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John Munroe Hospital - Rudyard Good

The provider of this service changed - see old profile

We are carrying out a review of quality at John Munroe Hospital - Rudyard. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Good

Updated 30 January 2020

Our rating of this location for people requiring long term rehabilitation and care for their dementia improved. We rated it as good because:

  • The hospital provided safe care. The ward environments were safe and clean and fit for purpose. For example Rudyard ward had been adapted to meet the specific needs of patients with dementia . The wards had enough nurses and doctors to provide care and treatment for patients with dementia and for patients requiring long term rehabilitation. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff provided a range of treatments suitable to the needs of the patients on both the long-term rehabilitation and on Rudyard, the dementia ward. The hospital followed national guidance on best practice for all patients. Staff working on the long-term rehabilitation ensured that the orientation and quality of therapies helped patients in their recovery and rehabilitation. The focus for patients with dementia was to support the development of skills in decision making and help patients plan wherever possible. Staff working on Rudyard had received specialist training in the management of patients with dementia and all patients had access to independent advocacy services. Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The hospital worked to a recognised model of mental health rehabilitation and dementia care. It was well led and the governance processes ensured that ward procedures ran smoothly. The registered manager, in post since the summer of 2018, had been instrumental in making significant improvements at the hospital. All staff recognised that these improvements, made with the full support of the hospital board, were essential to sustain and build upon.

However:

  • The inspection team reviewed twelve care records across the long-term rehabilitation and dementia wards. Seven of these records showed that staff had not included personalised details and treatment goals for patients. These plans were therefore not holistic or recovery orientated.Clinical support workers, who provided most of daily the care for patients, did not have access to the daily electronic patient record and could not personally write their records directly on the system. This meant that detailed information from staff who had frequent contact with patients was not fully available for developing individual rehabilitation plans for patients. However verbal reports, given at handover, from clinical support workers were uploaded onto the electronic record by registered nurses.

  • We found that hospital wards lacked a comprehensive range of accessible information on mental health problems, treatments, physical health problems and smoking cessation. All wards advertised independent advocacy services and all wards, except Kipling, had information on how to make a complaint.

Inspection areas

Safe

Good

Updated 30 January 2020

Our rating of this hospital improved. We rated it as good because:

  • The hospital’s long-term rehabilitation wards were safe, clean, well equipped and fit for supporting patients in their recovery journey and included facilities for patients to develop and maintain independence in making food and drinks. Rudyard ward had a long-term estates plan to ensure it met the standards for a dementia-friendly physical environment and made continual assessments of the its policies and procedures to make sure that its operations were sensitive to the needs of patients with dementia. The hospital had enough nursing and medical staff, who knew the patients and who received comprehensive induction and training to keep patients safe from avoidable harm. Staff were also supported with continuous professional development and received further training in person centred risk assessment, care planning, positive behaviour support de-escalation and harm reduction.
  • Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients’ recovery. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
  • Staff understood how to protect patients from abuse and the hospital worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff had easy access to clinical information and it was easy for them to maintain high quality clinical records – whether paper-based or electronic.
  • The hospital used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medicines on each patient’s physical health.
  • The wards had a good track record on safety. The hospital managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider services of the hospital. When things went wrong, staff apologised and gave patients honest information and suitable support.

However;

  • Clinical support workers did not have access to the electronic patient daily record and could not write care records directly on to the system to support registered staff in their clinical decision making. 

Effective

Good

Updated 30 January 2020

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

  • Staff assessed the physical and mental health of all patients on admission. They developed care plans for each patient, which they reviewed regularly through multidisciplinary discussion and updated as needed but these were not always person centred.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. This included access to psychological therapies, to support for self-care and the development of everyday living skills, and to meaningful occupation. Staff ensured that patients had good access to physical healthcare and they supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward teams had effective working relationships with other staff from services that would provide aftercare following the patient’s discharge and engaged with them early in the patient’s admission to plan discharge.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • Staff supported patients to make decisions on their care for themselves. They understood the provider’s policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

However:

  • Care plans did not always reflect the assessed needs of patients and were sometimes not personalised, holistic or recovery-oriented.

Caring

Good

Updated 30 January 2020

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

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.

  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.

  • Staff informed and involved families and carers appropriately of changes in a patients presentation in accordance with the hospital’s confidentiality policy.

  • Feedback from patients was that they felt cared for by staff and enjoyed the food and activities

Responsive

Good

Updated 30 January 2020

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

  • The hospital liaised with patients and carers before admission to ensure there were no no long delays. Patients and carers could also visit the hospital beforehand admission to familiarise themselves with the hospital.

  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason.

  • The design, layout, and furnishings of the wards within the hospital supported patients’ treatment, privacy and dignity. Each patient had their own bedroom and could keep their personal belongings safe. There were quiet areas for privacy.

  • The food was of a good quality and patients could make hot drinks and snacks at any time.

  • The wards met the needs of all patients who used the hospital – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.

  • The hospital treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and the wider hospital service.

    However:

  • There were mixed levels of accessible information on all wards, and on Kipling ward there was no information on how to complain. Other wards lacked comprehensive information on other sources of help and support for patients.

  • Larches ward only had one patient toilet which included a shower meaning if the shower was in use there was no patient toilet available for use. A female patient’s bedroom situated adjacent to Rudyard Ward had restricted access to the toilet and other facilities. This compromised the patient’s privacy and dignity.

Well-led

Good

Updated 30 January 2020

Our rating of this hospital improved. We rated it as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the hospital and approachable for patients and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

  • Our findings from the other key questions demonstrated that governance processes operated effectively at ward level and that performance and risk were managed well.

  • Ward teams had access to the information they needed to provide safe and effective care and used that information to good effect.

  • Staff engaged actively in local and national quality improvement activities

Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 30 January 2020

Wards for older people with mental health problems

Good

Updated 30 January 2020