Bromley Road Hospital

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

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

We have not awarded this service a score for Safe.

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

We scored this quality statement 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service demonstrated a positive learning culture underpinned by openness, multidisciplinary collaboration and a willingness to reflect on and improve practice. Staff demonstrated a clear understanding of incident reporting processes and safeguarding responsibilities and were able to describe how concerns were escalated and managed.

Leaders actively participated in multidisciplinary discussions and there was evidence of governance and team meetings , incident reviews and quality improvement activity designed to strengthen patient care.

We observed an open culture where discussion and reflection were encouraged.

Leaders demonstrated openness and transparency when responding to significant concerns, including a safeguarding incident involving inappropriate restraint. The incident was self-reported to the relevant external agencies and was subject to a comprehensive review.

Learning from incidents was shared through established governance arrangements, including governance and quality meetings, multidisciplinary team meetings, staff supervision sessions and individual one-to-one discussions.

Managers used these forums to review incidents, discuss lessons learned, monitor progress against action plans and reinforce expected standards of practice.

Staff were able to describe learning from incidents and the changes that had been implemented as a result. This supported a culture of continuous learning and improvement across the service.

We scored this quality statement 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service operated within a clearly defined rehabilitation model with structured admission and exclusion criteria. Referral screening processes were robust and ensured patients admitted were suitable for the service environment and level of care.

The service referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met. There was a clear care pathway in place from admission through to discharge. Care pathways focused on recovery, stability and progression towards community living.

Systems were in place to support safe care delivery across the patient pathway and demonstrated effective multidisciplinary working throughout assessment, treatment and rehabilitation planning. Staff worked collaboratively with internal and external professionals to support continuity of care and coordinated management of patients with complex physical and mental health needs.

We saw evidence of effective partnership working to improve access to healthcare. Medical staff were involved in clinical reviews, with multidisciplinary discussions supporting ongoing care and discharge planning.

We scored the quality statement 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service had safeguarding systems in place and staff demonstrated good awareness of safeguarding responsibilities and escalation procedures. Staff understood safeguarding responsibilities and responded appropriately to concerns. Staff were able to describe safeguarding processes and examples where concerns had been appropriately escalated to relevant agencies.

Safeguarding incidents were recognised, escalated and investigated, with evidence of partnership working with local authorities, commissioners and external agencies. Patients generally reported feeling safe and relatives expressed confidence in the care provided.

We reviewed examples of some incidents involving patient-to-patient conflict, unwanted physical contact and boundary concerns highlighted the need for continued vigilance, proactive risk management and strengthened relational security arrangements.

Staff demonstrated awareness of safeguarding risks and recognised the importance of protecting vulnerable patients.

Staff were kept up to date with mandatory training for safeguarding adults and children. Staff were kept up to date with training on the Mental Capacity Act, the Mental Health Act, and the Oliver McGowan Mandatory Training on Learning Disability and Autism.

We reviewed the service safeguarding log which included the total number of safeguarding concerns raised, immediate action taken and outcomes. We saw this included working in partnership with other agencies. At the time of the assessment, safeguarding adults and children training compliance rate was 94.3%.

We scored this quality statement 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour.

Patients were involved in aspects of treatment planning, and staff demonstrated a good understanding of positive risk-taking and recovery-oriented care. The multidisciplinary team promoted collaborative working with patients and sought to balance safety with individual independence, rehabilitation and recovery goals.

Records showed that staff completed an initial risk assessment for all patients on admission. These assessments considered both current and historical risks, including risks associated with patients' mental and physical health, previous incidents and individual vulnerabilities. Risk assessments were person-centred, reflected patients' changing needs and informed the development of risk management plans.

Staff demonstrated a good knowledge of patients' risks and the actions required to manage them safely. Risk information was routinely discussed and reviewed within the multidisciplinary team, including during ward rounds and care reviews. Staff shared key information effectively during shift handovers and team meetings to ensure continuity of care and promote patient safety. We observed that handovers included relevant information about current risks, changes in presentation, safeguarding concerns and any actions required to reduce identified risks.

We identified instances where risk assessments had not been updated promptly following significant events. This did not reflect expected standards for risk recording. However, staff demonstrated a clear understanding of patients’ current risks and the measures required to manage them safely. We found no evidence that these omissions had compromised patient safety or care delivery.

We scored this quality statement 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was generally clean, safe and appropriately maintained. Environmental risks were identified, monitored and managed through established governance systems and risk registers. Staff demonstrated a good awareness of environmental risks, including ligature risks, accessibility limitations and the absence of a dedicated de-escalation area. These factors were reflected in the service's admission and exclusion criteria to help ensure patients admitted could be safely supported within the environment.

