Kneesworth House

On this page

• 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 effective as good. At this assessment the rating has remained good.

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.

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

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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.

During the assessment we reviewed 9 care records. Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. All patients received a comprehensive mental state assessment by a doctor on admission. This included an assessment of the patient’s capacity to consent to admission and treatment.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff reviewed patients’ physical health on admission and at least once a week thereafter. This included checks of patients’ temperatures, pulse, oxygen saturation and blood pressure. Staff carried out an electrocardiogram (ECG) on patients, prior to administration of antipsychotic medication.

Staff developed a care plan for each patient that met their mental and physical health needs. Care plans were mostly personalised and recovery orientated. Plans for treatment set out the patients’ goals, as well as arrangements for occupational therapy, psychology and risk management.

We scored the service as 3. The evidence showed a good standard. The service 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.

Staff delivered care in line with best practice and national guidance. National Institute for Health and Care Excellence (NICE) guidelines recommend that people with an acute exacerbation or recurrence of psychosis or schizophrenia should be offered oral antipsychotic medication in conjunction with psychological interventions. Records showed that care and treatment was consistent with this guidance. Staff supported patients to develop a better understanding of their condition. This included support in understanding the reasons why medicines were prescribed and identifying the events and circumstances that could cause a deterioration in their mental health.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The service had access to an on-site physical healthcare team and physical health was regularly monitored.

Staff used technology to support patient care. At the time of inspection, this included video calls with relatives and external professionals during meetings about patient care.

Staff took part in clinical audits, benchmarking and quality improvement initiatives. The service conducted numerous monthly audits which included medication, patients’ records and observations. Actions were documented and audit findings were shared and discussed at clinical audit committee meetings.

Managers used results from audits to make improvements. For example, feedback and actions from audits were shared with staff which included specific actions for named roles to undertake to improve compliance.

Mental Health Act

94.7% of staff had received training in the Mental Health Act.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' 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.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

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. All patients were discussed and seen by the multidisciplinary team (MDT) in weekly ward rounds. If a patient’s risks were assessed as being too high for them to attend ward round, a member of the MDT would have a discussion with them on the ward to share what was discussed and obtain their views. This was usually completed by the doctor.

Staff shared information about patients at effective handover meetings within the team. Handovers took place twice a day, before the commencement of each shift. There was a process to escalate any high level concerns to a daily meeting that was attended by service leaders. Leaders discussed incidents and could organise additional support to wards if required. Staff described feeling supported by their team.

The teams had effective working relationships, with other relevant teams within the organisation, including the physical healthcare team. Staff were complimentary of physical healthcare staff, stating they were responsive and provided valuable support to patients and the ward teams.

The teams had effective working relationships with other teams outside the organisation. For example, there were robust processes in place for safeguarding patients and the service had developed positive working relationships with the local authority. Staff worked well with external teams involved in patient care such as care co-ordinators and community mental health teams. Staff maintained links with them while patients were in hospital and invited them to attend ward rounds.

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 identified patients’ physical health needs and recorded them in their care plans. Staff conducted checks of each patient’s pulse, temperature, weight, height and blood pressure each week. Staff wrote up detailed progress notes for each shift covering patients’ compliance with medication, food and fluid intake, personal hygiene and sleep.

Staff made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell.

The service had a patient newsletter which promoted the benefits of participating in exercise and the positive impact it could have on many mental health conditions.

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. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, clinicians completed the generalised anxiety disorder (GAD) assessment, the patient health questionnaire (PHQ). The PHQ is a screening tool for mental health conditions like depression. Clinicians also used the brief psychiatric rating scale (BPRS) to assess severity of psychiatric symptoms. Leaders monitored outcome measures at clinical governance meetings.

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 assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

Staff took all practical steps to enable patients to make their own decisions. When staff felt a patient may have lacked capacity to make a decision, staff provided support. For example, if a patient was thought to lack capacity to consent to treatment, staff explained why the treatment was important, how they would benefit from it and described any possible side-effects.