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Reports


Inspection carried out on 25-26 April 2017

During a routine inspection

We rated The Cloisters as good because:

  • Wards were clean and well maintained and patients told us they felt safe. Emergency equipment and medicine were stored safely and medicine management followed National Institute for Health and Care Excellence guidance.
  • There was access to out of hours support for patients’ mental health and physical needs and emergency contingency plans in place. Patients’ risk assessments and care plans were person centred and updated regularly. The Cloister’s focus was on recovery and patients had access to an outreach service which supported them after their discharge.
  • The Cloisters offered a full occupational therapy programme and empowered patients to access external resources such as the local college and gym. The service had purchased a wheelchair accessible minibus and patients had access to a garden and allotment. There was a good choice of fresh food available; staff catered for patients’ dietary needs and offered nutritional training.
  • There was very good assessment, monitoring and care of patients’ physical health needs and an effective relationship between the service and a local general practitioner practice. Staff had been trained to provide physical health care and participated in a number of audits to monitor the effectiveness of services provided.
  • The multidisciplinary team was consistently and pro-actively involved in patient care. Staff from all disciplines were invited to clinical huddles, non-clinical huddles and brief meetings to discuss key issues. Staff enjoyed working at the Cloisters and felt valued, supported and able to raise their concerns with senior staff members who were accessible.
  • The staff were kind, caring and motivated. We saw good professional and respectful interactions between staff and patients during our inspection. Patients told us that staff involved them in their care and that changes had been made to their care because of their feedback.
  • There were enough suitably qualified and trained staff to provide care to a good standard. Over 75% of staff had received mandatory training and over 95% of staff had received an annual appraisal. Staff had received safeguarding training and there were three safeguarding leads across the unit.
  • Governance structures were clear, well documented, adhered to and reported accurately. These are controls put in place so that managers can assure themselves that the service delivered is effective and delivered to a good standard. There was a strong commitment towards continual improvement and innovation.
  • Since our last inspection in October 2015, the service had experienced a change of provider. Senior Cloisters staff attended regular meetings with the commissioners and their new provider and felt supported in the process.

However:

  • Regular safety checks for fire and water were not in date. However, the service had provided an action plan in response and were addressing these issues.
  • Although medicine incidents were reported, there were no reports of near misses.
  • Managers did not always provide staff supervision consistently. During the six months prior to our inspection, monthly staff supervision completion rates ranged from 46% to 80%. However staff had access to group supervision and reflective practice sessions.
  • Staff discussed and reviewed patients’ capacity to consent to treatment and finances during the monthly multi-disciplinary review meeting but this was not recorded.
  • Patients told us they received copies of their care plan but the signed copies were not uploaded onto the patient electronic care record.
  • There was no formal strategy between the commissioners and the service about where the service fitted into the rehabilitation care pathway. This meant that patients might not have a clear pathway to move on to, leading to unnecessarily long stays.