Millbrook

Our rating of this location stayed the same. We rated it as good because:

• The ward environment was clean.
• Staff assessed and managed most risks well and stored medicines safely. Staff kept the use of restrictive practices to a minimum.
• Staff developed holistic, recovery-oriented care plans using the recovery star. Patient goals were now more clearly identified and detailed in the recovery star outcomes.
• There were good systems to ensure that staff oversaw and promoted patients’ physical health.
• While there were some staff vacancies, managers had filled most of these posts and they got regular agency and bank staff to cover the shortfalls
• Staff screened patients for any psychological needs and, when patients needed psychological input, this was provided or considered.
• Staff provided recovery-focused care which helped patients to develop their independent living skills and in line with national guidance about best practice.
• Managers ensured that staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
• Patients were exceptionally positive about the care they received from staff and felt actively involved in care decisions. All the patients interviewed felt safe. Carers were also highly satisfied with the service.
• The service had successfully discharged several patients with complex needs with better than expected rehabilitation outcomes for these patients.
• There were good links with the local community and the newly appointed occupational therapist was working to develop these further.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. Where discharge was delayed, this was outside of the hospital’s control.
• Managers had a vision for the model of mental health rehabilitation they wanted to provide. Staff felt the new managers were very approachable. Staff reported improved morale and were now confident and optimistic that they were being managed by staff who knew Millbrook well.

However:

• Staff had not acted quickly enough to resolve an issue relating to the fire safety risk audit from December 2021. For example, a drum-coiled electricity extension lead was still in use despite advice stating this should not be used due to the risk of overheating. In addition, you did not have a personal evacuation plan for a patient who refused to evacuate during a recent fire drill. These were addressed during the inspection.
• Staff had not notified us of a recent safeguarding incident. This was addressed shortly after the inspection.
• Staff were not always recording the expected or actual return time and/or outcome of agreed leave for detained patients. There had been a small number of instances where patients had been slightly late from their specific authorized section 17 leave. It was not clear that staff had discussed lateness as part of the outcome of leave to promote adherence to any conditions of leave in the future.
• There was no formal review of treatment for one relevant detained patient which should have been done when the patient’s detention had been renewed as evidenced by a completed section 61 review form.
• One patient who had been at the hospital some time did not have an initial or substantive care plan, risk assessment or recovery star. They did have a detailed assessment and some care documentation from the previous provider when they were in the NHS acute wards. This was addressed shortly after the inspection.
• A small number of audits had not identified issues we found on inspection or did not reflect fully the provider’s own findings. They did not always clearly record what action had been taken to show shortfalls had been fully addressed or to prevent a reoccurrence. The provider had recently introduced a new system to better record evidence that actions have been completed.