Dunnock View

On this page

• 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 is the first assessment for this newly registered service. This key question has been rated good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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.

The service maximised the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. All patients received a comprehensive mental state assessment by a nurse and a doctor on admission. This included an assessment of the patient’s capacity to consent to admission and treatment.

Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff reviewed patients’ physical health on admission and at least once a week thereafter. This included checks of patients’ temperatures, pulse, oxygen saturation and blood pressure. Staff carried out an electrocardiogram on patients, prior to administration of antipsychotic mediation.

Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. We looked at 6 patient care plans and they were all personalised and recovery orientated. Plans for treatment set out the patients’ goals, as well as arrangements for occupational therapy, psychology and risk management. They included the views of patients and carers.

The service planned and delivered people's care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Patients were typically admitted to the ward with acute mental illness. Care and treatment involved prescribing medicines and offering therapeutic activities, individual psychology and group therapy. Psychology staff provided evidence-based treatments such as cognitive-behavioural therapy (CBT), dialectical behaviour therapy (DBT), eye movement desensitisation therapy (EMDR) and family therapy. One family member told us that their loved one was benefitting from individual therapy with a psychologist which they had not been offered during multiple previous admissions at other hospitals.

The National Institute of Health and Care Excellence (NICE) recommends that people with an acute exacerbation or recurrence of psychosis or schizophrenia should be offered oral antipsychotic medication in conjunction with psychological interventions. Records showed that care and treatment was consistent with this guidance. Staff offered cognitive-behavioural therapy for psychosis at the hospital.

In addition to providing medicines and psychology, the service provided therapeutic activities and support with life skills. The service had introduced an initiative where therapeutic activities were being co-facilitated by occupational therapists and psychologists to enable patients to benefit from a multi-disciplinary approach. Examples of groups offered included mindfulness, yoga, baking and journalling. One patient was being supported to deliver yoga and fitness sessions to their peers.

At the time of inspection, staff were developing plans for the chef and maintenance assistance at the hospital to offer baking and DIY sessions to patients, and housekeeping staff were working with managers to develop a safe cleaning kit which patients could use to clean their own bedrooms and bathrooms to foster independence and develop life skills.

Some patients told us there were less activities organised at weekends. This was reflected in the April clinical governance meeting minutes where it was discussed there was a need to increase engagement in ward-led activities on Brant Ward. However, on Fieldfare ward healthcare assistants had used their initiative to facilitate activities and this had contributed to a reduction in incidents, increased patient satisfaction and a positive atmosphere on the unit. Staff had been facilitating baking, community walks, shopping trips, and taking patients to the Therapy Hub.

Staff used technology to support patient care. At the time of inspection, this included video calls with relatives during meetings about patient care.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. We spoke to a doctor who told us that all patients have a physical examination on admission. We saw evidence of this in patient care records. Staff undertook physical health observations every morning and there was a physical health nurse at the hospital. A GP came in every Friday to review patients with physical health issues and there was always a doctor on call who would manage and see any unwell patients out of hours. If any escalation was needed, patients would be taken to the local general hospital for further assessment and treatment.

Managers used results from audits to make improvements. We saw an example of an audit of headbanging incidents being undertaken at the hospital.

Managers supported permanent staff to develop through yearly, constructive appraisals of their work. 134 out of 154 staff (87%) were up to date with their appraisal. Appraisal meetings involved reviewing objectives, a review of knowledge and skills, training, professional registration, a summary of performance and setting objectives for the following year.

Managers supported staff through regular, constructive clinical supervision of their work. Clinical and managerial supervision compliance was 92% across all wards at the time of inspection.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. All the staff we spoke with were very positive about the personal and professional development opportunities that were available to them as an employee of Elysium and felt supported by their managers to develop in their careers.

Managers dealt with poor staff performance promptly and effectively. The hospital director was able to give examples of where poor performance had been addressed by disciplinary or HR processes.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. At these meetings, staff reviewed the patients’ progress and the effects of medication.

Staff made sure they shared clear information about patients and any changes in their care, including during handover meetings. Nurses and healthcare assistants held a handover meeting at the start of each shift. The multidisciplinary team met each day to review risks and incidents.

Ward teams had effective working relationships with external teams and organisations. For example, the wards had regular contact with the independent advocacy service. Managers also worked closely with bed managers in NHS trust’s that placed patients at the service. Bed managers were invited to ward rounds and multidisciplinary team meetings to discuss the progress of, and plans for, their patient.

Information relating to care, advocacy access, activities, communication needs and feedback on care were displayed on the ward notice board for patients.

The service supported people to manage their health and wellbeing so they could maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff identified patients’ physical health needs and recorded them in their care plans. Staff conducted checks of each patient’s pulse, temperature, weight, height and blood pressure each week.

Staff made sure patients had access to physical health care, including specialists as required. Patients were seen promptly by a doctor when they felt unwell.

Ward activities helped promote a healthy lifestyle for patients – for example fitness sessions, Zumba, yoga and walking groups.

Staff continuously monitored patients’ health, their mental state and well-being. At twice daily handover meetings, staff noted details of patients’ sleep, food and fluid intake, personal hygiene, compliance with medication, and engagement in activities. Any changes in a patient’s presentation were discussed at the daily multidisciplinary team meeting.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes.

The service told people about their rights around consent and respected these when they delivered person-centred care and treatment.

Staff assessed each patient’s capacity to consent to admission and treatment on admission. Capacity was monitored and recorded at multidisciplinary team meetings. Records showed that these assessments covered the four elements of capacity.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the Act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

When staff felt a patient may have lacked capacity to make a decision, staff provided support.

Staff engaged with patients’ families to understand each patient’s history and interests.