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

This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. However, we identified some gaps in the records relating to how the risks relating to young people on an oral diet who were refusing food were being managed.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We reviewed the care records of all 7 young people who were admitted to the ward at the time we inspected. All the records showed that staff completed a comprehensive assessment of the young person’s mental and physical health in a timely manner at, or soon after, admission. Each young person had a suite of care plans relating to their needs which included managing risks, supporting their mental and physical health and meeting their social and occupational needs. Care plans were personalised, holistic and recovery-oriented and included individualised goals for each young person. Staff updated care plans where necessary, for example when young people’s needs changed. Records showed that staff assessed young people’s physical health needs in a timely manner after admission and kept these under regular review.

We scored the service as 2. The evidence showed some shortfalls. We saw gaps in the records relating to young people’s food intake and it was not clear how this was followed up to ensure young people were receiving appropriate support for their nutritional needs. We also found that therapeutic activities were not consistently available for young people at weekends. However, the service usually planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

The records did not always show how staff consistently met young people’s needs for food and drink and for specialist nutrition and hydration. We saw some gaps in the food charts for some young people who were receiving an oral diet, suggesting their food intake was low on multiple occasions, and their records did not show how this had been followed up. We also received feedback from stakeholders that this had been identified as an issue during their quality monitoring visits. However, where nasogastric feeding was necessary to support young people’s nutritional needs this was provided and documented appropriately. Menus showed that a range of nutritious food was available for young people at mealtimes, however some of the young people we spoke with told us they did not like the food which was available.

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 (NICE). The provider had recently made changes to their risk assessment process to reflect new NICE guidance in relation to the management of self-harming behaviours. The young people we spoke with told us that they were supported with a range of therapeutic interventions, including psychology and occupational therapy and said this was helpful to them. They said an activity programme was available during the school holidays. Staff also told us about the activities available on the ward, which included sports, baking, arts and crafts, music and games and we saw an activities timetable which confirmed this. However, young people and family carers said that activities were not available at the weekends when the occupational therapist (OT) and OT assistants were not working. The ward had dedicated rooms for education and therapies and also a sensory room.

Staff ensured that young people had good access to physical healthcare, including access to specialists when needed. Records showed that young people had their physical health monitored through regular physical observations and calculation of the Paediatric Early Warning Score (PEWS), with any concerns identified from this being escalated appropriately and quickly. This included supporting young people to attend the local emergency department where necessary (for example following an incident or due to concerns about a worsening infection). The hospital had a physical healthcare team which supported the ward with referrals to external professionals as needed. We heard from stakeholders that there had been some concerns about young people’s physical health deterioration not being responded to quickly enough but that this had recently improved.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new staff with appropriate induction, and bank and agency staff received an induction and observations competency assessment when they started work on the ward. 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. The provider’s supervision and performance review records showed that 83% of staff on the ward were up to date with supervision and 98% were up to date with their performance reviews at the time of our inspection.

The staff we spoke with confirmed that they had access to regular team meetings and that minutes of these were shared if they could not attend. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. This included specialist training relevant to the patient group the ward served, for example working with children and young people, treatment of eating disorders and understanding autism and learning disabilities. However, some staff told us they would like more training about eating disorders to be made available to them. Records showed that managers dealt with poor staff performance promptly and effectively and took appropriate actions to maintain the safety of young people on the ward where concerns were raised about staff conduct.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. An audit dashboard was maintained by the ward manager which included audits of care plans, risk assessments, observations and ligature risk management, handover documentation and management of incidents and safeguarding concerns.

Mental Health Act

The provider’s records showed that 90% of staff working on Woodlands ward were up to date with their mandatory training in the Mental Health Act at the time we inspected. The staff we spoke with confirmed that they had completed this training. Staff had access to advice and support from a Mental Health Act administration team which covered the whole hospital, and they could access the relevant policies and the Mental Health Act Code of Practice via the staff intranet. Young people had easy access to information about independent mental health advocacy. This was displayed on the ward and was also included in the written information young people and their carers received on admission. The young people we spoke with confirmed they could access an independent advocate and said they felt well supported by their advocate. The advocate told us that staff were very supportive of their role and signposted the young people to the advocate frequently.

