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

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect. At our previous inspection we rated this key question good. At this inspection the rating has remained as good. This meant people were supported and treated with dignity and respect; and involved as partners in their care. Patients understood their care and treatment and were given the opportunity to discuss their individual needs with staff. Staff respected patient’s privacy and dignity and were observed treating patients with kindness and understanding.

However, due to the provider’s recent large-scale re-organisation of staffing across the hospital, staff did not always feel wellbeing was considered and did not feel engaged in the re-organisation process.

We have not awarded this service a score for Caring.

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

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We spoke with 4 patients during the inspection, those we spoke with told us staff took time to get to know them and understood their wishes and choices.

We observed staff treating patients with kindness, taking time to engage patients with meaningful conversations. Staff showed that they were respectful and responsive to patient’s needs and requests. This was reflected in the language used when talking about patients and the emotions they expressed.

Staff spent time with patients in communal areas, sometimes in quiet discussion and sometimes in groups undertaking activities. Staff we spoke with had taken the time to get to know patients and understood their care and support needs, which allowed them to support patients to understand their care and treatment. Staff understood how recent changes to staffing across the hospital had caused disruption in the patient’s therapeutic relationships and were focused on building up new therapeutic relationships.

Staff were respectful of patient’s privacy and dignity at all times. If a patient’s level of risk required them to be observed in the bathroom or whilst carrying out personal care, they would be supported by female staff.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

The service was able to make adjustments for disabled patients when required. The hospital and ward was all on one level and the service was able to access additional equipment such as shower chairs. When referrals were received, they were reviewed to ensure that an individual’s needs could be met.

Most of the patients we spoke with felt they had information on treatment options and knew how to complain. Records showed that staff regularly explained patients’ rights to them. The MDT engaged with patient’s local mental health teams, so even when a patient was out of area, individuals were aware of local services as part of discharge planning.

Staff ensured that information was accessible for patients, for example, autistic people had an autism passport which supported them to communicate their needs with staff. This was also discussed and updated within the ward round. Managers were also able to access interpreters or signers to support communication with patients. The service had access to Speech and Language Therapists (SALT), who could also provide communication aids for patients.

During the inspection we observed patients being supported in activities. When a patient asked to attend the hospital gym for a session, this was arranged between staff and the patient.

Patients were able to access a choice of foods that met their dietary requirements, accounting for allergies, intolerances and religious requirements.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

People’s social needs were understood. People were supported to maintain and develop their relationships with those close to them, their social networks and community. All patients we spoke with said they were able to speak to their friends and family and have them visit them whilst in hospital. Staff supported patients’ families to visit, and when the families were travelling from out of area, they were flexible with times to ensure patients could spend time with their loved ones.

If people wished to, they engaged in meaningful hobbies and interests in a personalised way. The ward had a daily activities schedule that patients could get involved in, such as walking groups as well as requesting additional activities like going to the gym.

The service worked to meet people’s individual choice, patients regularly attended ward rounds and were engaged in discussions around their care. This was reflected in the care records. If a patient was unable to attend the ward round in person due to increased risk, staff would take the time to discuss the meeting and outcomes from it.

Patients also had regular access to Independent Mental Health Advocacy services, who were able to support patients in making decisions or raising concerns.

The ward held regular community meetings that patients were encouraged to attend and voice their suggestions to improve or any concerns they had regarding the ward. The ward manager also arranged for different teams, such as domestic or estates staff to attend so that patients could engage directly with them.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We observed staff calmly and confidently managing a situation in which a patient was displaying heightened behaviours. Staff used de-escalation techniques to prevent the need for physical intervention. Staff displayed a good relationship with patients, engaging with them, supporting them and reducing the need for physical intervention.

We saw that staff were alert to individual’s needs and took the time to observe, communicate and engage people in discussions about their immediate needs. Staff also recognised the different ways in which each individual may be communicating discomfort, pain or distress, including both verbal and non-verbal cues.

Staff showed concern for people’s wellbeing in a caring and meaningful way. They responded to people’s needs quickly enough to avoid any preventable discomfort, concern or distress. We saw staff responding supportively and quickly, where possible, to patient requests.

Staff identified and responded to patients’ changing needs and risks following incidents on the ward. Incidents were reported and reviewed by the multi-disciplinary team to ensure they were responded to robustly.

Staff felt confident in identifying when a patient was deteriorating physically or mentally. They had support from the wider MDT and could access additional teams, such as physiotherapy or psychology quickly.

We scored the service as 2. The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

The provider had recently undergone a large-scale reorganisation of the hospital, which had resulted in staff changing wards, shift patterns, nursing staff and the senior leadership team. These changes were recent and had only just been implemented at the time of our inspection. As a result of these changes, most staff felt unsettled, as some of these changes had been made at short notice, with little discussion and staff could not always see a clear rationale for these changes. This meant that staff did not always feel respected, supported or valued.

However, most staff that we spoke with said they felt supported by their team and immediate managers. The ward manager was supportive, listened to concerns, and where possible adjusted work patterns to better support staff. During the inspection we also observed the hospital’s morning meeting, where managers from all wards and services would review the previous day’s incidents. We saw that as part of the review of the incident and actions that were required by the provider, there was a drive by the provider to ensure that staff were having well-being checks following incidents. However, some staff told us that this did not always occur.

The service’s sickness and absence rate was 4.37%, with 1.18% of absence being long term.