However, parts of the ward appeared worn out and did not consistently promote a therapeutic rehabilitation environment. Some bedrooms contained limited personalisation, which reduced opportunities for patients to create a living space that reflected their individual preferences and supported their recovery. We also identified that sightlines between male and female corridor areas had the potential to impact patients' privacy and dignity. Leaders acknowledged this concern and took immediate action during the inspection to address the risk by installing privacy screen. Staff responded positively to feedback and demonstrated a willingness to implement improvements promptly when concerns were identified.

We scored this quality statement 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing levels were generally sufficient to meet patients' needs. Vacancy rates remained low and recruitment processes were effective. Nursing vacancies had been filled, and leaders had recruited a substantive Registered Manager who was progressing through onboarding during the inspection. The multidisciplinary team included nurses, medical, occupational therapy, psychologist and healthcare assistants.

Staff received regular supervision, appraisal and ongoing professional support and training. Supervision records demonstrated sessions that covered areas such as patient care, risk management, safeguarding, professional development, reflective practice and staff wellbeing. Staff told us they felt supported by managers and were able to seek guidance when required.

Mandatory training compliance met the provider's targets, and staff were up to date with training relevant to their roles. This included safeguarding adults, safe and therapeutic management of violence and aggression (STMVA), Mental Capacity Act and Mental Health Act awareness, life support, information governance, physical health monitoring and medicines management. Staff were able to describe how training informed their practice and supported safe care of patients.

Staff demonstrated a strong commitment to patient care and worked collaboratively across multidisciplinary teams. Medical staff were visible and accessible on the ward. Multidisciplinary working was a consistent strength throughout the inspection. Patients and carers spoke positively about staff, describing them as supportive, approachable and caring. Staff demonstrated a good understanding of physical health escalation pathways, safeguarding responsibilities, recovery-focused practice and engaged positively with inspection activities.

Leaders maintained effective oversight of staffing arrangements and workforce development through supervision, appraisal and monitor training. There was a vacancy within the psychology team. Leaders had implemented mitigation measures, including support from wider psychology services and multidisciplinary teams, and were monitoring the impact to maintain access to appropriate patient support.

We scored this quality statement 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Systems were in place to support infection prevention and control, including outbreak management arrangements, escalation processes and governance oversight. Staff demonstrated awareness of infection control procedures and the provider had contingency arrangements for infection outbreaks and service disruption.

Appropriate infection prevention and control arrangements were observed during the inspection. Clinical areas were clean and staff demonstrated awareness of infection prevention principles. Systems were in place to support safe practice.

We scored this quality statement 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines were stored safely and securely, including controlled drugs. The service had a Controlled Drugs Accountable Officer, and staff were aware of who this was. There was a clear audit trail of stock checks for medicines liable to misuse, and robust systems were in place to identify and promptly remove or use medicines approaching their expiry date.

Clinical pharmacists provided oversight of medicines prescribed on patients' Medicines Administration Records (MARs), including clozapine prescribing requests, to support the safe and appropriate use of medicines. Staff followed established systems and processes to prescribe, administer and monitor medicines safely.

Since the previous assessment, the service had strengthened its monitoring arrangements for patients receiving high-dose antipsychotic therapy (HDAT), addressing the previous recommendation relating to annual physical health monitoring. Patients prescribed HDAT received the required physical health assessments and blood monitoring, and staff took appropriate action when abnormal results were identified. Patients prescribed clozapine also received the necessary blood monitoring in line with national guidance and local protocols.

The service had effective systems to monitor physical health alongside medicines management. However, documentation relating to clinical blood monitoring was not always consistent. For example, the required frequency of blood tests for antipsychotic monitoring was recorded on some medicines charts but not others, and care records did not always clearly document the planned monitoring schedule for individual patients. Staff were nevertheless able to describe monitoring requirements and demonstrate that required tests had been completed.

The service ensured patients' behaviour was not controlled through excessive or inappropriate use of medicines. Where required (PRN) medicines were prescribed for agitation or distress, these were used appropriately. However, staff did not always consistently record the de-escalation strategies attempted before administering PRN medicines, limiting assurance that non-pharmacological interventions had been fully documented.

Staff received mandatory medicines management training and told us they were also supported by additional input from the community pharmacy linked to the service. This helped ensure staff remained competent and up to date with safe medicines management practices.