Rosebank House

On this page

• 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 assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

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 service team included or had access to a range of specialists required to meet the needs of patients. 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.

Good: This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 maximises the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

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

During the inspection, we reviewed 9 care records. In most cases, staff completed comprehensive mental health assessments at, or shortly after, admission. 

Overall, staff developed care plans that met patients’ needs. The 9 care plans reviewed were personalised, holistic, and recovery oriented. Staff incorporated input from multidisciplinary teams to address individual needs.

Staff involved patient in planning their care. We observed in care records a collaborative approach, reflecting personalised care to individual needs. For example, one patient's care plan included Section 17 leave to maintain connections with family and the local community. Another patient's care plan identified support required to manage physical health needs associated with risks of falls and choking. We also reviewed a care plan that clearly documented discharge plans.

Staff assessed patients’ communication needs with them, and we saw evidence of this in patient records. For example, how patients wished to be communicated too and addressed.

Staff regularly monitored and reviewed patients’ physical health needs. The service had a dedicated Physical Health Lead Doctor who provided clinical oversight of patients’ physical health care. Staff used the National Early Warning Score 2 (NEWS2) to regularly assess and monitor patients’ physical health. NEWS2 is a nationally recognised clinical tool that helps healthcare professionals identify early signs of physical deterioration and determine when escalation of care may be required.

Staff also used the  Liverpool University Neuroleptic Side-Effect Rating Scale (LUNSERS) to monitor and assess patients’ experiences of side effects associated with prescribed medication.  LUNSERS is a 51-item self-report questionnaire used to measure subjective side effects experienced by patients taking antipsychotic (neuroleptic) medications. This supported the ongoing review of treatment effectiveness and patient wellbeing.

All patients admitted to the service were registered with a local GP to ensure access to primary healthcare services. Staff supported patients to arrange, attend GP, dental and optician appointments.

The service plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

The evidence showed a good standard. 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 provided a range of care and treatment interventions that were appropriate to the needs of the patient group and delivered in line with National Institute for Health and Care Excellence (NICE) guidance. This included trauma-informed interventions offered both individually and in a group.   Trauma-informed therapy is a framework designed to acknowledge and address the impact of traumatic experiences on individuals' lives. Patients were also offered individual cognitive behavioural therapy (CBT) where clinically indicated. CBT is an evidence-based psychological therapy that supports patients to identify and change unhelpful patterns of thinking and behaviour and is used to treat a range of mental health conditions. Staff delivered these interventions as part of a holistic approach to care and treatment.

The team had access to a range of specialists required to meet the needs of patients in the service including doctors and nurses, occupational therapists, clinical psychologists, support workers and external pharmacists’ support.

Mental Health Act.

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 found evidence of compliance with the Mental Health Act, within patient care and management records, all staff completed training on the Mental Health Act. Staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Health Act, they knew who to contact for advice including deprivation of liberty safeguards. 

The service had robust security processes in place. The doors were locked, entry operated and staff were able to monitor who entered and left the service. However, there were no signs informing informal patients of their rights to freely leave the unit at any time. We highlighted this to the hospital director who corrected this the same day

During the inspection, we observed the paper sign-in and sign-out section 17 leave forms were not always fully completed or signed by staff. As a result, staff could not be assured that patients had returned safely or whether prohibited items had been brought back. We were unable to review previous records to assess consistency, as these were not available. We discussed this with the senior leaders, as we were not assured all process was followed to keep patients safe.  We were told the paper forms are shredded because staff also completed an electronic form capturing the same information. 

Leaders acknowledged that this represents duplication of recording and stated, they will review the process to ensure there is a consistent and effective system for monitoring and reviewing patient leave.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

The evidence showed a good standard. 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 held regular and effective multidisciplinary team (MDT) meetings to review care and coordinate support for patients. Meeting agendas included learning from incidents, co-production, and discussions about maintaining patients’ dignity, privacy and respect. These meetings provided staff with opportunities to share information, reflect on practice, identify areas for improvement, and ensure care delivery remained person-centred and responsive to patients’ needs.

We saw that the daily handover meetings were effective and led to change. For example one patient wished to be addressed by a specific pronoun, and this was communicated to staff during the handover meeting. We also saw that the information was shared with other colleagues during the MDT meeting and ward round

The teams had effective working relationships with teams outside the organisation for example, local authority social services and GPs. 

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

The evidence showed a good standard. 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, reduced their future needs for care and support.

Staff supported patients to live healthier lives and develop the skills needed to promote greater independence. Patients had access meaningful activities designed to support their health and wellbeing. Staff encouraged and supported patients to acquire daily living skills, including cooking, managing personal hygiene and shopping. These opportunities helped patients build confidence, enhance their independence and prepare for living independently.

All patients had a Keeping Healthy Care Plan, which staff developed collaboratively with patients to reflect their individual needs, goals and aspirations during their admission. The plans included a weekly timetable of activities designed to support patients in achieving their recovery objectives and maintaining their physical health and wellbeing such as community outings. Care plans addressed a range of health needs and risks, including, choking risks, mobility support and falls prevention, ensuring a person-centred approach to care that promoted wellbeing, engagement and independence.

Staff encouraged patients to undertake activities and take on responsibilities that were recovery focused and equipped them to integrate seamlessly into their communities. These activities were recovery focused and enabled patients to acquire skills that will help them get gainful employment. For example, a patient had volunteered to do litter picking in the community. Patients had access to a garden where they could have gardening sessions and could take care of the plants. 

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. When it was safe to do so, some patients could use the kitchen to prepare their own meals. 

We routinely monitor people’s care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of people themselves.

The evidence showed a good standard. 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 outcome measures and assessment tools to assess, monitor and record patients’ needs, risks and progress. Occupational therapists completed the Model of Human Occupation Screening Tool (MOHOST) to assess patients’ ability to engage in meaningful occupations and identify areas requiring support. Psychologists used evidence-based assessment methods, including functional analysis and outcome questionnaires, to evaluate the effectiveness of interventions and measure progress over time. 

Staff developed clear, person-centred care and treatment plans that identified patients’ goals and the skills required to achieve greater independence, such as emotional regulation, self-confidence and community living skills. 

Interventions were tailored to individual needs. For example, staff supported one patient with obsessive compulsive disorder (OCD) to develop strategies for managing symptoms while accessing the community, while another patient received support to improve emotional expression and communication. 

The psychologist was trained in the Historical Clinical Risk Management-20 (HCR-20) assessment tool, which was used to inform the assessment and management of risks associated with violence and offending-related behaviours.

The service told people about their rights around consent and respect these when we deliver person-centred care and treatment.

 The evidence showed some shortfalls. The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We were not assured from the records we reviewed and speaking to staff that information to patients was provided when medicines was prescribed for unlicensed use. This was discussed with the consultant on the day of inspection.  

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. However, one patient record did not contain capacity assessment to treatment records. We reviewed patients’ medication charts and saw people detained under the Mental Health Act (MHA), had been prescribed and administered medicines not always in line with MHA consent to treatment authorisations.  The new responsible clinician wrote to the former responsible clinician but did not follow up on this, therefore the service was unlawfully treating this patient.

Records reviewed showed that the consultant had written to the previous consultant to seek confirmation of the consent authorisation arrangement. However, we did not see evidence of a response being received or any further documentation to demonstrate that the authorisation had been confirmed. We discussed this with leaders and the consultant who was addressing this.