbridge House staff offered second opinion assessments free of charge to ensure the patients could access the most appropriate treatment interventions.
  • Newbridge House provided patients with a homely and comfortable environment. Patients could personalise their rooms and display art on the walls of the communal areas. Since our last inspection in 2016, there had been some refurbishment of rooms. There was an ongoing schedule of refurbishment which included soundproofing of interview rooms.
  • Patients had access to a comprehensive range of therapeutic activities outside of school and therapy timetable. Patients told us the school was great and they really enjoyed the activities on offer at Newbridge House.
  • Newbridge House had an onsite school staffed with qualified teachers to support patients ongoing education. The school provision had been rated as good.
  • The kitchen had achieved a five-star rating for hygiene and cleanliness by the Food Standards Agency. Kitchen and dietetic staff worked well together to provide the right food for the patient’s needs.
  • Patients could access mobile phones and could make calls in private.
  • The service established strong links with the patients’ community teams and schools. They involved them in collaborative discharge planning and CPA meetings. This led to young people being successfully discharged.
  • Newbridge House could meet the needs of all the patients that used its service. This included spiritual, cultural, communication and mobility needs.
  • Parents and parents told us they knew how to make a complaint. Staff dealt with complaints promptly. Actions and learning from complaints had been well documented and cascaded to all staff.

Well-led

Good

Updated 1 August 2018

We rated well-led as good because:

  • Staff understood and implemented the vision and values of the unit. They knew the goals for the service and were ensuring these were implemented to a high standard.

  • Staff told us they knew who the senior managers within Schoen Clinic UK were and that the acquisition had been smooth with good communications. They told us managers at Newbridge were supportive and visible.

  • Since the last inspection in January 2016, Newbridge House had developed a new governance structure to become aligned with Schoen Clinic UK. It was finalised in February 2018. It had clear robust lines from ward to board, staff understood what was monitored and who did what to provide accountable, effective and safe care.

  • Managers had commissioned an independent staff survey to be completed in line with the NHS survey. Managers had produced action plans in response to the results. The results overall were positive, showed high staff engagement and good staff morale. Staff told us they were proud to work at Newbridge House and felt their role made a difference to patient’s recovery.

  • Newbridge House was committed to research and innovation within the eating disorders field. They took part in local, national and international research. Monthly research meetings were held and attended by the research director, hospital manager, nurses, psychologists and occupational therapists. It provided a space to discuss the process of ongoing research projects and new ideas. Treatment intervention were constantly evaluated and staff were committed to piloting new interventions with the aim of developing the evidence base for eating disorder treatment in young people and becoming a centre of research excellence.

However:

  • Managers had not ensured all eligible staff had undertaken the appropriate level of children’s safeguarding training as recommended by the Royal College of Paediatrics and Child Health.

  • Newbridge House had not sent all safeguarding notifications to the CQC. The manager had submitted safeguarding alerts to the local authority safeguarding team. We were satisfied that patients were safeguarded by staff raising alerts.

  • Managers had not assured that staff always followed the medicines policy when disposing of medicines.

Checks on specific services

Specialist eating disorder services

Outstanding

Updated 27 April 2016

Child and adolescent mental health wards

Outstanding

Updated 1 August 2018