Cheadle Royal Hospital

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive:

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

Requires improvement: This meant people’s needs were not always met.

At this assessment, the service was in breach of legal regulation in relation to Regulation 9 Person Centred Care.

We have not awarded this service a score for Responsive.

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

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

• The service did not always make reasonable adjustments for patients with protected characteristics. The lift used to access Evergreen ward was not working during the assessment and this meant family visits with children could not take place on the ward as there was no direct access to the visiting room without going through the ward. People with mobility needs who could not use the stairs would not be able to access the ward. However following the on site assessment, the service had created a new family visiting room on the main hospital corridor. This meant that there was a dedicated accessible space for family visits.
• A patient who was autistic on Evergreen ward, did not have any reasonable adjustments recorded in their care plan, or a sensory assessment. However, there were examples of staff being trained in how best to support an individual patient with a mental health need that was unique. Stakeholders told us of the staff teams on Pankhurst ward and Willows ward making reasonable adjustments for patients.
• We observed a very person centred ward round on Pankhurst ward where the consultant involved all present and ensured the patient had the time and opportunity to share their views and experiences and raise any issues they had. Clear actions were identified within the meeting.
• However, 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 has 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 meant all present could participate in the meeting. 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.
• The information provided was not always in a form accessible to the particular patient group. 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. However we did see on Willows ward, social stories in use for an autistic patient to help them understand their rights, restrictions and visiting arrangements.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

• Three patients gave positive feedback about activities which were varied and included games, cooking and walks. However 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.
• Six patients told us the access to psychological therapies had been helpful with their recovery.
• Staff supported patients to maintain contact with their families and carers. We saw family were involved in ward rounds. 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 when their loved one was admitted and about their rights. Five carers were not provided with any information about the ward.
• 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.
• There was a lack of facilities to visit, with visits having to take place in communal lounges and dining rooms which did not allow for privacy and dignity of the visits. However following the on site assessment, the service had created a new family visiting room on the main hospital corridor. This meant that there was a dedicated space for family visits, which provided the appropriate privacy and dignity required.
• Staff did not support patients to access their chosen place of worship within the community. However there was a chaplain based at the service one day a week. Patients could be referred to the chaplain or they could engage with them when they visited the wards. A patient spoke positively about the chaplaincy provision at the service.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

• Staff made notifications to external bodies as needed. We saw that CQC notifications were submitted.
• Information governance systems included confidentiality of patient records. Patient records were electronic and could only be accessed by staff who had completed the information governance training and had been provided with a login.
• Staff ensured that patients could obtain information on treatments, local services, patients’ rights, how to complain and other relevant information. Information leaflets were available on the wards.
• The information provided was not always in a form accessible to the particular patient group, including languages other than English. Staff did not make information leaflets available in languages spoken by patients.
• Staff did not always ensure carers, families and commissioners were regularly updated about the patient’s progress. 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 if they were responsible for overseeing the placement. This included discharge plans, changes to wards and levels of observations.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

• The service had received a total of 21 complaints across the 7 wards in the last 12 months. Six of these were upheld.
• Themes for the upheld complaints related to the environment, personal belongings, family not being invited to ward rounds and a Mental Health Act detention error. Records showed appropriate action had been taken following these complaints.
• Patients knew how to complain or raise concerns. Five patients told us they knew how to complain and would feel comfortable raising concerns with staff including the ward manager.
• Three carers knew how to complain and give feedback about the service. One carer did not know how to.
• There was no formal process in place for seeking feedback from carers, in other services at the hospital, this was linked to Care Programme Approach reviews, however due to the length of admissions in the acute wards and psychiatric intensive care units, formal feedback was not requested from families and carers. However we saw that informal feedback was requested if families and carers attended ward rounds.
• When patients complained or raised concerns, they received feedback.
• Staff knew how to handle complaints appropriately. Ward managers led on investigating complaints. Records showed that investigations took place.
• Staff did not always receive feedback on the outcome of investigation of complaints. We reviewed team meeting minutes and found that complaints were not a standard agenda item, this meant there was no consistent method of complaints, themes, findings and actions being shared with the staff team.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We actively seek out and listen to information about people who are most likely to experience inequality in experience or outcomes. We tailor the care, support and treatment in response to this.

• Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views. Community meetings took place with a you said we did format. Minutes showed progress being made. However there was no evidence of interpreters being used in these meetings for people whose first language was not English. Patients whose first language was not English told us that they did not understand why they were in hospital.
• The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.
• Staff were trained in equality, diversity, inclusion and human rights, with 83% compliance across the 7 wards.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.