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The Billingham Grange Independent Hospital Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 10 January 2019

We rated The Billingham Grange Independent Hospital as outstanding because;

  • Staff displayed a caring and compassionate approach to patients. Staff knew patients they cared for well and ensured that the support they gave was in line with their personal preferences.
  • There was a strong governance structure in place, which displayed joined up working from ward to board level. The service was very well-led at ward and regional level. Staff and patients told us the hospital director was approachable and supportive. The company had clear vision and values which were clearly embedded in the running of the service. Values were demonstrated by staff who cared for patients in a kind and compassionate manner.
  • Staff went the extra mile to ensure that patients were involved in decisions about their care and treatment. Staff made multiple attempts to engage patients and used different methods to help patients make choices. Where appropriate there was evidence of families being involved in decisions about care.
  • Patients, families and carers participated in the formulation of care plans. Where people were reluctant to participate, they were encouraged by staff. Patients were involved in planning for discharge. Discharge planning was embedded in care delivery and was discussed in multi-disciplinary meetings and ward rounds.
  • Patients who lacked capacity were automatically referred to independent advocacy services. Contact details for advocacy services were displayed throughout the service. Patients were supported and encouraged to access services in line with the Mental Health Act Code of Practice

  • Staff encouraged and supported patients to access health screening tests. There was a registered general nurse on each ward to monitor the physical health of patients. Staff used recognised screening tools to help them monitor various aspects of physical health.
  • All patients had a named nurse and secondary nurse. Photographs of named nurses were in patient’s bedrooms to help them remember who the named nurse was. Patients had regular one to one time with their named nurse.
  • There was minimal use of restraint and this was only used after verbal de-escalation had been attempted. Restraint was kept to low level holds and patients were given de-briefs following incidents.
  • The provider kept staff, patients and visitors up to date with the running of the service and ratings from previous CQC inspections were posted in the hospital to ensure people could see them.
  • Patients and carers were encouraged to give their feedback on the service and the care and treatment they received. The service had been proactive in capturing and responding to patients concerns and complaints.
  • There was a good and varied activities programme which provided patients with activities seven days per week. There were a range of activities which helped with patients’ physical and mental health and fitness.
  • Poor performance was identified and dealt with quickly and effectively. There was clear learning from incidents and lessons learned were shared both during clinical governance meetings and with staff from national Barchester Healthcare services. This helped to prevent recurrences of incidents.
Inspection areas

Safe

Good

Updated 10 January 2019

We rated safe as good because:

  • The service had all the equipment needed to carry out physical health checks.
  • The hospital adhered to infection control principles. There were hand washing facilities and alcohol gel dispensers on wards.
  • There were contracts in place with various outside agencies to service and repair equipment.
  • Staffing levels throughout the service were appropriate to the needs of the patients.
  • A recognised risk assessment tool was used to assess ongoing risks to patients. Regular reviews were carried out to monitor risks.
  • There was minimal use of restraint and was only used after verbal de-escalation had failed.
  • There were effective arrangements in place for the management of medicines. Controlled drugs were stored securely with restricted access to authorised staff.
  • There were no serious incidents between 1 January and 31 December 2017.

However, 

  • Protocols for the use of when required medicines were not consistent throughout the service.

Effective

Good

Updated 10 January 2019

We rated effective as good because:

  • Admissions to the hospital were planned to allow for a comprehensive pre-admission assessment to be carried out.
  • Care plans were personalised, holistic, detailed and comprehensive. Care plans were well maintained, up to date and were securely stored.
  • Regular reviews of care plans and risk assessments were carried out. Patients, families and carers participated in the formulation of care plans.

  • Staff used recognised screening tools to help them monitor various aspects of physical health. Multiple audits were carried out to ensure the quality and safety of care in the service.
  • All staff had regular supervisions and appraisals between 1 January and 31 December 2017. Poor performance was identified and dealt with quickly and effectively.
  • All staff were trained in the Mental Health Act and Mental Capacity Act and associated Codes of Practice. Patients were able to access independent mental health advocates in accordance with the Mental Health Act Code of Practice.
  • Capacity assessments were carried out if there were concerns about people’s ability to understand and make decisions.

Caring

Outstanding

Updated 10 January 2019

We rated caring as outstanding because:

  • People who used the service were continually positive about the way staff supported them. Patients had a named nurse and secondary nurse and there was a picture of them in their bedroom so they knew who that person was even if they found it hard to remember their name.
  • Patients were supported by staff who were kind and compassionate. Staff knew patients well and supported them in a way that met their personal preferences and needs. For example, staff were seen sitting with patients at mealtimes and supporting them in discreet manner where needed.
  • The care provided was very person centred and care plans included details such as the time people liked to go to bed or get up in the morning. The positive behaviour support plans also included details of how people wanted to be supported when they were distressed.
  • Staff empowered patients to be active partners in their care and treatment. Staff made multiple attempts to engage patients and used different methods to help patients make choices. For example, patients were offered food to taste to help them decide what they wanted to eat. Where appropriate there was evidence of families being involved in decisions about care.
  • Staff supported patients to communicate their needs, for example, using pictorial aids.
  • Patients, carers with the support of advocates where needed were actively engaged in the operation of the service. Patients and carers gave their feedback on the service and the care and treatment they received. This could be done in a variety of ways including surveys, comment boxes and meetings. People who were reluctant to give their views were encouraged by staff. Changes were made as a result of this feedback such as the refurbishment of the communal bathrooms.

Responsive

Good

Updated 10 January 2019

We rated responsive as good because:

  • Patients were involved in decision making regarding their discharge. Discharge planning was embedded in the hospital and was discussed at multi-disciplinary meetings and ward rounds. There were no delayed discharges between 1 January and 31 December 2017.
  • There was a good and varied activities programme which provided patients with activities seven days per week. There was a good range of facilities to support patients during their rehabilitation.
  • Patients were asked for their views on how the service was run. Changes were made to the service based on patient feedback.
  • Information was displayed throughout the hospital in relation to various subjects like advocacy, patient rights and complaints. Information leaflets were available in a range of languages and formats.
  • Complaints were handled and investigated in line with the company complaints policy. Lessons learned were shared during clinical governance meetings and with staff from the hospital.

Well-led

Outstanding

Updated 10 January 2019

We rated well-led as outstanding because:

  • The company had vision and values which were clearly embedded in the running of the service. Staff were highly motivated and demonstrated the use of these values in their work in their care and treatment of patients. Values were also embedded in staff development objectives and supervision.
  • The service was well-led at ward, hospital and regional level. This leadership was inclusive and effective. The hospital director prioritised the engagement of patients and staff and we heard they were approachable and supportive.
  • Staff success was celebrated through a range of staff awards and financial bonuses.
  • The service promoted the development of future leaders. Staff had access to leadership training and were supported to develop their skills and experience.
  • There was a strong governance structure in place, which displayed joined up working from ward to board level. Accurate information was collected on key areas such as incidents and physical interventions to monitor themes and drive internal decision making at clinical governance meetings.
  • The hospital was looking to continuously innovate and improve the treatment it was delivering. For example, they were monitoring the effectiveness of the key interventions in positive behaviour support plans to make ongoing improvements in their care and treatment.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Outstanding

Updated 10 January 2019

Wards for older people with mental health problems

Outstanding

Updated 10 January 2019