- Independent mental health service
Cheadle Royal Hospital
Assessment report published 9 June 2025
Contents
Ratings - Acute wards for adults of working age and psychiatric intensive care units
Our view of the service
The acute and PICU service was last inspected in February and March 2023 and was rated Requires Improvement overall. We served a warning notice in relation to medicines management. At this assessment the service had met the actions from the warning notice and the rating of the Safe key question had changed from Inadequate to Requires Improvement.
Mental Health Act and Mental Capacity Act Compliance
Mental Health Act
- 93% of staff had received training in the 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.
- 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.
- The provider had relevant policies and procedures that reflected the most recent guidance.
- Patients had easy access to information about independent mental health advocacy.
- Staff mostly explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done so. However, we found on Alder ward, rights were not available in a patient’s first language.
- 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.
- Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly so that they were available to all staff that needed access to them.
- Staff did regular audits to ensure that the Mental Health Act was being applied correctly including section 17 leave audits, findings from these were discussed at clinical governance meetings.
Mental Capacity Act
- 94% of staff had had training in the Mental Capacity Act.
- Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
- Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including Deprivation of Liberty Safeguards.
- Staff mostly took all practical steps to enable patients to make their own decisions. However, we saw on Evergreen ward, for an autistic patient, staff did not tailor their communication to improve the patients understanding and engagement. Their care plan did not include any reasonable adjustments or how best to communicate with them.
- For patients who might have impaired mental capacity, staff mostly assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. Examples included assistance with personal care and need for antibiotics.
- When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. We saw the rationale being discussed in a very person centred way on Pankhurst ward.
- The service had arrangements to monitor adherence to the Mental Capacity Act.
People's experience of this service
People's experience
We spoke with 24 patients during the on site assessment and 6 carers following the on site assessment. We received feedback from 6 stakeholders including advocacy services and commissioners. We conducted 4 Short Observation Framework for Inspection 2 (SOFI2) observations in the service, which are structured observations which capture people's experience of care during the on site assessment.
Patient Experience
We spoke with 24 patients during the on site assessment.
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Twelve patients talked positively about staff, including being listened to and that the service was more positive than previous services they have accessed. Two patients on Evergreen ward had not felt listened to in their ward rounds. However, a new consultant had just started on the ward and was getting to know the patients.
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Two patients told us that there can be a difference between night staff and day staff, with day staff understanding their needs more. Also, patients told us that bank and agency staff do not understand their needs and how best to support them as well as permanent staff.
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Six patients told us that the food was good, however sometimes there was not enough food to satisfy their appetite. Six patients said the food was not good, including a lack of variety. Two patients said there was a lack of halal food available. One patient said the food available did not meet their sensory needs.
Three patients gave positive feedback about activities which were varied and included games, cooking and walks. However, they informed us at weekends there was very little to do. Three patients, including 2 patients whose first language was not English said they felt bored and spent the majority of the time in their rooms. Three patients asked for access to a better equipped gym as the facilities in the main building were one treadmill, a bike and a few free weights in a small dark area. One patient wanted improved access to IT facilities.
A patient spoke positively about the chaplaincy provision at the service.
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Six patients told us the access to psychological therapies had been helpful with their recovery.
Five patients told us they knew how to complain and would feel comfortable raising concerns with staff including the ward manager.
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However, five patients told us of concerns with the environment and facilities including mould and stains in the showers, blocked sink, cold water, ward temperatures, curtains falling down then not being put back up. The lift was not working on Evergreen ward which meant children could not visit the ward, as there was no access to the visiting room without walking through the ward.
Five patients whose first language was not English, did not fully understand their rights including access to an advocate and how to complain. A patient requested support from an interpreter that was not facilitated, another patient had to rely on translation via an app on a mobile phone.
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Two patients told us they would have liked support from drug and alcohol services to support with their addiction whilst in hospital.
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Generally, patients felt safe on the wards, however one patient did not feel safe on Pankhurst ward and two patients felt unsafe on Willows ward. Two patients said Pankhurst ward was too loud for their sensory needs.
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Carer Experience
We spoke with 6 carers following the on site assessment.
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Six carers told us they were very impressed with the care delivered to their loved one. They felt involved with the service, with invites to the ward rounds and they received regular updates from staff.
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Five carers told us they were able to contact their loved one and have visits with them easily.
One carer told us they were given information in writing about the service and about their rights, when their loved one was admitted. Five carers were not provided with any information about the ward.
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Five carers told us they were involved in the care planning process and felt listened to. They were impressed with the therapies available to patients.
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Three carers knew how to complain and give feedback about the service. One carer did not know how to.
However, there was a lack of facilities for visitors, with visits taking place in communal lounges and dining rooms which did not allow for privacy and dignity.
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Carers told us they had to complain about patients vaping in communal areas of the ward and the detrimental impact this had on patients that did not vape.
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Carers told us that the facilities and environment needed improving, with a focus on the toilets and décor of the wards.
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Stakeholder Experience
We received feedback from 6 stakeholders including advocacy services and commissioners.
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Stakeholders told us that the service, particularly senior leaders were responsive to their requests, this had been an improvement over the last year, with senior leaders being more proactive. An example was a significant improvement in the WIFI within the hospital, resulting in improved access for patients.
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Stakeholders told us if they raised issues on behalf of patients, they were responded to positively and promptly by ward staff and ward managers.
Stakeholders noted improvements in the culture of the service, training for staff and the quality of care delivered to patients.
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Psychology provision was praised by stakeholders with them receiving feedback from patients about the positive impact therapy had on their recovery.
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Stakeholders observing care being delivered to patients told us that staff were caring and compassionate, and there was a warm and responsive culture.
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Stakeholders told us of the staff teams on Pankhurst ward and Willows ward making reasonable adjustments for patients.
However, stakeholders told us that the facilities and environment needed improving to improve patients experience. The lift not working on Evergreen ward had impacted on visitors to the ward.
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Stakeholders told us that contact with the wards could be difficult at times, with new wards opening that were not on the switchboard out of hours and when a direct number was located, the call was not answered. Also ward emails were not always being responded to. Stakeholders told us they did not receive regular updates about patients. This included discharge plans, changes to wards and levels of observations.
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Stakeholders told us that the service did not always check before starting meetings to see if external guests were waiting either remotely or in reception which had resulted in stakeholders missing meetings. Changes with dates and times of meetings such as ward rounds were not always communicated with stakeholders. Enabling external people to join meetings remotely was not always facilitated in a way that ensured all present could participate in the meeting.
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Stakeholders told us that ward based staff did not always support patients with the actions following ward rounds, resulting on occasion, for example in missed referrals.
Stakeholders told us that staff's knowledge of the chaplaincy service was variable and if this was increased, patients would experience more equity in having the opportunity to be referred to the service. Stakeholders told us there was no current provision in the service for patients of different faiths to access chaplaincy support including Muslim, Jewish, or Buddhist faiths.
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Observations
We observed patients vaping on Alder ward, Maple ward, Evergreen ward and Featherstone ward, staff did not challenge this or redirect patients.
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There were times when there were no staff in communal areas.
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When staff were interacting with patients, these interactions were positive.
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