Bradley Complex Care

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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.

Good: Staff assessed the physical and mental health of all people 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 people 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 people on the ward. Staff from different disciplines worked together as a team to benefit people.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

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 assessed mental and physical health needs holistically and there was a multidisciplinary approach to delivering care and treatment. We looked at 6 care records and found staff developed plans that met the needs identified during assessment. Relatives told us they were involved in providing information about their loved ones and confirmed that the hospital worked with other services involved in their care and supported them with external appointments. One external partner told us, “The individual has access to lots of practitioners and can engage in a way best suited to them. They are supported with flexibility and can join groups as they wish and on an informal basis. Reasonable adjustments are made in the way practitioners engage with the individual based on observations and individual assessment.”

Care records were reviewed every 3 months or after any changes. They included observations and evidenced regular physical health reviews were taking place. We identified missing medications in the Health Action Plans but saw evidence that other areas of the plan such as contact with external partners such as GP’s, dentists, physiotherapists, advocates and social workers was positive. The care records were person-centred, with clear discharge goals and ongoing review of needs and abilities.

The hospital employed a physical healthcare coordinator, who we spoke with. We were told that a health report was completed yearly for all people using the service. This included diagnoses, allergy information, height, weights, blood pressure and BMI, any action following tests, annual health check and last appointments with the dentist, podiatry and hospital appointments and actions required from these.

We scored the service as 2. The evidence showed some shortfalls. Staff did not always understand their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice. However, the service planned people’s care and treatment with them, including what was important and mattered to them and mainly did this in line with legislation and current evidence-based good practice and standards. Staff provided a range of care and treatment interventions, including psychological therapies, occupational therapeutic activities, opportunities for education and tutoring intended to help people acquire living skills. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence.

The team included or had access to the full range of specialists required to meet the needs of people in the service. As well as doctors, nurses and healthcare assistants, the service had an occupational therapist and assistants, forensic psychologist and assistants and a speech and language therapy team.

Staff ensured that people had good access to physical healthcare, including access to specialists when needed, such as dentists, GPs and the acute hospital.

The service facilitated one to one sessions with all people using the service and following assessment completed individual intervention plans, in relation to personal care, food and drink needs, cooking, introducing aids to support independence and personalised care.

Staff assessed and met people’s needs for food and drink and for specialist nutrition and hydration.

Staff were experienced and qualified, and they were receiving the training and knowledge to meet the needs of the patient group. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge.

Managers provided new staff with appropriate induction, training and shadowing opportunities to ensure they were confident and competent within their role.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. We were informed that staff received regular supervision and overall compliance at the time of inspection was 95%. The overall compliance for staff appraisals was 91%. However, 3 out of 10 support workers we spoke with told us that their supervision notes were not kept confidential as we were told these were being filed by a member of staff who was not the supervisor. Following our assessment the hospital informed us that they understood their process was in line with data protection and that the information governance lead and human resources lead had access to supervision notes for storage, management and auditing purposes. We reviewed the organisations policy and supervision contract which stated “Records of supervision sessions should be agreed and maintained between the supervisor and the supervisee. Clinical supervision notes will not be routinely accessible other than by the supervisor and supervisee.” The policy did not make any reference to the IG or HR lead having access.

Managers ensured that staff had access to regular team meetings, morning and evening handovers. We reviewed minutes of handover meetings, staff meetings nurse and therapies department meetings. The provider also shared minutes from a nurse and team leaders away days. The agendas were thorough including topics such as safeguarding, lessons learnt, incident reviews, performance, feedback and celebrating successes.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. Managers told us relevant guidance from the National Institute for Health and Care Excellence was reviewed, updated and fed back to the team.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

The provider informed us that staff received training in the Mental Health Act however, they did not provide a compliance figure. Most staff we spoke with had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles and they had access to local Mental Health Act policies and procedures and to the Code of Practice that reflected the most recent guidance.

Staff also had 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. People had easy access to information about independent mental health advocacy. We received feedback from the advocate who visited the service regularly. The advocate informed us that advocacy support is encouraged and the service is open to advocacy; staff listen to any concerns or views and wishes raised on behalf of people and these are dealt with appropriately. We were also told that Care and Treatment Reviews (CTRs) were conducted regularly and keyworker referrals made. We did not identify any concerns regarding people being explained their rights under the Mental Health Act.

