• Mental Health
  • Independent mental health service

Cheadle Royal Hospital

Overall: Requires improvement read more about inspection ratings

100 Wilmslow Road, Heald Green, Cheadle, Cheshire, SK8 3DG (0161) 428 9511

Provided and run by:
Affinity Healthcare Limited

All Inspections

Other CQC inspections of services

Community & mental health inspection reports for Cheadle Royal Hospital can be found at Affinity Healthcare Limited. Each report covers findings for one service across multiple locations

21,22,23 February & 8 March 2023

During a routine inspection

Our rating of this location stayed the same. We rated it as requires improvement because:

  • On this inspection we inspected the acute wards for adults of working age and psychiatric intensive care units. We rated these as: requires improvement overall; inadequate for safe, requires improvement for well-led; and good for effective, caring and responsive.
  • We have used ratings from previous inspections of other core services to aggregate ratings to location level in line with our guidance.
  • This inspection did not change the overall location rating which remains as requires improvement. However, the location rating for safe went down to inadequate. The location rating for well-led remains as requires improvement. The location rating for effective, caring and responsive remains as good.

17, 18, 19, 24 and 25 January 2023

During an inspection looking at part of the service

Our rating of this location went down. We rated it as requires improvement because:

  • On this inspection we inspected the child and adolescent mental health wards and this changed the location ratings to requires improvement overall and requires improvement for safe and well-led.
  • On this inspection, we rated the child and adolescent mental health wards as inadequate overall and inadequate for safe and well led, requires improvement in effective and responsive and rated caring as good.
  • We have used ratings from previous inspections for other core services to aggregate ratings to location level in line with our guidance.

26, 27, 28 April 2022

During a routine inspection

Our rating of this location improved. We rated it as good because:

  • The environmental issues identified in our previous inspection in June 2021 had been addressed. All wards had been comprehensively redecorated and refurbished. Every ward had new furniture, fittings, and flooring had been fitted throughout. Improvements had been made to the maintenance systems and processes throughout the service.
  • Ward teams had access to multidisciplinary staff and specialists. The eating disorder service had a dietician and two assistant dieticians. Staff could access additional training to develop their skills. The model of care on Fern ward (a female personality disorder ward) was a dialectical behaviour therapy model. All staff were trained in the approach, and staff could progress to undertake training to deliver group-based therapy sessions. The ward was decorated with prompts for patients and staff. Staff could follow up therapy-based sessions and practise techniques with patients between therapy. Nursing and support staff could describe the model and theory well and the approach was understood and embedded with staff and patients who we spoke to. The provider had a rolling programme of clinical audits for benchmarking and quality assurance.
  • Patients said most staff were discreet, respectful, and responsive when caring for patients. Most patients told us that they felt that staff respected their privacy. The hospital had recruited two experts by experience who were due to start work imminently. Patients could give feedback on the service and their treatment and staff supported them to do this.
  • Leaders were visible in the service and approachable for patients and staff. The ward managers were experienced and skilled and performed their role well. Staff told us they were visible, approachable, listened and supported them in their day to day tasks.


  • On two CAMHS wards we found doors that had been graffitied by patients who had chipped away the paint and this damage had not been addressed. It was not clear that any measures were in place or had been considered to prevent this from happening in the future. A damp patch on the ceiling of the laundry room on Orchard ward had not been addressed since the last inspection.
  • The service had not ensured that clinic rooms within CAMHS were checked and maintained appropriately. On Orchard and Woodlands, there were areas of the clinic rooms that were dusty, cluttered and unorganised. Expired equipment such as gloves, needles and syringes were stored on all three wards and had not been removed. These were stored alongside in date items so it was not clear to staff which equipment they should use. On Orchard, there was medication that had been opened with no start or expiry date recorded. The hospital’s governance processes had not ensured that the issues regarding the clinic rooms and medications were addressed in a timely and appropriate manner.
  • On three of the wards (Pankhurst, Alder and Featherstone) patients told us of concerns about a negative culture that had developed in relation to night. Patients said they did not always feel safe on these wards, they found staff were less supportive and less respectful. Patients on two wards told us there had been mistakes made at night with their medication which they had had to report. These issues were similar to those we found on one ward at our last inspection which the provider had addressed.
  • Whilst overall governance had improved, there were issues with oversight of some areas of practice, including ward-based audits and checks and physical health assessment and monitoring.

