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Inspection Summary


Overall summary & rating

Good

Updated 6 May 2020

Our rating of the service stayed the same. We rated The Dallingtons as Good because:

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm.
  • Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint only after attempts as de-escalation had failed.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • 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. Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery orientated.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported them to live healthier lives.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • The design, layout and furnishings of the wards supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an ensuite bathroom. Patients could keep their belongings safe. There were quiet areas for privacy.
  • The service met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results. These were shared with the whole team and the wider service.
  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.
  • Teams had access to the information they needed to provide safe and effective care and used that information to good effect.
  • Managers engaged actively with other health and social care providers to ensure that an integrated health and care system was commissioned and provided to meet the needs of the local population.

However:

  • We found out of date bandages, saline, dressings, tape and sterile gloves in the first aid kits and emergency fire grab bag. Staff immediately rectified this when it was bought to their attention.
  • Two patients who were on high dose medications did not have an appropriate monitoring tool in place. Staff put these in place immediately when this was bought to their attention.
  • Not all staff were up to date with their Mental Health Act training.
  • Not all staff were able to articulate the organisations vision and values.
  • Staff sickness and turnover was above the national average.
Inspection areas

Safe

Good

Updated 6 May 2020

We rated safe as good because:

  • Staff fully understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Managers fully supported staff to do so.
  • Safeguarding adults at risk of abuse, children and young people was given sufficient priority. Staff took a proactive approach to safeguarding. Staff took steps to prevent abuse from occurring, responded appropriately to any signs or allegations of abuse, and worked effectively with others to implement protection plans.
  • Staffing levels and skill mix were planned, always implemented and reviewed to keep people safe. Any staff shortages were responded to quickly and adequately.
  • Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible to facilitate patients’ recovery. Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. As a result, they used restraint only after attempts at de-escalation had failed.
  • Risks to patients were assessed, monitored and managed on a day-to-day basis. These included signs of deteriorating health, medical emergencies or behaviours that challenged.
  • The wards were safe, clean well equipped, well furnished, well maintained and fit for purpose.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.

However:

  • We found out of date bandages, saline, dressings, tape and sterile gloves in the first aid kits and emergency fire grab bag.
  • We found that two patients who were on high dose medications did not have an appropriate monitoring tool in place.

Effective

Good

Updated 6 May 2020

We rated effective as good because:

  • Staff carried out comprehensive assessments of patient’s needs upon admission. This included consideration of clinical needs, mental health, physical health, wellbeing, nutrition and hydration.
  • Staff developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery oriented.
  • Staff were qualified and had the skills they needed to carry out their roles effectively and in line with best practice. The learning needs of staff were identified, and training was put in place to meet these learning needs. Managers supported staff to maintain and further develop their professional skills and experience. Staff received regular supervision and annual appraisals.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The ward teams had effective working relationships with relevant services outside of the organisation.
  • Staff participated in local clinical audits, as well as quality improvement initiatives across the hospital. These had been shared across the organisation.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Staff routinely explained patients’ rights to them in a way that they understood and repeated this as necessary.
  • Staff supported patients to make decisions on their care for themselves. They understood the organisations policy on the Mental Capacity Act 2005. Staff assessed and recorded capacity clearly for patients who might have impaired mental capacity.

However:

  • Not all staff were up to date with their Mental Health Act training. We found that 74% of unqualified staff, and 64% of qualified staff were up to date with this training.
  • We identified that documented consent / capacity for one patient with bed rails in situ was absent.

Caring

Good

Updated 6 May 2020

We rated caring as good because:

  • Staff truly respected patients and valued them as individuals and empowered them as partners in their care.
  • Staff were fully committed to working in partnership with people and making this a reality for each person. Staff always empowered people who used the service to have a voice and to realise their potential.
  • Feedback from people who use the service, those who are close to them and stakeholders was continually positive about the way staff treat people.
  • There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.
  • Staff recognised and respected the totality of patient’s needs. They always took patients personal, cultural, social and religious needs into account.
  • People’s emotional and social needs were highly valued by staff and are embedded in their care and treatment.
  • Staff informed and involved families and carers appropriately.

Responsive

Good

Updated 6 May 2020

We rated responsive as good because:

  • There was a proactive approach to understanding the needs of different groups of patients. Staff delivered care in a way that met these needs and promoted equality. This included people who were in vulnerable circumstances or who had complex needs.
  • The involvement of other organisations and the local community was integral to how services were planned and ensured patients' needs were met. Staff supported patients with activities outside of the service, such as work, education and maintaining effective relationships.
  • Patient’s individual needs and preferences were central to the planning and delivery of tailored services. Staff helped patients with communication, advocacy, cultural and spiritual support. Staff had the skills, or access to people with the skills, to communicate in the way that suited the patients.
  • There was an active review of complaints and how they were managed and responded to. Improvements were made as a result across the services.
  • Staff planned and managed discharge well. They liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason.
  • The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an ensuite bathroom and could keep their personal belongings safe.
  • The food was of a good quality and patients could make hot drinks and snacks at any time. When clinically appropriate, staff supported patients to self-cater.

Well-led

Good

Updated 6 May 2020

We rated well led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.
  • Staff felt respected, supported and valued. Staff said the organisation promoted equality and diversity in daily work and provided opportunities for development and career progression. Staff could raise any concerns without fear.
  • Our findings from the other key questions demonstrated that governance processes operated effectively at team level and that performance and risk were managed well.
  • Teams had access to the information they needed to provide safe and effective care and used that information to good effect.
  • Managers engaged actively with other local health and social care providers to ensure that an integrated health and care system was commissioned and provided to meet the needs of the patients.

However:

  • Not all staff were able to articulate the organisations vision and values.
  • Staff sickness and turnover was above the national average.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 6 May 2020