Records confirmed that staff explained to young people their rights under the Mental Health Act (or as an informal patient) in a way that they could understand at regular intervals during their admission. Staff ensured that young people were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted. Care records showed that staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of young people’s detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them. Where young people had been nursed in seclusion, their care records showed that medical, nursing and multidisciplinary team reviews were taking place at the intervals required by the Mental Health Act Code of Practice. However, people did not always have specific, person-centred care plans on their records in relation to seclusion, which would have been good practice.

Staff regularly audited records to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits. The most recent audit took place in February 2026 which involved the review of 2 young people’s records. The score from this audit was 55% due to missing information in the records about young people being reminded about their rights and access to advocacy and the provider’s admission checklist not being completed. The audit report showed that action was taken immediately to address these shortfalls.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held regular and effective multidisciplinary meetings. We observed part of the multi-disciplinary ward round which was taking place on the day we inspected. This included representatives from the medical, nursing and allied health professional teams. The patient, their carer, their community care coordinator and their commissioning case manager were also all in attendance. A range of relevant issues were discussed at the ward round. These included recent incidents, potential adjustments to the patient’s leave entitlement, risk-related restrictions and prescribed medicines and the plans for their discharge to a community placement.

Staff shared information about patients at effective handover meetings within the team. We also observed a shift handover which included an overview in relation to each patient of key risks, their presentation during the previous shift and any incidents which occurred and any important information to note for the forthcoming shift. The records we reviewed showed that ward rounds were taking place regularly for all patients and handover records were available for each change of shift. These were downloaded directly from the online records system, to ensure they were up to date.

The teams had effective working relationships with teams outside the organisation (for example, local authority social services and GPs). The hospital had physical health and safeguarding teams which supported staff in making external referrals as needed. Managers and staff described good working relationships overall with external health and social care stakeholders. Stakeholders told us that staff were responsive and approachable and they were happy with the information they received about the young people whose care they were involved in. However, we did hear from stakeholders that when there were organisational changes within the service this was not always shared with commissioners in a timely manner, leading to confusion about who the correct point of contact was for the ward.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported young people to live healthier lives. Ward activities helped promote a healthy lifestyle for patients, for example exercise and sports activities and occupational therapy support with developing skills for cooking healthy meals. A range of healthy food was available including 24 hour access to healthy snacks such as fruit. Young people also received healthy lifestyle support through the skills building therapeutic interventions they received, including occupational therapy and psychological therapies. Young people’s care records showed they received support with sleep hygiene and stress reduction techniques where this was needed. One to one health promotion sessions were also available to young people from the physical health team for any specific support they needed, for example smoking cessation or in relation to any individual physical health concerns they had.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it.

Staff used recognised rating scales to assess and record severity of presenting issues and outcomes for young people. For example the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) had been completed at least once on all the care records we reviewed. The Children’s Global Assessment Scale (CGAS) was also completed regularly for young people at their Care Programme Approach review meetings.

The service had a range of quality monitoring systems in place including audits, dashboard monitoring of key performance indicators for the ward, environmental checks and a range of feedback mechanisms for young people, carers and staff. Minutes of governance meetings showed how action was taken in response to the findings of these processes to implement improvements to the standard of care on the ward on an ongoing basis. However, we did identify some issues during the inspection which had not been picked up by the provider’s internal quality monitoring processes.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. The young people we spoke with told us that staff explained things to them and listened to their views. The only concerns raised by young people about staff delivering care which they did not consent to related to care which was being provided under the Mental Health Act to meet their needs and ensure their safety. The correct documentation was in place on all the records we saw to confirm whether the young person had the capacity to consent to their care, whether they had consented to their medical treatment and, if not, the legal basis for treatment under the Mental Health Act. However, for young people under the age of 16 it had not been specifically documented on the records that the young person’s ‘Gillick competence’ (the threshold at which a young person is able to make their own decisions about their medical care and treatment) had been assessed, which would have been good practice.

For young people with impaired capacity to make certain decisions about their care, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions and frequently reviewed the assessment in recognition of the potentially fluctuating nature of the young person’s decision-making capacity. 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 a positive example of how the capacity assessment and best interests decision making process had been documented in relation to a young person’s care when they had impaired capacity in relation to maintaining their personal care.