27 July 2021 28 July 2021 29 July 2021

During a routine inspection

Due to the concerns we found during this inspection, we asked the provider to take urgent and immediate action.

The provider addressed the most serious concerns immediately. We have also issued warning notices for two breaches of regulation to ensure that swift action is taken, and plans put in place to maintain improvements.

Our rating of this location went down. We rated it as requires improvement because:

  • We found evidence that maintenance of ward areas and furniture was not being kept up to a good standard. It was not a caring environment which respected patient’s dignity and did not aid recovery.
  • The service had not maintained medical equipment such as defibrillators and weight scales.
  • The service had not ensured that corridors and exits were free from obstructions, in the case of an emergency or fire. We found one corridor was blocked with chairs.
  • The service had not ensured that all staff had access to alarms to alert other staff in case of an emergency. We found that one ward did not have the required number of alarms for the number of staff working on that day.
  • The service had not ensured that there was always a place for patients to relax. We found a female lounge was being used as a visitor’s room for large parts of the day.
  • Staff were not always following the providers policy in relation to checks on controlled drugs and sharps boxes.
  • Our findings demonstrated that governance processes did not always operate effectively.


  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

14th and 15th October 2019

During an inspection looking at part of the service

This was a focused unannounced inspection just looking at the safe domain of the child and adolescent mental health wards at Cheadle Royal Hospital.

Our rating of safe of the child and adolescent mental health wards at Cheadle Royal Hospital stayed the same. We rated it as requires improvement because:

  • We found that the provider’s policy on prevention and management of disturbed/violent behaviour was not being followed when prescribing “when required medicines”. The policy stated that prescribing should be tailored to the patient and be part of their individual plan. It should not be administered routinely or automatically and should be reviewed regularly. One patient had no record of a review of the need for two “when required” medicines even though these had not been administered for five and nine months respectively.

  • Staff did not directly record incidents onto the hospital’s electronic system, instead a separate paper system had been developed where staff completed a form and another member of staff then entered the details into the electronic system at a later date. We found the paper system to be poorly maintained with loose sheets and a back log waiting to be uploaded. There was no audit for this process, so the hospital could not be certain that incidents were being accurately recorded.

  • The record of physical observations that had taken place after the administration of rapid tranquilisation were poorly organised although we were confident the observations were taking place in practice. We found post rapid tranquilisation forms which had been completed but were stored in different locations, for example we examined 27 records of episodes of intramuscular administration recorded on prescription charts and 19 of these had no post rapid tranquilisation monitoring form attached.

  • We found inconsistent recording within care records. We saw examples where incidents were not included in notes and information was recorded in different places.
  • Mental Health Act paperwork was not always completed in relation to patients’ treatment.


  • The wards were clean and tidy and being renovated to improve safety.

  • Staff assessed and managed risks. There was a comprehensive risk assessment for all patients and a daily communication sheet provided for staff which included all patient risks.

15 -17 August 2017

During a routine inspection

Patients using the service told us that they were treated with kindness, dignity and respect. We observed that staff took time to communicate with patients in a respectful and compassionate manner. Patients were empowered to become active participants in their care which required good communication skills from staff to enable them to address patient needs effectively.

All patients underwent a thorough assessment of need, care plans were holistic and recovery oriented and included physical health assessments, these were completed in collaboration with the patients, progress was regularly reviewed. Regular multidisciplinary meetings were held and attendance by outside agencies was encouraged. Good communication was evident with external agencies such as local authorities and community mental health teams. Families and carers were involved in this process where appropriate. Advocacy services were accessible and available to support patients.

