Nelson House

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

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly and updated as needed. Staff provided a range of treatment and care for patients 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 patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

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.

We reviewed 6 care records during the assessment. Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Staff assessed patients’ physical health needs in a timely manner after admission. Staff developed care plans that met the needs identified during admission and regularly reviewed during their time on the ward.

The provider uses 4 standardised care plan templates. Care plans were personalised, and recovery-oriented but there was limited documented input from the therapy team. Care plans relating to occupational therapy and psychological intervention were stored elsewhere. Staff regularly reviewed and updated care plans when patients' needs changed. Most patients were aware of their current care plans and what their goals were for achieving discharge. It was documented when patients had been offered a copy of their care plan and whether they had refused or accepted.

All patients had up to date positive-behavioural support (PBS) plans in place which had input from patients, where they agreed to be involved, and the multidisciplinary team following a formulation session with the psychologist. These helped guide staff in ways to de-escalate patients according to their wishes. Although detailed and high quality, the PBS plans were lengthy and due to the format of the electronic patient record system, they were not able to be printed for patients in an accessible or easy read format. We were told that if a patient was admitted to the service and had a learning disability, their PBS plan would be created as an easy-read document on Microsoft Word and then uploaded to the electronic system where it would be referenced in the care plans.

Staff provided a range of care and treatment suitable for the patients in the service, which were delivered in line with best practice and national guidelines. Care and treatment on offer included both medication, occupational and psychological therapies. The ward had access to a range therapeutic activities that were suitable to the needs of the patient group on the rehabilitation ward.

The team included the full range of specialists required to meet the needs of patients, including doctors, nurses, support workers, an activity co-ordinator, occupational therapists and assistant, and a psychologist and assistant. Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Staff identified patients’ physical health needs and recorded them in their care plans. Patients who were prescribed high-dose antipsychotic medication, and medication that requires additional physical health monitoring such as clozapine and lithium received physical health checks as required such as regular blood tests and ECGs.

Staff made sure patients had access to physical health care, including specialists as required. All patients were registered with the GP surgery that was located next door. Staff supported patients to attend regular dental, optician and GP appointments.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Where applicable, patients had care plans relating to food and fluid intake and had food and fluid charts in place to monitor input.

Staff held regular multidisciplinary meetings to discuss patients and improve their care. Staff made sure they shared clear information about patients and any changes in their care, including during handover and weekly ward round meetings.

The service had effective working relationships with external teams and organisations. For example, local authority, social services and local NHS trusts, local GP surgeries and NHS dentists. The service has reinstituted the weekly visits of the advocacy service.

Staff supported patients to live healthier lives. Staff provided patients with healthy eating advice and there was a fitness instructor employed to support patients using the onsite gym.

Ward activities helped promote a healthy lifestyle for patients for example walking groups, sports activities and cooking healthy meals.

Staff used recognised rating scales to assess and record severity and outcomes, including the Vona du Toit Model of Creative Ability, DIALOG, Camberwell Assessment of Need, the General Anxiety Disorder Scale (GAD–7), the Patient Health Questionnaire (PHQ-9) and the Brief psychiatric rating scale (BPRS). These were used for both mental and physical health outcomes. Staff took part in clinical audits. They were supported by a regional quality improvement lead. Results from audits and quality assurance processes were used to make improvements.

Staff had a good understanding of the Mental Capacity Act, including the five statutory principles. Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and the service was 92% compliant.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. We saw evidence of decision-specific mental capacity assessments being completed for example to make financial decisions, attend a tribunal and to take part in an incident investigation.

All patient records reviewed had their consent to treatment documented and appropriate legal authorisations were in place. Patients had their section 132 rights regularly read to them and staff made sure they understood them. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. We saw evidence of best interest decisions recorded in patient records.