Staff ensured that people were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. We received feedback from staff and external partners who told us Section 17 leave “seems to be going well and managed better since the change in leadership.”

We reviewed 6 medication records and identified some inconsistencies with the prescription charts. We were aware of recorded issues raised back to the provider from section 61 reports (Section 61 of the Mental Health Act requires providers to report certain events and certified treatment to the regulatory authority). The last of these issues were identified in October 2025 and a further issue during our inspection. The service informed us that monthly audits were completed to ensure all relevant consent to treatment authorisations are current and in place in each person’s medication folder, however it was apparent that this process needed to be more robust.

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 meetings, which included people and families as partners in their care. The service held monthly independent care review meetings for all people using the service. The service invited relatives and external partners to these meetings on a quarterly basis.

Staff shared information about people at effective handover meetings within the team. We reviewed reports from handovers, which included the handover of information such as people’s presentation, immediate actions for people, planned activities, appointments, and physical health monitoring.

The teams had effective working relationships with teams and organisations outside the service, for example adult safeguarding teams, community mental health teams, social workers and other community services including the police.

Care records evidenced regular contact with partners. We received feedback from external partners who told us that “Care and Treatment Reviews are well supported with participation from across the MDT and sharing of information ahead of the 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.

We saw evidence in care records that staff supported people in terms of managing any physical and mental health risks, dentistry, monitoring food and fluids managing and reviewing medications.

The service had easy read posters regarding healthy eating in the service, and they informed us that meal choices aligned with individual health needs, dietary requirements, preferences and cultural considerations. We received some feedback from staff that there was not sufficient food for the whole week due to the budget. We checked this during our inspection and found that there was a varied amount of food depending on the apartment but we were told shopping was due to be done on the day of inspection. The hospital had plans in place to develop a central kitchen.

We were also informed that activities helped to promote a healthy lifestyle for people and that activities were individual needs led, for example walking, sports activities, including access to the gym and swimming and working with people regarding budgeting and healthy meal planning.

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 told us they completed training that enabled them to best support the needs of people who used the service. Staff feedback was positive and training compliance rates were good. For example, all staff completed training on learning disability and autism, and staff were 100% compliant at the time of our inspection. Nurse managers completed leadership and management training, and all support staff were supported to complete the Care Certificate (a set of standards for health and care professionals to provide compassionate, safe and high-quality care and support).

We spoke to the team about outcomes for people and we were given some examples about meeting their needs and their goals, for example staff were exploring options to support a person’s ability to understand different languages and we observed and saw reference in people’s communication care plans about a positive use of social stories to support understanding around a range of daily living skills and other practical activities.

The service had a focus on the regular review of incidents themes and trends and any use of restraint. This data was used to make changes to peoples care plans and the staff’s approach to meeting needs. We observed a discussion in the independent care reviews that we attended. Data highlighted specific days or times of distress and a positive multidisciplinary discussion was held. Action was being taken to make changes to try and reduce these times of distress, for example one person was having gradual exposure to their support team following evening handover, for another person it was ensuring the service had stock of a specific drink and these changes would be added to a person’s positive behaviour support plan.

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 we spoke with were trained and had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Training compliance at the time of our inspection was 96%.

We looked at 6 care records which demonstrated consideration of a person’s capacity to consent. Capacity assessments were carried out as appropriate and were both time and decision specific. Records demonstrated that best interest decisions were carried out, when appropriate and involved the person's family or advocate.

The service conducted regular reviews for people and regularly reviewed the restrictions it imposed on people. Audits were in place to monitor consent and Mental Capacity Act practices to ensure they were only in place when necessary.

People had access to advocacy. The independent advocate we spoke with told us that people were supported to maintain relationships and understand their rights. Practices regarding consent and record keeping were actively monitored and reviewed to improve how people were involved in making decisions about their care and treatment. The service engaged with people who use services and their relatives and other carers, to make decisions based on a person’s best interests and ensured these were made in accordance with legislation and people’s wishes, feelings, culture and history.