Cheadle Royal Hospital

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• 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 inspection we rated this key question requires improvement. At this inspection the rating has changed to good.

This meant people’s needs were met through good organisation and delivery. Staff managed beds well. A bed was available when a young person needed one. Young people were not moved between wards except for their benefit and staff did what they could to ensure young people did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported young people’s treatment, privacy and dignity. Staff supported young people with activities and maintaining relationships outside the service. The service met the needs of all young people – including those with a protected characteristic. Staff helped young people with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the results.

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.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Staff within the service based the care of young people around individual needs and preferences. Each young person had individualised care plans relating to their mental and physical health, social, emotional, educational and occupational needs. These plans included personalised, recovery focused goals which had been created in partnership with the young person as much as possible. Young people had bespoke weekly planners which included education, leisure activities and therapeutic sessions with their named nurse and the occupational therapy and psychology teams. The young people we spoke with told us that they felt that they were treated as individuals and could give examples of how they had received person-centred care. For example, being able to pursue educational goals, receiving individualised support in building skills to enhance their recovery and being supported to observe their religion during their time on the ward.

Staff empowered young people to make their own decisions about their care and treatment as much as possible. Records showed that young people attended their own ward rounds with their responsible clinician and multi-disciplinary team and their family carers were also able to attend by video call. This was the case in the ward round we observed, with the young person attending in person and their parent dialling in. The young people we spoke with told us that they felt involved in their care and treatment and staff could give examples of how they supported the young people’s involvement. We saw evidence on the records of young people receiving support to understand their care and enhance their involvement, for example through the use of social stories for an autistic young person.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

When appropriate, staff ensured that young people had access to education opportunities. The hospital had an on-site school (the North West Hospital School) and the young people attended education sessions in a classroom based on the ward. The young people we spoke with told us that the education available on the ward was good and met their needs. Some young people were studying for GCSEs during their admission, and we observed several young people accessing the ward school during our visit.

Young people also told us that they were supported to maintain contact with their families and carers, both on the ward and through home visits as they worked towards their discharge. We observed young people taking leave to spend time with family during our time on the ward and records showed that this was facilitated as often as possible for young people. Carers told us that they were able to visit at times to suit them and they could keep in contact with their child by phone in between visits.

Staff supported young people to access their chosen place of worship within the community. At the time we inspected the hospital had recently carried out a piece of work in partnership with the local mosque. This was led by one of the young people and was a positive example of community engagement and patient involvement.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Young people told us that they received information about the ward, the medicines they were prescribed and their rights under the Mental Health Act. We saw examples of written information which was available to young people about the ward (including the process for raising concerns about care), the Mental Health Act and the use of restrictive practices on the ward (as required by the Mental Health Units (Use of Force) Act 2018). The ward manager told us that written information could be made available in other languages and easy read formats if required by an individual young person. Information was also displayed on noticeboards in communal areas of the ward, including information about the staff team, the staffing of the particular shift, activities, menus and improvements made in response to feedback from young people.

Staff ensured carers, families and commissioners were regularly updated about young people’s progress. The carers we spoke with told us that they were kept up to date in relation to their child’s care. We received feedback from commissioners that staff were responsive and kept them up to date in relation to each young person’s progress. Some stakeholders told us that historically they had not been informed about incidents or physical health deterioration in a timely manner but that this had recently improved.

Information governance systems included confidentiality of patient records. Most of the young people’s care records were electronic and they were stored securely on a password protected system. Paper records, such as observation charts, were either kept with a member of staff or locked in the ward office. Staff completed data protection and confidentiality training as part of their mandatory training and at the time we inspected 98% of staff were up to date with this on Woodlands ward.

The service complied with the Accessible Information Standard. Records showed that they identified the communication needs of all young people at the point of admission and that support was in place to enable their communication. Young people with specific communication needs, for example due to neurodivergence, had care plans in relation to these. We saw examples of how young people had been supported with these additional needs, which had positive outcomes in improving their care and overall wellbeing. Ongoing compliance with the Accessible Information Standard was monitored by the provider through routine care planning reviews, governance meetings and feedback from young people and families.