The hospital followed national guidelines on cleaning standards and monitoring procedures to provide and maintain a clean and appropriate environment to prevent and control healthcare associated infection. The wards were clean and tidy and there was an established cleaning regime. All clinic rooms were fully equipped with accessible emergency equipment which was maintained appropriately. Medicines were dispensed and stored securely and weekly audits were undertaken to ensure safe practice.

There were arrangements in place to provide safe and effective care in the event of a failure in major utilities, fire, flood or other emergencies. We had sight of the hospital's fire risk assessment, service evacuation plans and details of fire training for staff.

The ward environments were situated in older buildings and were subject to constraints in observation. These were effectively managed and risks mitigated with the use of observation and individual risk management planning. Regular environmental quality checks were conducted and patients were able to discuss and resolve environmental issues in community meetings. Ongoing refurbishment plans had seen improvements to the ward environments.

Staffing levels were determined using a staffing ladder model. Electronic rostering was used to support staff management and staffing was reviewed regularly to ensure there was enough staff with the relevant skills to deliver safe patient care. Patients were supported by a skilled multidisciplinary team of staff which included nursing, psychiatric, psychological, occupational and dietetic support. Staff were supported to deliver effective care and treatment they told us that they received meaningful and timely supervision and were supported to maintain their professional skills and experience.

Treatment practices including physical health care and prescribing practices were based on nationally recognised guidance. Care planning was holistic and positive risk management was evident. Care planning, risk and review were undertaken regularly and patients and their carers were involved in this process. Any identified spiritual needs and cultural requirements were supported and families and carers groups were active in the service.

Safeguarding processes were in place which reflected national guidance, and understood by all staff. There was a clear structure of reporting and responsibility for safeguarding adults and children. Any concerns relating to adult and child protection were communicated to the relevant protection agencies.

Restrictive practices were reviewed regularly and patients were involved in the process, the service had a patient representative who met with patients regularly and acted as their voice in communication with senior managers. Regular patient surveys and community meetings informed improvements in patient care across the hospital.

Referral systems and admission criteria were in place and admission waiting times monitored. Delayed discharges and length of stay was also monitored, procedures and strategies were in place to reduce the length of stay.

Staff were trained in and had a good understanding of the Mental Health Act and Mental Capacity Act. Staff followed local procedures and support was available from Mental Health Act administrators. Patients were given information and support to ensure appropriate representation and aid understanding of their rights.

There was an established governance structure with a defined hierarchy of reporting and decision making within the service. There were clear systems of accountability and senior managers were actively involved in the operational delivery of the service. There was a clear statement of visions and values, staff knew and understood the vision, values and strategic goals of the service. Processes and systems of accountability and governance were in place and performance management and quality reporting was clearly set out. Risks were identified and monitored. Performance issues were escalated and discussed at relevant governance forums and action taken to resolve concerns.

All staff we spoke with were positive about their roles and were passionate about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments. The service was committed to improving the services on offer and continually improving the quality of care provided to patients.


The hospital had a policy and action plan in place regarding reducing the use of restrictive practices including the use of restraint in line with national guidance. However on the child and adolescent mental health wards two patients reported painful holds were used during restraint. This raised concerns about the use of pain compliance in the form of wrists holds being taught to staff in the management of violence and aggression training.

  • On the acute wards for adults of working age and psychiatric intensive care units and the child and adolescent mental health wards there was inconsistent monitoring and recording of physical observations following the use of rapid tranquilisation.
  • On the acute wards for adults of working age and psychiatric intensive care units staff had not received training around personality disorders.
  • Within the psychiatric intensive care units there were higher levels of seclusion reported than levels of restraint.
  • On the long stay/rehabilitation mental health wards for working age adults, staff were not always specifying clearly the decisions leading to capacity assessments and recording the decisions made in patients’ best interests when patients were assessed as lacking capacity.
  • Food in the patients’ kitchens was not always stored in a way that minimised risk of food borne viral infections.

