Arbury Court

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

We assessed five quality statements from this key question. The rating from the last inspection was requires improvement.

Our rating for this key question is good.

Patients gave generally good feedback about permanent staff across the wards who patients described as caring, although some patients did raise concerns about some night staff and staff speaking in their own languages.

Patients had opportunities to be give feedback about their wards through community meetings and via the patient council.

There was provision for those patients who had communication difficulties or poor language skills as well support for those from different cultural backgrounds with different diets and religious leaders available.

Care plans were generally holistic and individualised which reflected the patient’s voice and identified their needs and how staff should support them with these.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients stated that staff were generally caring and were positive about the permanent staff on the wards. Some patients raised concerns that certain staff were not always respectful to them or spoke in their own languages, particularly on nights. Patients also noted that staff did not always interact with them or were just on observations, which impacted on the patient experience on the wards. The provider had been undertaking work to address these patient concerns and ensure that all staff met the values and approach to care that the service expected.

Patients that we spoke to did not raise a concern about staff being visible on the wards, but did note that staff were often busy or in demand on the wards.

One patient stated that staff did not always knock on their bedroom door before entering whilst another patient commented that staff only sometimes knocked before entering.

We spoke to two patients who had been restrained whilst on the wards who gave very positive feedback about how staff had managed the restraint and supported them afterwards.

Staff that we spoke to understood the individual needs of patients, including their personal, cultural, social and religious needs. Staff recognised that patients should be treated as individuals and that they should be respectful of patients’ needs and preferences.

Staff said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences.

Partners did not raise any concerns in relation to the kindness, compassion or dignity of the service at the time of the assessment.

Staff attitudes and behaviours when interacting with patients were generally discreet, respectful and responsive. Whilst we observed times where staff provided patients with help, emotional support and advice at the time they needed it, the wards were at times very busy and staff lacked capacity to support all patient requests or facilitate certain ward activities.

We did however witness some positive interaction between staff where they took time to interact and engage with the patients.

Patients generally gave mixed feedback in relation to staff treating them as individuals or taking their specific needs into consideration. Whilst some patients felt involved in and that staff supported them to understand aspects of their care such as medication, others stated that they did not feel staff did this.

One patient commented that the food available for vegan patients lacked choice and, although this had been fed back to the chef, nothing had changed following this feedback.

Staff and managers described how patients would be treated individually and how they would take into consideration any specific patient needs or wishes.

Staff were aware of how to access translation services and interpreters as required.

Ward managers gave examples as to how adaptations and adjustments had been made on their wards to support patients with specific needs, such as a physical disability.

During our onsite assessment we observed that there was information available to patients on activities available on the ward, patient liaison officer details, safeguarding lead details, you said we did actions, how to make a complaint and advocacy services, although this differed across the wards.

Care records were written individually for the patients and were generally holistic.

The service could access translation services, interpreters and signers when these were required.

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

The hospital ensured that patients had access to appropriate spiritual support if this was requested by patients.

Patients gave mixed feedback about their experiences on the ward. Some patients described that they did not always feel involved or informed about aspects of their care such as medication.

Patients mostly had access to their care plans or stated that they had been offered a copy, although one patient stated they had requested a copy of their care plan which was not provided, and this was raised with the ward manager.

Patients also gave mixed feedback in relation to activities that were on offer across the wards. Some patients stated that there were limited activities or that they preferred to do one to one activities. Other patients noted that they had access to education sessions which they gave positive feedback about.

Some patients gave positive feedback about the opportunities they had within the hospital to work and earn money. This included the café and supporting activities. Patients also noted that, on a patient suggestion, a patient library was formed which they had the opportunity to help organise.

Staff described how patients could give feedback and were involved in their care and treatment, including recording preferences within their care plans such as around restraint. Staff noted that patients were involved in their ward rounds and through one to ones with their named nurses. Staff also explained that patients could give feedback on activities on the wards and that their preferences would be taken into account where possible.

