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Inspection Summary


Overall summary & rating

Good

Updated 10 August 2018

We rated Richmond House as good because:

  • Staff completed detailed risk assessments using recognised tools that included comprehensive risk management plans. Staff updated individual risk assessments following incidents. Staff knew what incidents should be reported, incidents were reviewed and feedback distributed to staff via the Friday meeting and during staff handovers. The levels of incidents and physical restraints had reduced since the last inspection.
  • Overall service specific mandatory training compliance for staff was 100%. Safeguarding adult training compliance was 100% and for safeguarding children was 100%. Staff received supervision in line with the provider’s policy, attending both 1:1 supervision and group reflective practice sessions.
  • The provider had estimated staffing levels for each shift and the numbers and mix of staff was adjusted to take into account of patient need and safety. The manager ensured the consistency of agency staff booked to provide continuity of care for patients.
  • A comprehensive ligature risk assessment was in place. This was updated regularly. The provider had mitigated risks posed by obstructed lines of sight by the use of convex mirrors. New bedroom windows had been fitted to ensure that patients were safe and risks were mitigated. The provider had refurbished the bathrooms and wash hand basins in bedrooms with anti-ligature fixtures and fittings. Staff and patients kept the service clean.
  • Patients accessed regular physical health care through visits to a local GP. Care records showed that staff monitored patients’ physical health needs throughout their admission.
  • Staff encouraged and supported patients to access opportunities to aid reintegration with the local community.
  • Staff held regular multi-disciplinary team meetings and encouraged patient attendance to contribute to their care and treatment programmes. Patient records contained detailed information relating to individual rehabilitation.
  • We observed caring and compassionate interactions between staff and patients. Patients told us that staff were caring and approachable, and most said they felt safe on the unit. Patients were involved in developing care plan goals, and completed a document that included their goals, strengths and how they liked staff to support them.
Inspection areas

Safe

Good

Updated 10 August 2018

We rated Richmond House as good for safe because

:

  • We identified positive reductions in restrictive practices linked to individualised risk assessments. Staff had completed detailed risk assessments using recognised tools that included comprehensive risk management plans. Staff updated risk assessments following incidents.
  • The unit had a comprehensive ligature risk assessment in place with risk mitigation clearly identified. For example, the provider had mitigated risks posed by obstructed lines of sight by the use of convex mirrors.
  • The provider had refurbished the bathrooms and wash hand basins in bedrooms with anti-ligature fixtures and fittings. New bedroom windows had been fitted to ensure that patients were kept safe and risks were mitigated
  • Staff and patients kept the unit visibly clean.
  • The provider had estimated staffing levels on the unit and the numbers and mix of staff was adjusted to take into account of patient need and safety. The registered manager had block booked agency staff to provide continuity of care for patients.
  • Overall mandatory training compliance for staff was 100%.
  • Staff knew what incidents should be reported, all incidents were reviewed and feedback distributed to staff via the Friday reflection meeting and discussion in monthly rehabilitation staff meetings.

Effective

Good

Updated 10 August 2018

We rated Richmond House as good for effective because

:

  • Patients accessed regular health care monitoring through visits to a local General Practice and visits to a local dental surgery. Care records showed that staff monitored patients’ physical healthcare needs throughout their admission.
  • The staff team completed pre-admission assessments, collecting historic risk information and worked closely with the patient’s previous placement.
  • Psychology staff delivered specialist treatment programmes, working to models recognised for use in rehabilitation services.
  • Occupational therapists provided rehabilitation programmes and encouraged patients to access opportunities to aid reintegration with the local community.
  • New staff received a thorough induction programme and bank and agency staff received information before working on the unit.
  • Staff accessed regular reflective practice sessions as part of group supervision.
  • Patient records contained detailed information relating to leave entitlement and outcomes.
  • All staff had received training in the Mental Health Act and Mental Capacity Act and followed the guiding principles.
  • Staff received supervision in line with the provider’s policy, attending both 1:1 supervision and group reflective practice sessions. The current compliance rate was 94% for June 2018.

Caring

Good

Updated 10 August 2018

We rated Richmond House as good for caring because

:

  • We observed caring and compassionate interactions between staff and patients.
  • Patients told us that staff were caring and approachable, and most said they felt safe on the unit
  • Patients were involved in developing their care plan goals, and had completed a document that included their goals, strengths and how they liked staff to support them.
  • Staff allocated patients a buddy on admission to assist with settling in and becoming familiar with the unit
  • Patients accessed advocacy services who visited the service weekly.
  • The unit held weekly community meetings to offer patients the opportunity to make complaints or contribute to the service.

Responsive

Good

Updated 10 August 2018

We rated Richmond House as good for responsive because

:

  • Staff regularly discussed discharge planning as part of multi-disciplinary and professionals meetings. Discharge planning commenced at the point of admission and staff on the unit focussed on treatment, recovery and reintegration back into the community.
  • The service had a large kitchen for cooking classes and a patient lounge where groups were held.
  • Patients could personalise their bedrooms, and communal areas on the wards contained art work and items designed and chosen by patients.
  • Patients attended weekly activity planning meetings to contribute to ward activity timetables and to plan their meals for the week ahead.
  • The service offered a range of activities including group sessions on mindfulness and relaxation, cooking and gardening sessions.
  • Patients had a rota for cooking and each cooked one meal per week. Patients chose what they wanted to cook with input from staff and a weekly menu was agreed at the community meeting. The service provided easy read and visual information leaflets on treatment, activities and local services in an admission pack that patients had been involved in writing.
  • The service had a clear complaints and feedback policy that patients were all aware of and all formal complaints were investigated and responded to.
  • Patients accessed spiritual support, with regular visits to local churches. Diets for specific health or religious needs were available.
  • The unit had a record of compliments received.

Well-led

Good

Updated 10 August 2018

We rated Richmond House as good for well led because

:

  • Staff reported high visibility of the senior management team, offering regular support and visits to the unit.
  • The provider’s electronic dashboard allowed the manager to see an overview of staff training, supervision and appraisal compliance, linked to staff performance. This allowed the unit manager to monitor compliance with the provider’s key performance indicators.
  • The unit manager and staff demonstrated a strong recovery focussed approach for patients linked to the provider’s vision and values.
  • The unit manager held and regularly updated a unit specific risk register.
  • The overall sickness rate on the unit was below three percent.
  • Staff morale and job satisfaction was high across the unit. Staff felt involved in decision making and were actively involved in improving the care and treatment delivered to patients. There were no reported incidents of bullying or harassment at the time of the inspection.
  • Staff recognised the importance of strong team working and support for colleagues.
  • Staff demonstrated an understanding of the duty of candour and implemented this in their practice and approach towards patients.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Requires improvement

Updated 20 July 2016

Wards for people with a learning disability or autism

Good

Updated 10 August 2018