Mill Garth

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last inspection we rated responsive as good. At this inspection the rating has remained good. Staff managed beds well. Patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service, such as work, education and family relationships. The service met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

We have not awarded this service a score for Responsive.

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

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Patients interviews and care records evidenced that care and treatment had been arranged around patient’s needs and preferences.

Staff completed various nationally recognised tools and assessments when developing treatment plans. Staff supported, informed and involved people using the service and their families or carers.

During our tour of the service, we saw that patients could personalise their bedrooms. Patients had lockers in which to securely store their possessions. There was a multi-faith room available to patients.

Patients had a choice of food to meet the dietary requirements of religious and ethnic groups.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Care records and staff interviews evidenced that staff worked well to ensure patients had access to joined-up care. The service had links within the local community to enable patients to engage in various opportunities, including volunteering. Managers recognised that establishing links and having experiences outside of the service formed an important part of the pathway and ensured they had support on discharge from the service.

When appropriate, staff ensured that patients had access to education and work opportunities. No patients were enrolled in formal education at the time of our inspection, but managers described how they had supported this previously. One patient was supported to attend acting classes in the community.

Staff communicated with patients in a way that they could understand about the different aspects of their mental and physical health care and treatment.

Managers had regular engagement with stakeholders and external services, inviting them to regular meetings and care programme approach meetings.

In preparation for discharge, staff worked closely with care coordinators and supported living services, who were involved in discharge planning. The service identified whether housing or benefit arrangements were needed to be put in place to avoid delayed discharge.

Staff supported patients to maintain contact with their families and carers. We observed visits taking place and patients going out on leave with their family during the inspection. Where patients did not consent to family involvement in care, staff revisited this with them during care programme approach meetings.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff gave patients a booklet on admission which provided a range of information. A staff member would contact the patient’s family member or carer on admission subject to patient consent.

Staff made sure people could access information on treatment, local services, their rights and how to complain. Wards had notice boards in patient areas with a variety of information to support this.

Leaders and staff told us patients could be given information in a variety of ways to meet their needs. These included information in different languages, fonts, braille, and easy read versions. Patients had access to interpreters and signers if needed.

Staff provided regular updates to commissioners about patient’s progress and invited them to multidisciplinary team meetings, care programme approach and discharge planning meetings. Staff also informed commissioners of incidents or statutory notifications they submitted.

Care records evidenced that staff regularly reminded patients of their rights and legal status.

Staff maintained the confidentiality of information about patients. Care records evidenced that staff sought patients’ consent to share information and reviewed this regularly. Staff we spoke with understood the principles of data protection legislation.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients told us they felt listened to when they voiced their preferences or asked questions about their treatment or medicine. Staff were visible and available for people to speak to as and when needed. Staff were observed engaging with people.

We observed staff actively involving patients in ward round discussions and seeking their views around their care and treatment.

Patients had access to independent advocacy. Carers, friends and families attended ward rounds and multidisciplinary team meetings where appropriate.

The service investigated complaints made by patients. There had been a total of 7 complaints in the 12 months prior to inspection. One complaint had been upheld, 1 had been partially upheld and 5 were not upheld. We reviewed 5 of these complaints and found that managers had acknowledged these in a timely manner, completed comprehensive investigations and identified learning or actions where appropriate.

Staff we spoke with understood the policy on complaints and knew how to handle them. Patients could raise concerns with any member of the team, and they would try to resolve them as quickly as possible with most concerns being resolved informally. Informal complaint themes included patient disagreements and food choices.

Managers had introduced a lived experience partnership within the service with a patient appointed as a lived experience partner. Managers involved them in clinical governance meetings and patient consultation ensuring they sought feedback from others which could be used to inform service delivery. One example was seeking patients’ feedback about food and liaison with the service’s food subsidiary company to ensure meal choices reflected patient’s preferences, balanced against promoting healthy living. The lived experience partner was also involved in the planned review of the service’s business model.

The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients had access to a range of professionals including a dietician, psychologist, speech and language therapist, and an occupational therapist. Staff worked as part of a multidisciplinary team model where all professionals worked collaboratively to deliver holistic rehabilitative care.

Staff told us that on admission should any reasonable adjustments to care and treatment be identified then these would be recorded and incorporated into patient's care plans, such as, the need for a translator or any additional support needed for patients with a learning disability or physical mobility issues. The unit was single storey, and all bedrooms and patient areas were located on the ground floor.

There was adequate medical cover day and night, a doctor could attend the ward quickly in an emergency and the hospital was within a reasonable travelling distance to the local acute hospital.

Staff ensured patients had access to post-discharge care including section 117 aftercare, community mental health services and crisis services.

Staff worked collaboratively to facilitate safe discharges and ensure continuity of care when aftercare had been identified. One patient was clinically ready for discharge. However, they remained under Ministry of Justice Restrictions and staff were liaising with the Ministry of Justice as they continued to identify an appropriate placement for the patient.

Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Patients’ human rights were protected; they were supported by staff who promoted equality and helped them overcome barriers to care.

We did not identify any barriers to care, support and treatment. The service complied with legal equality and human rights requirements, including avoiding discrimination. Staff had regard to the needs of patients with different protected characteristics and made reasonable adjustments to support equity in experience and outcomes. Staff within the service and the wider organisation promoted a culture in which patients felt empowered to give their views.

Managers demonstrated a commitment to improving equity in experience and outcomes through implementation of the Patient and Carer Race Equality Framework (PCREF). A local PCREF lead and staff focus group supported its implementation, working collaboratively with neighbouring services to share learning and develop the framework locally.

Managers provided evidence to show that PCREF was embedded into culture reviews and staff engagement activities, with plans in place to increase patient and carer involvement through partnership with a lived experience lead.

Managers used equality data alongside reviews of incidents and restrictive practice to identify opportunities to improve equity of access, experience and outcomes. Staff were also encouraged to raise concerns through Freedom to Speak Up and other feedback mechanisms, and managers used this information to inform ongoing improvements.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Patients told us they were involved in decisions about their future care and treatment. They were supported to access advocacy and were referred to healthcare professionals to manage their mental and physical healthcare needs.

Discharge planning started soon after admission, in line with best practice. The multidisciplinary team considered a range of possible outcomes for each patient based on their individual needs. Occupational therapists completed functional assessments with patients on admission to assess different areas of progress, to inform treatment plans and determine what therapeutic inventions were needed.

Managers described a “strong focus” on developing activities of daily living skills including cooking, shopping, and cleaning, telling us the service aimed to mirror community life.

We saw evidence in care records that staff actively discussed and planned for discharge. Care plans referred to developing activities of daily living, therapeutic engagement and goal setting. Staff held regular care programme approach meetings involving family members and their wider network.

Patients were involved in discharge planning meetings, and a detailed plan was developed with patients and carers where appropriate. Several patients spoke positively about their goals for treatment and recovery and were aware of longer-term plans for discharge.