Richmond 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 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 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.

We reviewed 5 care records during the inspection. Staff completed a comprehensive mental health assessment of each patient in a timely manner as part of the admissions process.

Staff assessed patients’ physical health needs in a timely manner after admission. Assessments and care plans included a physical health care plan and monthly health monitoring was in place.

Care plans were personalised, holistic, recovery-oriented and completed in the patient’s voice. Staff took account of individuals’ communication preferences and needs, ensuring that patients could understand and engage with their care planning. Discharge planning was clearly documented in the care plan section of patient’s files.

Communication needs and preferences were clearly recorded, and where necessary, staff adapted their approach using various methods to improve the patient’s understanding and involvement. All care plans were updated as part of the multidisciplinary team meeting.

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 those recommended by, and delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medication and psychological therapies, activities, training and work opportunities intended to help patients acquire living skills. Patients told us they volunteered at a local foodbank, they had work placements, and they attended local community groups.

Patients had timely access to physical healthcare support and were referred to specialists if required. All patients had been signed up to a local GP and dental surgery.

Staff assessed and met patients’ nutritional and hydration needs, including referral to specialist dietary support where needed. Staff supported patients cooking evening meals on a rota basis and patients prepared their own lunches.

The hospital developed the provider specific Drake Award Program to empower individuals to lead engagement activities based on their hobbies, interests and needs, promoting independence. Participants earned internal awards for achieving goals and building life skills. Patients we spoke with were keen to show us their Drake awards and described how much the awards benefited them.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, patients had regular support from occupational therapists, psychologists and dietitians.

occupational therapists, psychologists and dietitians

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. All new staff, including bank staff, were provided with appropriate induction.

Managers ensured that staff had access to regular team meetings. Managers provided staff with supervision and appraisal of their work performance. The percentage of staff that received regular clinical supervision was 98% in the 3 months leading up to inspection. In the same time period, 83% of staff had received managerial supervision. The percentage of staff that had had an appraisal in the last 12 months was 100%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

100% 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, which staff had access to.

Patients had easy access to information about independent mental health advocacy, which included easy read information.

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 had been granted.

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.

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 multidisciplinary meetings to discuss patients and improve their care. Daily meetings took place with a range of staff from all disciplines. These meetings were effective in discussing a range of issues including changes to patients’ risk, incidents, changes in observation levels, section 17 leave, medication and patient views.

The teams had effective working relationships, including good handovers, with other relevant teams within the organisation.

The service had effective working relationships with teams outside the organisation. For example, local authority social services, GPs, dentists, care co-ordinators and community mental health teams.

The manager and senior leaders attended regular regional meetings.

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 supported patients to live healthier lives. For example, patients were supported monthly by the dietician who attended the ward every 4 weeks. As part of the dietician’s role, they supported patients to set care plan objectives to help them make healthier choices.

Health promotion was delivered by the teacher and practice nurse and covered a range of topics relevant to the patient group. This included, physical and mental health awareness, oral health, haircare, foot care and breast awareness.

The service used easy read information to support patients to understand relevant health information and procedures.

All patients had an external gym membership, which enabled them to attend with supporting staff. This was funded by the provider. Due to a low uptake the service arranged for patients to have private sessions with a personal trainer at the external gym bi-weekly to support in building up motivation and confidence to attend.

The service was a non-smoking site, any new admissions were made aware of this during their initial assessment, and smoking cessation was offered. Psychology staff offered drug and alcohol awareness sessions. Patients identified as having risks associated with drug and alcohol were offered additional support.

Ward activities helped promote a healthy lifestyle for patients – for example walking groups, knit and natter and cooking healthy meals.

Staff used the Life Skills Profile (LSP) with patients. The LSP is an assessment tool, which evaluates functioning in daily life activities and assesses self-care, including grooming and hygiene, social skills, like initiating conversations and showing warmth, and compliance with routines and treatment plans.

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 suitable for the client group. For example, staff used Learning Disabilities Clinical Outcomes in Routine Evaluation (LD-CORE-30). The CORE system comprises tools and advice to support monitoring of psychological recovery, health and well-being and has been developed for use with people with learning disabilities. Staff also used the DIALOG scale, where patients rate their satisfaction with 8 life domains and 3 treatment aspects on a 7-point scale, and HoNOS – Secure, (Health of the Nation Outcome Scales for use in secure and forensic mental health services).

The Brief Psychiatric Rating Scale (BPRS) was also used which is a rating scale which is used to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour.

Outcome data was regularly recorded and reviewed to support care planning, monitor change, and adjust treatment where needed.

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. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately on a decision-specific basis.

Staff complied with the Mental Health Act 1983, ensuring patients’ rights were upheld and clearly communicated both verbally and in writing, including the right to appeal. Section 132 rights were explained on admission and revisited regularly, or when there were changes to Mental Health Act status, Responsible Clinician, or treatment plans. All readings were consistently documented in patients care records. Consent to treatment forms (T2 and T3) were present, well-organized, and accurately completed. No concerns were identified in the records reviewed.