Staff made notifications to external bodies as needed. Information was shared with CQC, local safeguarding authorities and commissioners in a timely manner. The feedback from stakeholders confirmed that information was shared with them without any delay.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Young people told us that they felt involved in decisions about their care and said they were able to attend their ward round reviews. However, 1 young person told us that their carer had raised concerns about their physical health which had not been listened to by staff.

Young people said they had access to independent advocacy. One young person told us that their carers could find it difficult to get in touch with the ward at times, however the family carers we spoke with said they were able to contact staff when they needed to. Young people told us that they had access to one to one support from nursing staff but 1 told us they would like this to be available more often and also said they would prefer to have weekly ward rounds. Young people told us that their carers were able to attend the ward rounds and we saw that this happened during the ward round we observed. The carers we spoke with also confirmed this.

Regular community meetings took place on the ward and some of the young people who had attended these told us that action was taken to address issues they had raised at the meetings. Young people were also aware of the process for raising concerns about their care, said they would feel able to do this if they needed to and said they had felt listened to when they had raised issues in the past. Staff protected young people who raised concerns or complaints from discrimination and harassment, we saw no evidence that any young people had experienced any negative consequences due to raising concerns about their care.

Carers told us that they were happy with the information they received from the ward and their level of involvement in their child’s care. The minutes of the safety huddles taking place on the ward showed that action had been taken to improve communication with carers during a period of high acuity on the ward which understandably increased family members’ anxieties about their young person’s wellbeing.

The provider received 4 complaints about care on Woodlands ward in the 12 months preceding our inspection, of which 2 were upheld and 2 were not upheld. There were no trends or themes of concern identified from the complaints and they were all investigated and responded to within the provider’s complaint policy timescales. The provider also documented compliments received about the ward, 56 were recorded in the 12 months preceding our inspection about a range of subjects. These included the support received from ward staff and the multidisciplinary team, the progress the young person made during their admission and support received in relation to moving on from the hospital at the point of discharge.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

There were no young people with mobility needs on the ward at the time of our assessment. The ward itself was accessible to wheelchair users and there were 2 larger bedrooms which would be allocated to young people with mobility issues. However, the ward facilities were not fully accessible to people with mobility issues as the secure garden was down a flight of stairs. The ward manager said that this was taken into account when young people were assessed for admission to the service and young people who were not able to use stairs would be offered a placement at an alternative Priory hospital if possible.

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. The staff we spoke with said that they could always get support from a doctor quickly when this was needed, including out of working hours.

Staff planned for young people’s discharge, including good liaison with commissioners and care co-ordinators. We observed this happening during the ward round we observed and saw evidence of this in the care records we reviewed. These discussions included arrangements for continuity of the young person’s mental health support following their discharge including aftercare as required by section 117 of the Mental Health Act. At the time of our inspection there were 3 young people who were clinically ready for discharge. The ward manager told us that their discharge was delayed due to challenges in arranging a suitable discharge placement for them and we saw evidence in the care records of ongoing attempts by the multidisciplinary team to overcome these challenges and progress the young person’s discharge as fast as possible.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their 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. The young people we spoke with told us that they felt listened to by staff and records showed that weekly community meetings took place at which young people clearly felt comfortable raising concerns and making suggestions about improvements they would like to see 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. This formed part of the provider’s mandatory training for all staff and 98% of staff on Woodlands ward were up to date with this at the time of our inspection.

The provider had undertaken work to introduce the national Patient and Carer Race Equality Framework (PCREF) at the hospital. Implementation of PCREF was part of the provider organisation’s strategic goal to “embed a culture of openness, inclusion and trust where people feel like they belong”. The work carried out so far at the time of our assessment included the introduction of quarterly PCREF listening circles to gather lived experience feedback from patients and carers to enhance inclusion and to promptly identify and tackle any racial discrimination people were experiencing.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff ensured all relevant healthcare professionals and other relevant bodies were involved in planning the care and treatment of people with complex needs. At the time of our assessment there was a young person being nursed in long term segregation and their records showed positive partnership working with stakeholders in relation to their care and progress towards discharge. During the ward round we observed, we saw engagement by the multidisciplinary team with the young person’s community team and commissioners to facilitate their discharge to a suitable community placement as soon as possible. Stakeholders told us that the service showed commitment towards effective discharge planning for young people with complex needs.