Mill Garth

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• 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 means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated effective as requires improvement. At this inspection 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 through multidisciplinary discussion 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.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Patients told us their individual needs had been assessed, and that staff had taken the time to listen to and involve them in their care and treatment planning.

We reviewed 5 care records which evidenced staff had completed comprehensive and timely inspections of patient’s physical, mental, emotional and communication needs. Assessments were person-centred and reviewed regularly with the patient and their families, if appropriate. Staff used clinical tools alongside professional judgment to build a comprehensive understanding of each patient’s individual needs. If a person lacked capacity to make decisions, staff adhered to legislation and best practice which ensured decisions were made lawfully, and in the person’s best interests.

Occupational therapists used the model of human occupation screening tool (MOHOST) to assess capability, and need, and this was used as a baseline and to track patient’s progress. They shared the results with the multidisciplinary team to evidence progress and ensure patients' needs were being met.

Care records evidenced that staff considered carers’ needs during assessments subject to consent, and provided them with safe, effective support.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well

The service planned and delivered care and treatment which was in line with legislation, best practice. Care and treatment were co-produced with patients and focused on individual need.

Staff demonstrated an understanding of their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice, applying this knowledge consistently, and effectively.

Staff provided a comprehensive range of interventions which were person centred, including medication management and psychological therapies. Interventions were in line with guidance from the National Institute for Health and Care Excellence (NICE). The service delivered care through a clearly defined and structured model of care for mental health inpatient rehabilitation, which supported patients from assessment through to recovery and discharge. Care was delivered through a multi-disciplinary approach, with coordinated input from medical, nursing, psychology, and occupational therapy teams.

Care records evidenced that staff completed comprehensive physical health assessments on admission. There was a physical health nurse on site 2 days each week who completed physical health triaging and coordinated appointments with external healthcare services. Effective record-keeping and monitoring systems ensured that physical health checks were attended, and patients reported feeling confident and reassured that their physical health was effectively managed alongside their mental health.

Managers provided new staff with an appropriate induction before starting on the wards. New starters were supernumerary for 2 weeks which gave them time to meet patients, familiarise themselves with the environment, shadow staff and complete required training.

Managers provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance.

Monthly clinical and managerial supervision compliance was 95% or above for the 6 months prior to inspection with this figure being 100% for 4 of the 6 months. The percentage of staff that had had an appraisal in the 12 months prior to inspection was 100%. Managers described how they used supervision and appraisals to further develop the skills knowledge, and competency of staff.

Staff had access to regular team meetings to reflect on practice, share learning, and continually improve care. Staff participated actively in clinical audit, benchmarking, and quality improvement initiatives, ensuring care was consistently measured against national standards and aligned with best practice.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us that they had regular access to team meetings. Managers documented meeting minutes and shared these with all staff.

Care records and staff interviews demonstrated the service had good, effective working relationships with teams both within and outside of the organisation. There was evidence of joint working with mental health services, acute hospitals, GPs and the police. This ensured patients experienced coordinated care that supported recovery and progress toward them rejoining their communities. Staff shared all assessment outcomes, and care plans promptly when patients moved between services or transitioned to community living.

Managers had developed a working relationship with a local charity shop, and 2 patients were currently engaged in volunteer work.

Throughout our inspection, we saw different healthcare professionals working in partnership together well. There appeared to be respect throughout the different disciplines for each other's point of view and clinical insight.

Managers ensured that tasks were delegated to staff members at the beginning of each shift. The nurse in charge was responsible for allocating duties such as medicines, attendance at meetings, leave, observations and checks.

Staff shared information about patients at handover meetings from one shift to another. We observed a handover during the inspection and saw that staff discussed patients’ presentation, risk and concerns, identifying and agreeing any actions needed.

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

Managers implemented healthy living through nutrition, physical activity, and behavioural support to improve overall patient wellness. During interviews they acknowledged that some prescribed psychiatric medicines could cause side effects like weight gain. Care records evidenced that they monitored patient’s physical health appropriately in response.

The organisation had introduced a ’Priory Fresh’ scheme which involved a review of meal choices, with catering staff and dieticians devising a range of healthy meal options. Manager acknowledged this had met with some resistance from patients and that the process of embedding this was ongoing. The service currently restricted patients to 2 takeaways each week. We spoke with managers about this and they could provide a clear rationale for the restriction. This was documented on the blanket restrictions register and reviewed monthly.

Staff made sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs. 2 patients had malnutrition care plans in place which staff closely monitored.

There was a gymnasium on site which patients could use, and patients described activities involving exercise and access to fresh air including walk groups and trips to local parks. There were a table tennis table and pool table within the therapy suite which patients could access.

We saw evidence in care records that staff had referred patients to external healthcare services such as podiatry and dentistry.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes. These included the National Early Warning Scores 2 (NEWS2) which is a standardized system to measure vital signs, and Health of the Nation Outcome Scales (HoNOS) to measure the mental health and social life of patients. Care records evidenced that staff used the Malnutrition Universal Screening Tool (MUST) to identify patients at risk of malnutrition.

Staff also used the Even Briefer Inspection Scale for Depression (EBAS-DEP ) to assess and diagnose patient’s depression, and the LUNSERS (Liverpool University Neuroleptic Side Effect Rating Scale) to monitor side effects from antipsychotic medicines.

Patients and carers told us that they received the care and support they needed. Patients said their care was regularly reviewed, and they were seen by appropriate teams and professionals to support both their mental and physical health such as psychologists, occupational therapists and GPs.

Staff completed care plan and risk assessment audits. Managers also completed section 132 rights audits to check that staff explained to patients their rights under the Mental Health Act on admission and revisited this regularly.

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

Staff explained patients' rights to them in a way they could clearly understand. Staff explained things in a way that enabled patients to make informed decisions about their care and treatment.

There were independent advocacy services that supported patients. An independent mental health advocate (IMHA) visited the wards regularly. IMHAs could also speak to patients by phone or arrange face to face meetings.

We saw in care records that patients were regularly reminded of their rights. There was evidence that when patients lacked capacity, staff held best interests’ meetings with the patient, their family, IMHAs, and members of the multidisciplinary team involved in the patient's care and treatment.