15, 24 April 2014

During an inspection in response to concerns

We undertook this inspection in response to a serious incident which occurred at the hospital. We wanted to obtain assurances the people within the Child and Adolescent Mental Health Services (CAMHS) were safe and receiving appropriate care to meet their individual needs.

The inspection team spent time speaking with young people, we invited them to share with us their experience of the care provided at The Priory Cheadle.

People were positive about the staff team and the care they received. They told us “He’s a good doctor, he makes the right decisions.”

Throughout the two days we visited the services we observed staff engaging with people in a kindly manner and involving them in decisions about activities related to their care needs.

The hospital had effective policies, procedures and systems in place to manage medicine and the administration process. We did highlight some concerns with regards to the following and completion of some of the procedures to support medicine management.

The hospital managed staffing levels appropriately and there were suitable arrangements in place to deal with foreseeable emergency cover. Staff told us they felt well supported by their team.

As part of the inspection process we reviewed the incident and complaints policies and procedures. We found evidence of good investigation and reporting processes but felt the learning had not been embedded following an investigation to minimise the future risks of similar incidents.

17, 22 October 2013

During a routine inspection

When we visited Cheadle Royal Hospital Orchard Unit we spoke with nine of the 13 young people who were patients on the ward. The atmosphere on the ward was relaxed welcoming and sociable.

The young people presented as relaxed and comfortable in the presence of staff. They spoke openly and confidently about the staff and the quality of care and treatment they received. They told us that they were helped to identify and understand their mental health needs and behaviours and were involved in the development of care and treatment plans tailored to their individual needs and personal preferences.

We found that the young people who used the service received safe and appropriate care that met their needs and protected their rights.

Some of the young people spoken with told us that they were unhappy with quality of food provided. However, we were told that these concerns had already been identified and the manager showed us that action was being taken to improve quality and presentation of food.

We could see the quality of treatment, care and service provided was continuously monitored so patients were protected from the risks of unsafe or inappropriate care.

We observed staff carrying out their duties and responsibilities in good humour and in a relaxed and positive manner. We found that there were enough qualified, skilled and experienced staff to meet people's needs.

26 September 2012

During an inspection looking at part of the service

We spoke with three patients about their medicines and the care they received.

Comments from patients included:

‘’I feel safe here, everything is fine’’

‘’I have been told about my medicines I know what they are’’

‘’Sometimes other patients frighten me but I can go to my own room where I feel safe’’

Overall we found good improvements in the management of medicines.

18 June 2012

During a routine inspection

An inspection team, including a pharmacist and two compliance inspectors visited Cheadle Royal Hospital on 18/6/12. We visited four wards across the hospital, which included Orchard unit, Pankhurst, Elmswood and The Meadows. Our report relates to our findings and observations of these wards and units.

We spoke with some of the patients at Cheadle Royal Hospital.

Some of the comments from people included:

'The food and the staff are ok.'

'Have been doing the care plan with staff.'

'Can talk to staff and doctor if not happy about anything.'

As part of this review process we saw a draft report following a visit to the service from Stockport Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No concerns were raised in the report.

We spoke with a representative of Pennine Foundation Trust who monitors the care of the people who have been placed at Cheadle Royal Hospital by the Trust. She told us that she was happy with the care and attention people received and had no concerns.

23 September 2011

During a routine inspection

An inspection team, including a pharmacist and two compliance inspectors visited Cheadle Royal Hospital on 13/09/2011. We visited several wards across the hospital including Orchard unit, Pankhurst, Elmswood and The Meadows. Our report relates to our findings and observations of these wards and units.

At the same time a Mental Health Commissioner colleague was also doing an announced inspection of The Willows ward.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.