Althorp Grange

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

Staff assessed peoples physical and mental health needs and provided care based on national guidance. Multidisciplinary teams worked well together, and most care plans were person-centred and recovery focused. However, one person’s care lacked individualised detail, and leaders did not always act appropriately in response to deprivation of liberty concerns. Therapeutic activities were frequently cancelled due to staffing shortages, impacting people’ health outcomes. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes. Staff used recognised tools to monitor wellbeing and outcomes, but gaps in leadership knowledge and audit processes affected compliance and effectiveness.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care and treatment were generally planned with people, but key therapeutic interventions were often unavailable.

Some people and carers told us therapy sessions were cancelled due to insufficient staffing. The cancellation of therapeutic activities directly affected people’s ability to engage in recovery-focused interventions, which are essential in long-stay rehabilitation service. This undermined the effectiveness of care and may have delayed progress toward people’s discharge and recovery goals.

Staff planned a range of care and treatment interventions suitable for the patient group staying on rehabilitation wards. The interventions were those recommended by and delivered in line with guidance from NICE. These included medication and psychological therapies, activities, training and work opportunities intended to help people acquire daily living skills. Some staff expressed frustration that ongoing staff shortages limited their ability to provide regular therapeutic activities for people.

Staff ensured people had good access to physical healthcare, including access to specialists when needed. The provider had a physical health lead who oversaw people’s physical healthcare and access to secondary care.

Staff assessed and met people needs for food, drink, and specialist nutrition and hydration. Leaders carried out monthly nutrition audits with findings feedback to ward teams and discussed at governance meetings. Staff had completed training in dysphagia and the international dysphagia diet standardisation initiative (IDDSI). Dysphagia is a condition that affects swallowing, often caused by medication or health conditions such as acid reflux or stroke. Training compliance for both dysphagia and fluids and nutrition were 99%.

The team included or had access to the full range of specialists required to meet the needs of people in the service. The hospital team consisted of doctors, nurses, occupational therapists, clinical psychologists, health care assistants, and activity coordinators. Support staff included the housekeepers, kitchen and reception staff.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers ensured that staff received the necessary specialist training for their roles.

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.

The percentage of staff that had had an appraisal for July 2025 were 91%. The percentage of staff that received regular supervision for August 2025 were 95%. Managers had produced a supervision tree to ensure staff supervision were carried out regularly.

Staff held regular and effective multidisciplinary meetings. The multidisciplinary team worked to well with joint assessments and discharge planning.

We observed multidisciplinary teams and services worked well together at the monthly ward round. Staff were preparing people to transition to appropriate services. Staff and local teams attended including care coordinators, hospital leads, community health teams and advocates, to review each person’s readiness for transition. Some people were at the beginning of finding appropriate placements; whilst other people were already transitioning to another service with planned visits and overnight stays in place.

We observed staff providing updates from people’s discharge and recovery plans, including wellness recovery action plans, and positive behaviour support plans. These plans were co-produced with people (with some exceptions). We observed one person’s family member was virtually involved in the ward round and spoke on behalf of their relative. They said their relative would be unsettled during a move to another service. The psychologist agreed to provide psychology sessions including mindfulness to help support their relative through the transition.

Staff shared information about people at handover meetings within the team for example, shift to shift.

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

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. The service did not always support people to live healthier lives. Poor staff deployment meant people could not consistently access therapeutic opportunities, which affected their ability to meet health and recovery goals.

Staffing arrangements did not always support the delivery of therapeutic activities that promoted people’s health and wellbeing. The provider offered a range of activities to support healthy lifestyles including access to an on-site gym, café, cinema room, walking on the grounds, pool table, cooking, and woodwork. People and staff told us that these were frequently cancelled due to staff shortages. The hospital also had extensive grounds, and opportunities for people to care for and feed the chickens. However inconsistent staffing meant people could not always benefit from these therapeutic opportunities.

People’s records showed people accessed appointments with GPs, dentists and primary health care.

Staff supported people to live healthier lives for example, through participation in smoking cessation schemes, healthy eating advice, attendance at the dentist and managing cardiovascular risks. Some people had health issues relating to substance misuse and were receiving regular support from community-based addiction services, including counselling and relapse prevention programmes.

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 rating scales to assess and monitor people’s wellbeing. For example, the Clinical Outcomes in Routine Evaluation (CORE-10) measured levels of distress over the past week, and the Mental Health Confidence Scale (MHCS) assessed people’s confidence.

Staff regularly used the Health of the Nation Outcome Scales (HoNOS), a clinician-rated tool designed to assess the health and social functioning of individuals with severe mental illness. This supported consistent monitoring of patient outcomes and informed care planning.

Staff also used the Malnutrition Universal Screening Tool (MUST) to identify adults who were malnourished, at risk of malnutrition, or obese. This ensured that nutritional risks were identified early, and appropriate interventions were put in place. Clinical leads used the results of all these tools to review and adjust care plans accordingly.

Leaders told us they tracked people feedback from community meetings, online reviews, stakeholder feedback, and through the outcomes of ward rounds.

The service did not consistently inform people of their rights regarding consent and, in some cases, failed to respect those rights when delivering care and treatment

Staff generally assessed and recorded capacity to consent appropriately. However, on Cottesbrooke ward, one patient with impaired capacity was not adequately protected, as their capacity to consent was recorded inaccurately. Following the inspection, the provider took prompt action to address this, reviewing the persons care and conducting further assessments to ensure appropriate care and support arrangements were in place.

Staff took all practical steps to enable people to make their own decisions. We saw in care plans people were involved and consulted in their planned care. People were invited to monthly ward rounds and often attended. People were encouraged to ask to speak with their named nurse or member of the multidisciplinary team.

Advocates were available to support people with their rights around consent to treatment and decisions about appropriate transition plans.

Staff explained rights to people detained under the Mental Health Act and ensured they understood them. We saw posters displayed promoting patient rights around the hospital.