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Inspection Summary


Overall summary & rating

Good

Updated 8 April 2020

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

  • The hospital provided safe care. The ward environments were safe and clean. The wards had enough staff. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff undertook a range of clinical audits to evaluate the quality of care provided.
  • 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 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 or other reasons outside the hospital’s control.
  • The hospital used a holistic range of approaches, tailored to each patient’s needs. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Due to staff absence, fire safety checks had not been completed for two weeks.
  • The provider’s ligature risk assessment identified that a staff member was always required to be supervising the communal areas of the wards For a brief time on the day of our inspection, not all communal areas were being supervised by staff.
Inspection areas

Safe

Good

Updated 8 April 2020

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

  • All wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose.
  • The hospital had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm.
  • 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. Local authority safeguarding professionals visited regularly to offer confidential support to patients, staff and management.
  • 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 service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • Due to staff absence, weekly fire safety checks had not been completed for two weeks. Managers should ensure contingencies are in place that ensure all audits are completed when the designated person is not at work.
  • The provider’s ligature risk assessment identified that a staff member was always required to be supervising the communal areas of the wards. For a brief time on the day of our inspection, not all communal areas were being supervised by staff. Managers should ensure mitigation actions are carried out at all times.

Effective

Good

Updated 8 April 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 individual care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.
  • 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. Staff ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff used recognised rating scales to assess and record severity and outcomes, and worked effectively as a multi-disciplinary team to ensure the results were understood in a holistic context.
  • Ward teams included or had access to the full range of specialists required to meet the needs of patients. 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. Where agency staff were used, this was on a locum basis to provide continuity and agency workers received induction, training and supervision.
  • 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 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.
  • The hospital operated a bespoke psychology graduate programme. This was a new initiative implemented by the organisation and involved psychology graduates working on the wards, supported by the psychology department. The aim of this programme was to enhance clinical skills on the wards as well as promote learning and development for psychology graduates.
  • 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 in a way they could understand.
  • 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.

Caring

Good

Updated 8 April 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.

Responsive

Good

Updated 8 April 2020

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

  • 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, discharge was rarely delayed for other than a clinical reason or reasons outside the hospital’s control.
  • The design, layout, and furnishings of the ward/hospital supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an en-suite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • Most patients were self-catering or working towards being so. They received a generous food budget and support to cook their food. Where patients were not self-catering, 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.
  • Staff supported patients to access the local community and educational opportunities. Staff went the extra mile to ensure important relationships were maintained and that patients remained in contact with family and friends. For example, we were told about was a patient who wished to attend a very significant family event a long distance away from the hospital, but needed permission from the Ministry of Justice, special transport and three staff members to accompany them. Staff went to considerable lengths to secure all necessary permissions and provided the staffing and transport to enable the patient to attend this event.
  • 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 service.

Well-led

Good

Updated 8 April 2020

Our rating of this hospital stayed the same. 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.
  • Leaders and staff actively and openly engaged with patients and staff.
  • Managers and staff displayed a culture of learning and continuous improvement.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 8 April 2020