Staff involved patients and generally gave them access to their care planning and risk assessments. Patient records that we reviewed indicated that patients were involved in their care planning, although it was not always clear in all records reviewed how much patients had been involved.

Staff made sure patients understood their care and treatment and found ways to communicate with patients who had communication difficulties.

Staff advised that all patients could access advocacy services. Patients told us they had access to advocacy services.

We observed a patient community meeting on one of the wards during the assessment. The meeting itself did not run effectively due to staff and patients talking over each other and it was not protected from disruption with staff walking in and out of doors creating noise. Patients did have the opportunity to give their feedback on the ward and raise any issues during the meeting.

The wards held community meetings that patients could attend. The service had a standard agenda for these meetings which was used across all 4 wards. The agenda covered various aspects, such as the environment, community and planned events and activities, along with having a section to reflect on achievements and celebrations.

The hospital also had a patients’ council at which representatives from each ward, along with senior management at the hospital, attended to discuss various areas of the service and for the patients to raise any issues or concerns that the wards may have.

Care plans were generally holistic and individualised which reflected the patient’s voice and identified their needs and how staff should support them with these. The hospital collated data so managers could see how often care plans were updated.

Patients gave mixed feedback about how staff responded to people’s immediate or changing needs. Some patients described that staff were attentive and responsive to their needs, whilst others stated that staff did not always respond appropriately or were often too busy. Some patients spoken to did not feel that some of their specific needs they had raised with staff had been addressed appropriately.

Most of the patients spoken to during this assessment stated they had not been restrained whilst at the hospital. Two patients gave very positive feedback about their experiences of restrictive practices used by the service. We spoke with one patient who had been restrained who noted that, whilst the restraint itself was distressing for them, staff managed it well and spoke with them afterwards. A further patient also gave positive feedback about how staff had managed a restraint with them, including individualised ways that staff were aware of and utilised to try to de-escalate the patient.

Staff described how they would utilise de-escalation techniques as appropriate to reduce the need for restrictive interventions on the wards.

Staff that we spoke to generally understood individual patient needs and requirements. Staff and managers could describe how they monitored patients and could identify if there were escalating needs or risks, including how these would be managed and escalated within the service.

Where staff were allocated to enhanced observations, we observed that they remained with the patient. Although these staff did not always interact with patients, we did see staff supporting patients and being responsive to their needs.

Whilst some of the wards were particularly busy, staff made attempts to respond to patient requests for support or explained to the patients why they could not undertake immediate actions if they were busy.

Managers ensured that policies and procedures prioritised individual needs.

The hospital held monthly clinical governance meetings at which patient and carer experience was considered including feedback from community meetings, the patient council and carers, along with themes from recent complaints and compliments. Actions identified at these meetings were clearly recorded in the minutes to ensure that these followed up and closed appropriately.

Staff that we spoke to felt supported within their roles by the ward managers. Staff reported feeling respected and could raise concerns with their direct line managers.

Staff did reflect that they were very busy on the wards and this could impact on their ability and time to undertake therapeutic work and activities along with 1:1 time with patients.

Some staff reported that they did not always feel a connection between the wards and senior management with the hospital and lacked some confidence in actions being taken to improve staff retention.

Staff had access to support for any emotional or physical health needs that they may have had.

Managers described the support that was available to staff and how they monitored and managed their staff teams to ensure their needs were being met.

Senior managers within the hospital recognised that managing staff burn out and resilience was a key priority for the service moving forward. The management team was undertaking work to manage this impact including having a training module on resilience; reflective practice and supervision sessions; access to a staff counsellor; an employee engagement lead; and staff recognition awards.

The sickness levels for the overall hospital were not significantly high, with the average monthly absence figures for the 12 months prior to this assessment being 3.82%.

The service had similar turnover levels across the 12 months prior to this assessment without any significant increase or decrease. The highest months turnover was in December 2023 at 28.36%. The service monitored vacancy levels and undertook recruitment as appropriate.

The provider utilised monitoring reports and data to have an oversight of staffing performance figures, which could be used to highlight any areas of concern.