Cheadle Royal Hospital

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

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

This meant young people were supported and treated with dignity and respect; and involved as partners in their care. Staff treated young people with compassion and kindness and respected their privacy and dignity. They understood the individual needs of young people and supported them to understand and manage their care, treatment or condition. Staff involved young people in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

We have not awarded this service a score for Caring.

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

We scored the service as 3. The evidence showed a good standard. The service treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

Young people told us that staff were kind and friendly and said they usually treated them well. However, some young people said that when agency staff were working, they would sometimes ignore them or if they came with them on home leave, they would not interact much with them and their family. Young people told us that staff treated them with dignity during restrictive interventions such as physical restraint, explaining to them what they were doing and why and using the least restrictive approach possible to maintain their safety. One young person, who at times could not have bathroom privacy due to her individual risk, told us that only female staff would observe her in the bathroom.

During our time on the ward, we observed staff treating young people with compassion and respect. We saw individual staff members who had built up a good therapeutic rapport with the young people they were caring for. Staff who were carrying out continuous therapeutic observations with young people were interacting with them positively. The observations records we reviewed showed that staff were completing therapeutic observations at the correct frequencies for each young person, although the records for young people receiving 2:1 observations were not always signed by both members of observing staff.

Staff supported young people to understand and manage their care, treatment or condition. The records showed that young people had access to regular one to one meetings with their named nurses as well as other members of the multidisciplinary team, such as occupational therapists and psychologists. The young people and staff we spoke with confirmed that these took place. Information was also displayed on the ward for young people, for example about the activity timetable, the weekly menu and ‘you said, we did’ information about changes which had been made in response to feedback.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care, support and treatment met people’s needs and preferences. However, they did take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The young people we spoke with told us that the food available on the ward did not meet their needs and said they did not always feel well supported at meal-times, for example due to staff staring at them while they ate and not always being offered nutritional supplements if they did not complete their meal. However, young people confirmed that mealtimes were flexible and drinks and that snacks were available at all times. The menus confirmed that dietary options were available to meet a range of individual needs, for example cultural needs and vegetarian/vegan food.

Young people were able to personalise their bedrooms, unless this was not possible on the basis of risk. Young people who wished to practice religious observance were supported to maintain this during their admission and we saw an example of some positive partnership working with a local mosque. Young people had care plans on their records in relation to their social and occupational needs and these included recovery focused goals which had been agreed with the individual where possible.

The ward was accessible to wheelchair users and other people with mobility impairments, although access to outside space was restricted as this was down a flight of stairs. Managers and staff told us that written information could be made available in other languages and interpreters for languages other than English, including British Sign Language, could be requested as needed by individual young people.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

The care records we reviewed showed that young people were regularly reminded of their rights under the Mental Health Act, or as an informal patient if they were not detained. Young people told us that they felt involved in their care. We saw minutes of community meetings which took place weekly on the ward and were well attended by the young people. The meetings provided a forum for young people to share their views and make suggestions for changes and improvements on the ward. A ‘you said, we did’ poster was displayed to show how action had been taken in response to recent feedback received from young people and this was also shared at subsequent community meetings.

Young people were supported to maintain contact with their families and other significant people in their lives during their admission, this included overnight leave from the hospital where this was clinically appropriate. Each young person’s leave entitlement and level of access to restricted items was reviewed by their multidisciplinary team at each ward round to ensure young people were not being subjected to excessive restrictions. The ward maintained a blanket restrictions register, which documented all the restrictions which applied to all young people, and they kept this under regular review.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

Staff were aware of and dealt with any specific risk issues and care planned for these accordingly. The staff we spoke with were aware of the specific risks relating to each young person’s care, for example particular self harm risks they presented with and we observed staff providing care to mitigate these risks and meet young people’s needs. Information about changing risks and needs were discussed at handovers and ward rounds, we observed this happening in the meetings we observed. Records of previous handovers and ward rounds also showed evidence of this.

Young people told us that their rooms were comfortable and they had access to sufficient bedding to maintain their comfort. They told us that they usually received their medicines on time, although one young person said their evening medication could sometimes be delayed and said that at times they had to remind staff for this. Staff used de-escalation techniques to reduce the need for physical interventions when young people’s behaviours became heightened. We observed this happening during our time on the ward and the young people and staff we spoke with confirmed this.

We scored the service as 2. The evidence showed some shortfalls. The service did not always ensure the wellbeing of their staff. However, they did provide support which enabled staff to deliver person-centred care.

Some staff reported having been injured at work when managing incidents of aggression or disturbed behaviour with the young people and the provider’s records showed that staff were injured in 92 incidents in the 12 months preceding our inspection. The staff we spoke with told us that they had felt well supported by the provider organisation if they had been injured at work and/or involved in challenging incidents on the wards. There was a staff room on the ward for staff to take their breaks, however the furniture in the staff room was not in good condition and needed to be replaced. Staff told us that some Black colleagues had raised concerns with them about not being treated equally to White staff members, however none of the staff from ethnic minorities or global majorities we spoke with reported experiencing any racial discrimination themselves from managers or colleagues. This was fed back to the ward manager and hospital manager to enable the concern to be further investigated. Stakeholders told us that during their site visits in the 12 months prior to inspection, staff at times had appeared unsupported, fatigued and frustrated. We saw evidence from the ward’s safety huddle meetings that this was also identified by managers at the hospital at the time and action was taken to improve the wellbeing offer for staff and review workloads and specific challenges in response.

Staff we spoke with told us they felt respected and valued and said the team on the ward worked well together. Staff said they usually got to take their breaks and they said they were not experiencing a lot of work-related stress. We saw that there had been an increased focus on staff wellbeing in the months preceding our inspection due to a challenging period on the ward which had negatively impacted staff members. Wellbeing support was available to staff, including monthly wellbeing events. The provider recognised staff success and longevity of service through awards. Staff feedback on their experience working for the provider was gathered through pulse surveys, however the results of these were not available at ward level. Scores at the hospital wide level were lower than average across the whole Priory group for almost all indicators included in the survey. No formal grievances were raised by staff on Woodlands ward in the 12 months preceding our inspection.