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Inspection Summary


Overall summary & rating

Good

Updated 2 January 2020

We rated Bradley Complex Care as Good because:

  • Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice. This included access to psychological therapies, support for self-care and the development of everyday living skills and meaningful occupation. Staff supported patients with their physical health and encouraged them to live healthier lives. Staff used recognised rating scales to assess and record severity and outcomes.
  • The hospital included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The hospital staff worked well together as a multidisciplinary team and with those outside the hospital who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They involved patients in decisions around their care and treatment.
  • Staff managed admissions and bed occupancy well and ensured patients always had a bed on return from leave. They carefully planned patients’ discharges with external services to make sure this went well and supported patients when they were transferred to prevent readmission.
  • Managers had the skills and experience to perform their roles, Staff felt supported and able to raise concerns without fear. The provider had an effective governance structure to monitor and improve performance.

However:

  • The service did not have enough night time medical cover available to attend the hospital quickly in an emergency. Managers could not be assured that staff were recognising incidences of seclusion and therefore keeping appropriate records which are required to ensure the necessary safeguards are applied.
  • The hospital environment had some areas where staff had limited visibility and some of the apartments had bathrooms which were damp and musty.
  • Staff did not document all the patient’s needs in their care plans and ensure that they were recovery orientated. Records did not clearly show the patient’s discharge plans.
  • Staff did not fully involve families and carers in decisions around the care and treatment of the patient.
  • The service did not always use effective communication formats for patient information such as signage and care plans. 
Inspection areas

Safe

Requires improvement

Updated 2 January 2020

We rated safe as requires improvement because:

  • The service did not have enough night time medical cover available to attend the hospital quickly for a psychiatric emergency.
  • Managers could not be assured that staff were recognising incidences of seclusion and therefore keeping the appropriate records which are required to ensure the necessary safeguards are applied.
  • The hospital had some blanket restrictions in place, however these were being addressed during our inspection.
  • One apartment in the hospital did not allow staff to observe all areas; there was limited visibility from the kitchen area.
  • The bathrooms in some apartments were inadequately ventilated with a damp and musty smell.

However:

  • The service had enough nursing and medical staff during the daytime, who knew the patients and received basic training to keep patients safe from avoidable harm. They had reducing rates of agency staff and had improved recruitment checks and the induction process for those agency staff used.
  • Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. All staff were trained in appropriate restraint techniques.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s physical health.
  • The hospital had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learnt with the whole team.

Effective

Good

Updated 2 January 2020

We rated effective as good because:

  • Staff assessed the physical and mental health of all patients on admission. They developed individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapies, to support for self-care and the development of everyday living skills, and to meaningful occupation. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes.
  • The hospital included or had access to the full range of specialists required to meet the needs of patients. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.

However:

  • Staff did not ensure care plans were recovery orientated or that they reflected all assessed needs.
  • Staff did not always ensure a patient’s rights were explained without delays on admission.

Caring

Good

Updated 2 January 2020

We rated caring as good because:

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.
  • Staff understood the individual needs of patients and supported them to understand and manage their care, treatment or condition. Patient meetings were person-centred and conducted in a way to fully involve the patient in decisions.
  • Staff ensured that patients had easy access to independent advocates.

However:

  • Staff did not always involve families and carers in decisions around the patient’s care and treatment.

Responsive

Good

Updated 2 January 2020

We rated responsive as good because:

  • Staff managed admissions and bed occupancy well and ensured patients always had a bed on return from leave.
  • Staff carefully planned patients’ discharges with external services to make sure this went well and supported patients when they were transferred to prevent readmission.
  • The design and layout of the hospital supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and easy access to outside space.
  • When appropriate, staff supported patients to self-cater. They could make hot drinks and snacks at any time.
  • Staff supported patients with activities. These included outside the service.
  • The hospital met the cultural and spiritual needs of patients who used the service and made adjustments for those with physical disabilities.
  • The service treated concerns and complaints seriously, investigated them and learnt lessons from the results, and shared these with the whole team.

However:

  • Staff did not clearly document a patient’s discharge plans in their care and treatment records.
  • Patients were not always offered a secure place to store personal possessions.
  • The service had limited information around the hospital and in patient records which was in a format to support effective communication.

Well-led

Good

Updated 2 January 2020

We rated well-led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for patients and staff.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.
  • Our findings from the other key questions demonstrated that governance processes operated effectively at hospital level and that performance and risk were managed well.
  • Staff had access to the information they needed to provide safe and effective care and used that information to good effect.
Checks on specific services

Forensic inpatient or secure wards

Good

Updated 5 April 2018

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 2 January 2020