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

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 their needs.

• Young people’s individual needs were not always assessed adequately. Staff did not implement Manual Handling Operations Regulations 1992 (Sections 106 – 108), to ensure that young people had an individual person assessment when moving during restraint was required for treatment and interventions as set out in care plans.
  Young people did not always receive special diet meals they had been assessed as needing. Meals were either not provided for each meal or they arrived late. When meals arrived late this led to some young people missing mealtimes with others and eating alone.
• Young people, parents, stakeholders, and staff told us special diet meals were repetitive and lacked menu choice. Parents reported that they often had to purchase take away meals and they provided snacks for young people with dietary intolerances.
• Parents of young people were not invited to ward round meetings as standard practice.
• We saw evidence of individualised approaches to support communication with young people with communication difficulties. However, there were delays in acquiring communication aids where different approaches to communication had been identified and planned. We also noted in care plan records that communication methods were limited to verbal communication and non-verbal communication was not recorded.
• Stakeholders told us that young people did not always have their preferred pronouns referenced.
• We reviewed evidence of detailed individualised care and incident plans to ensure consistency for young people with complex care needs.
• We saw care plans that recorded risk alerts and daily medical, nursing, psychological, and physical health monitoring of young people with complex care needs.
• Staff reported that Mental Capacity Act assessments are carried out on admission of young people to Woodlands ward, and for new decisions or changes in presentation.
• The SILAS scoring tool was used on Woodlands ward for ligature management. SILAS provides a structured method for balancing safety and support for young people assessed to have capacity, to regain control. Was saw evidence of care plans with strategies to support young people to regain control and direct their own care needs.
• Young people attended ward meetings and staff told us that they were encouraged to express their wishes about care and treatment. However, young people and stakeholders told us that ward meetings could feel overwhelming for young people.
• Staff were able to describe how young people are encouraged to make their own decisions about their care and treatment, for example through inclusion in ward meetings, during one-to-one therapy and key worker sessions, and in relation to care and support preferences when they experience high levels of distress.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

• Young people had access to education facilities. The education service listened to young people, advocates, and nurses to explore new ways of delivering education on Woodlands. Staff and stakeholders told us that subsequent changes in education staffing and provision had led to improved attendance of young people.
• Parents fed back that education staff kept in touch with them, however, parents and young people said that support could be limited when young people need subject specialist educational guidance, for example when preparing for exams.
• Staff supported young people where appropriate to engage in wider community activities. A range of planned external trips and activities were advertised on the ward activities board and therapeutic activity plans were discussed at community ward meetings.
• Staff supported and encouraged young people to maintain contact with their families and carers. Family contact could be facilitated on the ward in a designated visiting room or young people with escorted or unescorted Section 17 leave accessed local community facilities. However, young people and parents told us that escorted leave could be affected by availability of staff
• We did not see evidence of young people accessing spiritual support, however the provider had chaplaincy provision which was available through self-referral or referral by staff.

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

• Parents gave mixed feedback about the information they were provided with about the care and treatment of young people.
• We were told information about care, treatment, and progress was variable in detail and could depend on which member of staff was spoken to. Information provided could be delayed and not always reach parents in a timely way.
• Parents often found information out from young people themselves before receiving this from the ward. Some parents contacted the ward frequently or there were arrangements in place for a weekly or daily email update to be sent to parents.
• One young person commented that they found the format of care plans confusing.
• Parents told us they had received information about the ward on admission, processes were explained, and they were informed about the complaints procedure.
• Parents were aware of how to submit complaints and concerns about care and they told us they would do so on behalf of young people if needed.
• Stakeholders also reported mixed feedback on receiving information from the provider. Comments included that there can be a lack of responsiveness to external professional’s enquiries, but also that there were timely updates regarding incidents.
• 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 and at the entrances of wards. 
• The provider web site provides written information for family and friends and photographs of the environment and facilities. There is a specific web page for the child and adolescent ward.

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. 

• Woodlands ward had a total of 3 complaints in the last 12 months. 1 was upheld, 1 was partially upheld, and 1 was treated as a concern.
• Complaints related to personal belongings and young people/staff relationships.
• Inclusion and involvement of parents in care planning for young people was variable. Some parents felt involved, while others felt they were told about care plans rather than involved in their development. Parents found written updates lacked detail, and young people told us that they updated parents of changes rather than information coming from the ward.
• Cheadle Royal Family and Carers Perspectives statement recognises the integral part collaboration with these groups has for informing care, assessment of risk, and discharge planning. However, parents of young people are not invited to Woodland ward round meetings as standard practice.
• Carers, parents and young people knew how to complain or raise concerns. Five parents and four young people told us they knew how to complain and that they would feel comfortable raising concerns with staff including the ward manager.  
• Young people and staff reported that issues and complaints could be raised at the ward community meetings. We saw evidence of this in community meeting minutes. However, young people told us that some complaints were long standing, and no action had been taken, for example about food and menu choice, and drains smelling in bedrooms.
• 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.  
• When patients complained or raised concerns, they received feedback.
• Staff knew how to handle complaints appropriately. Records showed that investigations took place.
• Staff told us that feedback sheets were given to young people prior to ward round meetings and feedback was invited in one-to-one sessions. Feedback could also be provided at ward community meetings and in comments boxes. We were also told that young people are invited to portions of governance meetings, but that they are not keen to do so.
• Patient and carer experience, both complaints and compliments were recorded in clinical governance meetings.

The provider did not always make sure that everyone can access the care, support and treatment they need when they need it.

• Young people reported inadequate staff cover when some young people needed higher ratio staff support. They told us that this resulted in activities or leave being delayed or cancelled. It could also result in lack of support for other young people with lower priority needs.
• Young People and staff complained of poor internet connections.
• Young people with food intolerance diagnoses and special dietary requirements did not always receive the special meals and food prescribed. This was corroborated by parents and staff and was described as an ongoing issue.
• Staff ensured the needs of patients with mobility issues were met, for example, wheelchair users were placed in bedrooms at ground level or had access to lifts. We saw evidence of mobility equipment available on the ward if required.
• Staff made reasonable adjustments for patients, for example, parents told us that education approaches were adjusted for young people with psychological conditions that impacted on learning.
• There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.
• Staff planned for patients’ discharge, which mostly included good liaison with care managers/co-ordinators. However, stakeholders told us that lack of information could sometimes affect robust discharge planning.
• There were mixed comments from parents about discharge planning including that parents had been listened to, and plans were in place, but also parents commented that they did not know what plans were in place.

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. Parents told us that young people felt able to raise issues either with individual staff or at community ward meetings.
• Woodlands ward has a ‘you said we did’ notice board in the main ward corridor and there were several actions reported. However, we did not see evidence of the ‘we did’ action for an ‘accessible fruit bowl on the ward’.
• 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 a compliance rate for Woodlands staff of 75.40%.

We support people to plan for important life changes, so they can have enough time to make informed decisions about their future, including at the end of their life.

• Staff ensured that all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. However, stakeholders told us that social services representatives were not always included where this was needed.
• Young people were supported with their education on Woodlands ward, and parents and young people told us that they were supported with preparing for educational examinations.
• Parents reported a lack of information about future plans for young people transitioning out of child and adolescent services to adult services.