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Inspection carried out on 29-30 November 2017

During a routine inspection

We rated Raglan House as Good because:

  • Morale amongst staff at the service was excellent. The registered manager and head of care were described as providing consistent, effective and visible leadership and staff reported that working as part of the multi disciplinary team was like being part of a family.
  • Staff at the service completed a range of environmental and individual risk assessments to ensure the safety of patients receiving care. Detailed contingency plans were in place in the case of emergencies and all patients received a review of their presenting risk on a daily basis.
  • Care plans were detailed, holistic and recovery focussed. We found evidence that patients were assisted from the point of admission to identify and achieve their rehabilitation goals, and to work towards increasing independence and eventual discharge from the service.
  • Sufficient numbers of skilled staff were available and patients were able to access nationally recognised therapeutic interventions, including psychology and occupational therapy. Professional development was encouraged by senior staff and monitored through the routine use of clinical and managerial supervision.
  • A comprehensive audit programme was in place and completed by staff to ensure the delivery of a high quality service. Action plans were developed based on audit results and improvement was evident where previous results had not reached the required standard set by the provider.
  • Patients and carers that we spoke with provided positive feedback in relation to the care and treatment provided by staff at the service. We were told that staff treated patients with kindness, dignity and respect, and that families and carers were routinely involved in the care planning process.
  • Effective governance procedures were in place at a local and national level to monitor the quality of the service. The registered manager met routinely with the leaders of other hospitals to share good practice and to ensure lessons were learnt as an organisation when things did not go as planned.
  • Staff and patients reported an open culture where they felt safe to raise concerns if necessary and were assured they would be supported by to do so. We found that where complaints or concerns had been raised, staff had responded promptly and duty of candour was evident where appropriate.

Inspection carried out on 11th-12th January 2016

During a routine inspection

We rated Raglan House as good because:

  • There had been a recent ligature risk audit of the service in October 2015, this contained detailed information and plans to mitigate risks identified. The clinic room for the storage of medication was well maintained. Equipment was present and checked in line with manufacturers recommendations. All areas were clean and furniture was in good order. All cleaning records reviewed were up to date and complete.
  • Staff vacancies and sickness levels were low and the manager had access to bank staff that had been trained by the provider and were familiar with the patients and service. All shifts were covered by staff of a suitable discipline and skill mix. Most staff were up to date with statutory and mandatory training.
  • Risk assessments were present in all care records and were detailed and in date. The multi disciplinary team reviewed the risk and wellbeing of all patients on a daily basis and adapted the care provided to reflect changes.
  • All of the care records reviewed contained person centred and holistic care plans with a wide range of identified needs to support patients. Patients strengths and goals were evident in the care planning process and were reviewed regularly in 1:1 sessions and multi-disciplinary meetings. There was evidence of discharge planning in all eight of the care records reviewed
  • Medication audits and reconciliations were carried out regularly by qualified staff. All medication was stored securely.
  • Staff knew how to report incidents and there were robust governance structures to support them in doing so and to receive feedback.
  • All prescription charts had evidence of consent and capacity to consent to treatment being documented.
  • There was evidence of physical health needs being assessed and monitored and effective links had been established with the local general practice for information sharing and physical health monitoring.
  • Medication was prescribed in line with national guidance and regular audits were carried out to monitor this. Recognised outcome measures and rating scales were used by all disciplines to measure the effectiveness of interventions that were offered by the service..
  • Staff employed by the service had undertaken the appropriate checks to ensure they were skilled and qualified to provide quality care. Management systems were in place to address poor staff performance and this was reviewed through regular supervision and appraisal.
  • Specialist training was available for staff to support them in their role alongside statutory and mandatory training from the provider.
  • Well structured and effective staff handovers and multi-disciplinary team meetings took place daily and included a review of all patients and an updated risk rating.
  • We observed staff treating patients with dignity and respect. Staff had developed a good rapport with patients and showed awareness of their individual needs. Patients reported that they had regular 1:1 sessions with staff and that staff took time to listen to them and provide practical and emotional support.
  • Patients carers and families were involved in the care planning process when appropriate. Copies of leave forms could be provided if required and families and carers attended regular review meetings at the service.
  • A weekly community meeting for patients took place and provided an opportunity for patients to provide feedback into the running of the service.
  • There had been sixteen admissions and fourteen discharges from the service in the year prior to our inspection. This represented a patient throughput of approximately 50%. Eleven of the discharges that took place in the year prior to our inspection had been to step down or community services.
  • There was a variety of therapeutic and education based activities for patients to attend and feedback about these was positive. A range of rooms and facilities were available for patients including therapy kitchens, lounges, areas to carry out daily activities and a hairdressing salon. The occupational therapist and psychologist collaborated to deliver some groups to support patients and links had been made with local voluntary services and colleges for patients to attend.
  • Quiet areas were available for patients to use including a newly equipped sensory room. All patients who used this had individual sensory care plans to support them and followed a sensory diet sheet including strategies that were helpful for them when distressed.
  • Most patients we spoke to said that the food provided was of a good quality. Kitchen staff attended the weekly patient community meeting to discuss menu options with patients.
  • Interpreting services had been used to support patient and family involvement in the care planning process where English was not their first language.
  • Robust governance procedures were in place to enable patients to complain or register concerns. All complaints that had been registered had been investigated and patients had been provided with verbal and written feedback regarding the outcome. Duty of candour had been displayed by the services senior management team when responding to a complaint from patients about the structure of clinical meetings.
  • Most staff we spoke to knew and agreed with the organisation's values. All staff we spoke with described the principles of treating patients with dignity and respect.
  • All staff said they felt able to contribute to the running of the service and their views were listened to and valued by senior staff. Staff morale was good. All staff reported feeling supported and that there was a culture of team working and providing good quality care for patients.
  • There were effective systems for information and clinical governance in place on a local and provider level and regular meetings took place to review the services performance. Systems were in place to audit the effectiveness of the service, this included a monthly review of patient engagement in meaningful activity, staff education and training compliance levels and risk management.
  • All staff we spoke to described a strong culture of leadership and openness from the registered manager and that they felt comfortable to approach them if they had concerns. All staff said they felt able to raise concerns without fear of victimisation and were aware of the providers whistleblowing policy.
  • Staff were open and transparent with patients and we saw that duty of candour was exhibited when the service had made mistakes.

