Castle Lodge Independent Hospital

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment, the rating has remained good.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

We have not awarded this service a score for Effective.

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

We scored the service as 4. The evidence showed an exceptional standard. The service always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff assessed patients’ mental and physical health needs in a holistic and person-centered way, and there was a multidisciplinary approach to delivering care and treatment. We looked at 6 patients’ care records and staff developed plans that met the needs identified during assessment. Relatives told us they were fully involved in providing information about their relatives and confirmed that the hospital worked with other services involved in their care and supported them with external appointments. External partners told us that Castle Lodge “operate within a strong biopsychosocial model that gives parity to physical and mental health needs.”

Care records were comprehensive and reviewed monthly or after any changes. They included admission observations, evidenced regular physical health reviews were taking place, and evidence of contact with external partners such as GP’s, dentists, physiotherapists, advocates and social workers.

Our SOFI (a short observational framework for inspection, which is used to capture the experiences of people who use services who may not be able to express this for themselves) observations showed that staff knew and understood patients well and were constantly alert to their changing needs. A staff member we spoke with told us that the team valued information from previous placements and said, “Getting to know people is important.”

The care records were patient-centred, with clear discharge goals, ongoing assessment of needs and abilities and utilised recognised tools for monitoring outcomes. Where patients were unable to give their personal preferences or input, family members were included in the care planning and regular multidisciplinary team meetings.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff provided a range of care and treatment interventions suitable for the patient group. The service used a range of evidence-based tools and rating scales recommended by the National Institute for Health and Care Excellence. Nurses were trained to complete a recognised wellbeing assessment tool and a scale for recognising depression in dementia. We saw examples of these in care records. Staff also use a pain tool to monitor pain where patients could not verbalise.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed, such as dentists and tissue viability nurses.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors, nurses and support workers, the service had an occupational therapist and an art psychotherapist within the team and individual patients were referred for psychology input, when required. Staff assessed and met patients’ needs for food and drink and referred to speech and language therapists when required.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Staff we spoke with also told us they were encouraged to learn about innovative approaches and attend training that could improve the way care was delivered to people. The hospital implemented the Safewards model (the objective of the model is to reduce conflict and containment within mental health services) and staff had completed several training courses such as understanding behaviours, top 4 interventions and building on interventions.

Managers provided new staff with appropriate induction, training and shadowing opportunities to ensure they were confident and competent within their role. The service also had a range of competency checks, including pat down search training, ligature cutters, diabetes and insulin, medication and physiological observations. The service had files which included policies and information sheets for staff and an induction portfolio for registered nurses

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The percentage of staff that received regular supervision was 92%. The percentage of staff that had had an appraisal in the last 12 months was 100%.

Managers ensured that staff had access to regular team meetings, and we reviewed minutes of these meetings which included agenda items such as reviewing agreed actions and feedback, organisation values, current issues and lessons learnt, planned activities and performance.

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. 91% of staff had received training in the Mental Health Act. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice that reflected the most recent guidance.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

Patients had easy access to information about independent mental health advocacy. We received feedback from the advocate who visited the service on a weekly basis. The advocate informed us they receive invites for important meetings, and all staff listen to any concerns or views and wishes raised on behalf of the patients and take these into account.

The service had compliance audits in place to ensure staff provided evidence-based care and treatment, including treatment under the Mental Health Act 1983, completed quarterly by the service and annually by the organisations Mental Health Act lead.

This ensured all detained patients were aware of their rights and patient restrictions were regularly reviewed to maximise their independence. Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Staff requested an opinion from a second opinion appointed doctor when necessary.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings, which included patients and families as partners in their care.

Staff shared information about patients at effective handover meetings within the team. We reviewed minutes from handovers and daily meetings, which included the handover of information such as immediate actions for patients, planned activities, appointments and maintenance and documentation such as observation forms and diet and fluid charts.

Managers ensured staff attended regular team meetings. The hospital manager held regular meetings with all staff including separate meetings for allied health professionals, housekeepers and maintenance. Maintenance and housekeeping staff also attended morning meetings and gave updates of ongoing work and received new requests from staff for improvements.

The teams had effective working relationships with teams and organisations outside the service, for example adult safeguarding teams, physical health services, social workers and voluntary sector organisations. Care records evidenced regular contact with partners. We received feedback from external partners who told us that the team at Castle Lodge worked proactively and collaboratively with other stakeholders to ensure continuity of care and smooth transitions.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduced their future needs for care and support.

Staff supported patients to live healthier lives in terms of managing any physical and mental health risks, managing and reviewing medications and monitoring food and fluids.

Ward activities helped promote a healthy lifestyle for patients. Activities were individually needs led, for example yoga sessions were organised for a patient who wanted to engage in some more physical exercise. The service also supported patients with arts and crafts, nit and natter group, walking in the community and sports activities, such as swimming and cooking healthy meals.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service used audits to monitor and improve outcomes for patients. Audits were in place to review the number of incidents and any use of restraint, which was also monitored by the provider’s restrictive practice group. The provider had a Use of Force Act policy in place aimed to reduce the use of force and ensure accountability and transparency. Managers completed a use of force audit and a trend analysis post intervention. Blanket restrictions were regularly reviewed to ensure least restrictive practice was being used, and restrictions were discussed with senior leaders during regional audits.

The service encouraged the completion of the ‘Barchester Tell All’ surveys and provided support for patients who wanted to feedback. We reviewed 6 surveys which were completed in September and found the responses were all positive. Staff also attended regular meetings to consider lessons learnt, and actions that could be taken to improve outcomes.

Staff used recognised rating tools to complete risk assessments and positive behaviour support plans. All risk assessments were regularly reviewed to recognise changing risks which were reflected in positive behaviour support plans.

Staff utilised technology to help support patients and to support communication needs. The service had a Magic Table (an interaction light projector that responds to hand and arm movements to engage in a variety of games and activities.) Technology stimulated physical, cognitive and social interactions. We observed this being used for patients during our onsite inspection. Staff supported patient and relatives to stay connected where needed.

However, we received feedback from external partners that patient outcomes could be improved if the service “commenced discharge planning earlier in the patient journey, such as requesting Care Act needs assessments sooner, could help reduce any delays to discharge due to long waits for these assessments”.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff we spoke with were trained and had a comprehensive understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

We looked at 6 care records which demonstrated consideration of a patient's capacity to consent. Capacity assessments were carried out as appropriate and were both time and decision specific. Records demonstrated that best interest decisions were carried out, when appropriate and involved the patient's family or advocate.

The service conducted regular reviews for people who required a modified diet, for example and had a flexible approach to any restrictions it imposed on people such as use of safety interventions or restrictive items such as chair belts and bed sensors. Nursing staff evaluated this at least monthly, and audits were in place to monitor consent and Mental Capacity Act practices to ensure they were only in place when necessary.

Patients had access to advocacy. The independent advocate we spoke with told us that patients were supported to maintain relationships and understand their rights. The advocate confirmed that people who lack capacity were always auto referred to the service. Practices regarding consent and record keeping were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. The service engaged with people who use services and their relatives and other carers, to make decisions based on a person’s best interests and ensured these were made in accordance with legislation and people’s wishes.

During our site visit we completed a SOFI (a short observational framework for inspection). which is used to capture the experiences of people who use services who may not be able to express this for themselves. Our observations showed exceptionally good interactions between staff and people and that staff promoted independence to deliver person centred care and treatment.