Cheadle Royal Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. 

At our last assessment we rated this key question Good. At this assessment the rating has remained good. 

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this. 

We have not awarded this service a score for Effective.

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

The provider maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

• We looked at 4 care records during the assessment.
• Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission.
• Physical health needs were assessed and if necessary investigated. Staff were able to describe the correct procedures for carrying out and documenting physical health monitoring. Body maps were used to record injury.
• Physical health assessment was recorded on a specialist CAMHS observation sheet. These were paper based and required uploading to care notes weekly. However, staff had access to these notes, which were kept in the ward office.
• Care plans were personalised, holistic and recovery-oriented. We saw evidence of communication plans for young people needing support in this area.
• Staff updated care plans and care records when necessary and following incidents.

The provider plans and delivers people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

• Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development), and appraisal of their work performance.
• Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence Quality Standards for children and young people, including for eating disorders, self-harm, medication and psychological therapies.
• Evidence based psychological therapies were available to young people and these were tailored to their assessed needs. Examples of one-to-one therapies included Cognitive Behavioural Therapy, Compassion- Focused Therapy, Acceptance and Commitment Therapy, and Eye Movement Desensitisation and Reprocessing therapy for trauma.
• Staff ensured that patients had good access to physical healthcare, including access to specialists when needed, including for emergency treatment and care. We saw evidence of physical health assessment and monitoring in young people’s care records.
• Staff were experienced, qualified and had the right skills and knowledge to meet the needs of the patient group.
• The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as nurses, health care assistants, and specialist doctors, Woodlands multi-disciplinary team included occupational therapists, clinical psychologists, art and family therapists, and education staff. There was also access to a hospital dietitian and social worker.
• Managers provided new staff with an appropriate induction.
• Managers ensured that staff had access to regular team meetings.
• Staff appraisal rates for Woodlands ward were 100%.
• We were told that staff received monthly supervision. For the three months before inspection, compliance was 60% in September and 100% in October and November.
• Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.
• Managers ensured that staff received the necessary specialist training for their roles.
• Managers dealt with poor staff performance promptly and effectively. We saw evidence of two disciplinary actions for Woodlands in 2024.
• We saw evidence of dietary assessment for specialist nutritional needs, however young people with dietary intolerances and their parents reported that special diet meals were not always provided. Special diet meals were described as repetitive and lacking choice.

The Provider works effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

• Staff held regular and effective multidisciplinary meetings.
• Staff shared information about young people at effective handover meetings within the team, for example shift to shift and at specifically convened meetings relating to complex care. During our assessment we observed a comprehensive handover for a new support worker joining the ward.
• The teams had effective working relationships, including good handovers, with other relevant teams within the organisation, for example, psychology, education, and social work.
• Care staff spoke positively about the education service available to young people on the ward. This was delivered from 9.00am – 3.30pm each weekday. They described education staff as supportive and experienced. The North West Hospital School, which provided the education on Woodlands ward was Ofsted inspected and was rated overall Good and Good for all areas at their last inspection in June 2024.
• There were mostly effective working relationships with teams outside the organisation, for example schools and colleges. Staff told us that they aimed to include community teams in best interest meetings. However, we received stakeholder feedback that reported there could be a lack of social care services presence at meetings.
• Woodlands ward is part of the Children and Adolescent Mental Health Services (CAMHS) Low Secure Network which has membership of eight other low secure CAMHS units across the country.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

• There were limited ward facilities that promoted healthy dietary choices or options. Parents, young people, and staff commented on limited food choices and quality. The kitchen was locked, and young people did not have free access to drinks, fresh fruit, or snacks. Young people needed to request access to the locked kitchen and be escorted by a member of staff. Mealtimes were described as flexible, however young people and parents told us that it was not always possible to access the kitchen microwave to heat up food.
• Woodlands ward had a good size gym set off the ward that was available to young people. It had a number of pieces of gym equipment and was clean and well maintained. Young people needed to be accompanied by staff to attend the gym and sessions needed to be scheduled so use could be limited depending on staff availability.
• Young people had access to the hospital grounds or a local park with escorted or unescorted leave. Access to the ward garden outside space was facilitated by staff and young people told us staff availability could restrict use of this space.
• The education team included a PE teacher.

The provider routinely monitors people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

• Staff used recognised rating scales to assess and record severity and outcomes. Baseline assessments were made and examples of psychological tools used were The Beck Youth Inventory self-report measure, the Million Adolescent Clinical Inventory psychological assessment tool, trauma checklists and resilience scales. Ashton charts were used for recording physical observations.
• Staff used technology to support patients effectively, for example, electronic access to care records and pharmacy for medicines, monitoring dashboards and audits to track incidents, interventions, safeguarding, physical health audit actions, risk assessments. Physical observation sheets were paper-based.
• Staff told us that they would benefit from more ward laptops and that office computers were in high demand, and difficult to access to review and update care records.

The provider tells people about their rights around consent and respect these when we deliver person-centred care and treatment.

• Staff took all practical steps to enable young people to make their own decisions.
• For young people who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We saw evidence in care records of capacity assessments.
• When the provider assessed capacity, this was done on a decision-specific basis with regard to significant decisions.
• When young people lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. We saw evidence in care records of best interest decision meetings.
• Parents told us that young people’s decisions about consent in relation to sharing information with them was respected.