However:

  • We did not always see that where complaints had been upheld regarding staff behaviours and attitudes this was included in personnel files or addressed during the supervision or appraisal process. The registered manager and operations manager were made aware of this during our visit
  • We did not see individual risk assessments to reflect the use of the service's contraband list of banned items. This was not in line with Mental Health Act Code of Practice guidance. However, following our inspection, the provider was in the process of updating its policies and procedures. The use of a contraband list was discontinued.
  • Staff reported poor communication links with the local advocacy service. The registered manager was seeking to resolve this at the time of our inspection.

Inspection carried out on 30 December 2013

During a routine inspection

On the day of our inspection25 people lived at Raglan House. No one knew we would be visiting as our inspection was unannounced. We spoke to four people who lived at the hospital, two relatives, three staff, the head of care and the manager.

The people who lived at Raglan House had mental health care needs. People told us about their experiences, we looked at records and observed staff that cared for them. Staff we spoke to was able to tell us about people's needs so that they received care in a way that they preferred. One person said, �The staff are really knowledgeable and help me here.��

We saw that systems were in place to keep people safe from harm. A relative told us, �I am sure they are safe there.�� One person said, ��I like living here.��

We found that staffing levels were adequate to ensure that people�s needs were met and that they were safe.

There were systems in place to monitor how Raglan House was run, to ensure people received a quality service.

We saw that complaints processes were in place for people or their relatives to use if they were not happy with the service provided.

Inspection carried out on 14 January 2013

During a routine inspection

On the day of our visit there were 22 people living at the hospital. No one knew we would be visiting. We spoke to four people who lived at the hospital, three relatives, three staff, and the head of care.

The people who lived at the hospital had mental health care needs. People told us about their experiences, we looked at records and observed staff caring for them. Staff we spoke to was able to tell us about people's needs so that they received care in a way that they preferred. One person said, ��Staff really know how to help me here.��

Relatives told us they were kept informed about their relative's health so they felt involved in their care. One relative said, �Its� absolutely fabulous care, I can sleep at nights now she is there.��

We saw that systems were in place to keep people safe from harm. A relative told us, �They do seem to take a lot of care.�� One person said, ��I feel comfortable living here.�� Staff received a range of training to support the people who lived in the home. There were systems in place to monitor how the home was run, to ensure people received a quality service.

Inspection carried out on 23 February 2012

During an inspection in response to concerns

We spoke with the majority of people who used the service and were on the premises at the time of our visit. We spoke with staff of all grades and experience and the manager.

We spent the morning sitting with people in the communal areas, chatting with them and observing the interactions between people and staff. We looked at a selection of care records including risk assessments and support plans.

People told us that generally the staff were good and that they felt at ease and comfortable talking with the staff. People told us they have regular meetings and discussions with staff about the care and support they need. They told us that they have their own copy of their support plan. Staff told us of the support they offer to people each day. The information we saw recorded in the support plans was consistent with what staff and people had told us.

People told us the food was good and there was a choice available. Kitchen facilities are provided for people who wish to cook for themselves. We observed the lunchtime meal to be a lively and busy period.

Some people require one to one support from staff to help reduce the risk of harm to themselves and others. We saw staff providing this level of support in a calm and effective way. We did not see anyone waiting for help and support when it was needed.

The manager and staff told us they feel that the current staffing levels are sufficient to meet the needs of people. The manager told us of the contingency plans for other staff to be available if there are any changes to the level of support people need.

Staff told us of the training programme that is arranged for them. All staff we spoke with told us they felt the training was sufficient for them to do their job.