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. 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.

We reviewed 4 care records for the bungalows during this assessment. These showed regular and consistent physical health monitoring of patients, involvement of specialists including occupational health therapist, psychologist, GP and dietitian. Family involvement was documented, patients and carers attended multidisciplinary team (MDT) meetings. MDT meetings were regular and consistent. Detailed discharge planning was in place for each of the patients.

We reviewed 4 care records for Wortham ward. We saw evidence of professional involvement and interventions in place. Physical and mental health needs of patients were addressed and consistently monitored. One patient had his family involvement mentioned in care records. However, there was little or no patient involvement in care planning, most interventions were professionally driven, prescriptive, and no family involvement or views expressed.

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. The interventions were recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies and, in rehabilitation wards, activities, training and work opportunities intended to help patients acquire living skills.

Staff described how therapy catered for people at different stages of their recovery. The team included or had access to the full range of specialists required to meet the needs of the patients. As well as doctors and nurses we saw occupational therapists, clinical psychologists, pharmacists, speech and language therapists, dieticians, specialist autism spectrum disorder and learning disability psychologists and a positive behavior support practitioner.

Staff described how sessions were adapted to meet communication styles and needs. Staff were involved with discharge planning and care program approach meetings with patients and their carers. Staff held therapy groups on the wards, patients had a choice if they struggled with group work, of an individual bespoke session. Psychology sessions included trauma informed work (therapy through the eyes of the patient, compassion rather than judging behaviour response), and a peer led group (patients experience of hearing voices). On Wortham ward there was a fire prevention group, a bespoke package designed with the fire service. The team also provided a bespoke substance misuse treatment program.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. There was regular involvement from local GP practices and dietitians.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

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 team (MDT) meetings which patients and carers were invited to attend. Therapy teams contributed to all joint meetings. Staff told us they shared information about patients at effective handover meetings within the team. Staff told us in the bungalow handovers they discussed observations, risks, care plans, activities, appointments, food, fluid, personal hygiene, medication and new patient information. The teams had effective working relationships, including good handovers, with other relevant teams within the organisation. The teams had effective working relationships with teams outside the organisation including local GP surgeries and providers. Staff from the bungalows spent time working with their new patients in other organisations as part of their transition before moving.

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 monitored the physical needs of patients and involved specialists including occupational therapists, GPs and dietitians. The patients social club ran a weekly healthy eating session to encourage preparing and eating healthy foods.

Occupational therapists told us they took patients out of the ward regularly for walks in the community and to encourage the use of public transport. There was a gym in the local community that patients could access. On Wortham ward there was a pool table and exercise bike in the communal room. There was a café for patients use to purchase drinks and snacks and meet up for social contact.

The hospital had a physical health team, staff told us they supported patients with physical health issues such as diabetes and had a wellness clinic at the weekend when staff monitor patients’ vital signs. Patients had a wide choice of foods to choose from for their meals.

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 used recognised rating scales to assess and record severity and outcomes and staff regularly monitored patients’ health. Staff completed the generalised anxiety disorder (GAD) assessment and 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.

In 1 of the bungalows staff monitored the patients’ incidents, we saw a graph on the wall in the communal area. Staff told us how this had had a positive effect on the patient.

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. In the bungalows staff told us if a patient did not have capacity, they held a best interest meeting and had regular discussions at handover and multidisciplinary team (MDT) meetings about their best interests and how to meet them.

We saw evidence in care records of capacity assessments and family involvement. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis about significant decisions.