Kneesworth House

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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 assessment we rated this key question good. At this assessment 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.

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 7 care records. Staff completed a comprehensive assessment of patients in a timely manner at, or soon after admission. 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. Staff regularly reviewed and updated this assessment at regular time points during their stay at the service.

We reviewed minutes from multidisciplinary meetings, these evidenced patient’s care and treatment being reviewed by the multidisciplinary team, patients and their carers with a person-centred approach to meet patient’s needs.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. 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 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 provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured patients had good access to physical healthcare and supported patients to live healthier lives.

We reviewed 7 care records and saw that staff delivered interventions in line with National Institute for Health and Care Excellence guidelines, this included evidence based psychological therapies and evidence based occupational therapy input, including activities of daily living (ADL) skills, vocational training and work opportunities like animal care and domestic cleaning. The service created Positive Behaviour Support Plans (PBS) with patients, with the input from nursing and psychology to enable a person-centred approach. PBS plans supported staff and patients to manage potentially triggering situations by focussing on the underlying needs and circumstances that may contribute to them.

Staff ensured that patients had good access to physical healthcare, we saw evidence in care plans of patients being referred to specialists. 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, the wards were supporting patients to use Zoom.

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 staff roles to undertake to improve compliance.

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 shared information about patients at effective handover meetings within the team, these 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.

Staff had regular and effective multidisciplinary meetings (MDT). There were professionals involved in the assessment and review of patient’s health, care and treatment, wellbeing and communication needs. Professionals were engaged in reviews and assessments. 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 worked closely with external organisations such as local authorities and commissioners of health care services. We saw evidence in patients care plans of the service working with commissioners, community mental health teams, social workers and advocates to support patients.

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 made sure patients had access to physical health care, including specialists when required. Patients could access healthcare appointments that were unplanned, such as accident and emergency, because staff and leaders had devised plans that worked for patients.

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.

We saw evidence in care plans or staff supporting patients with diet and exercise, plans had been developed and progress recorded. The service also 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 patient’s capacity to consent to admission and treatment. Staff assessed patient’s capacity for specific decisions throughout their care and treatment. Capacity was monitored and recorded at multidisciplinary team meetings. Staff we spoke with told us if patients lacked capacity to make a specific decision, staff made decisions in their best interests, recognising the importance of the person’s wishes and involving their carers.

Staff took all practical steps to enable patients to make their own decisions. Patients made their own choices and decisions on a day-to-day basis about what they did, what they ate and how they filled their time. When staff felt a patient may have lacked capacity to decide, 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.

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.

Most carers told us staff explained consent, confidentiality and how they share information.