Baldock Manor

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 good. At this assessment, the rating has remained. This meant people's outcomes were consistently good, and people's feedback confirmed this.

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.

The service ensured people’s care and treatment were effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 4 care records during the inspection. Staff completed comprehensive mental health assessments of patients in a timely manner on admission. This included an assessment of the patient’s capacity to consent to admission and treatment. A full physical health check was completed by the doctors or the physical health nurse on admission and regularly throughout the patients stay.

Staff developed care plans that met the needs identified during assessment. Care plans were comprehensive, personalised, holistic and recovery oriented. For example, we saw detailed care plans on how to manage a patient’s diabetic care and personalised care plans on how to support patients when distressed or when being restrained. The physical health nurse provided support with complex physical health needs of patients to ensure the plan of care was clear to meet the needs of these patients. Staff updated care plans when necessary.

Patients were involved in care planning, and we saw evidence of patient views in records.

Staff planned and delivered 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.

Patients were typically admitted to the ward with acute mental illness. Staff provided a range of care and treatment interventions suitable for the patient group. Care and treatment involved those recommended by, and delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). These included medication and psychological therapies, therapeutic activities, and some training and work opportunities intended to help patients acquire living skills.

Psychologists and occupational therapists worked together to co-facilitate therapeutic interventions to enable patients to benefit from a multi-disciplinary approach. This involved individual or group based sessions. They followed a joint treatment pathway that started with an ‘assessment’ where the patient and the therapies team worked together to make sense of the patients’ experiences and how best to support them. This then moved on to ‘seeking safety’ where established risk behaviours and overwhelming feelings were supported. Finally moving on to ‘growing stronger’ where patients built new skills and understanding, which led to ‘moving on’ where patients were supported to plan for a safe discharge. Examples of groups and interventions offered included trauma informed yoga, sensory assessments, one to one work on safety skills, pet therapy, psychological formulations, one to one talking therapy and trauma therapy.

NICE recommends that people with an acute exacerbation or recurrence of psychosis or schizophrenia should be offered oral antipsychotic medication in conjunction with psychological interventions. Records showed that care and treatment was consistent with this guidance. Staff offered cognitive-behavioural therapy for psychosis at the hospital. Staff monitored patients on antipsychotic medicines, including high doses, and patients on lithium for mood disorders to ensure good physical health.

Additionally, the service offered a range of other evidence-based treatments such as cognitive-behavioural therapy (CBT), dialectical behaviour therapy (DBT) and eye movement desensitisation therapy (EMDR). The service also offered music and art therapy.

Staff ensured that patients had good access to on- going physical healthcare and annual physical health checks. The physical health nurse worked alongside a general practitioner (GP) at a local surgery to ensure all physical health issues were addressed. The general practitioner attended the site once a week to see patients as necessary and refer to specialist services when needed.

Staff assessed and met patients’ needs for food and drink which included specialist nutrition and hydration. The physical health nurse ensured staff monitored patients’ food and fluid intake and referred to dieticians and speech and language therapists as needed. Staff used the Malnutrition Universal Screening Tool (MUST) to monitor patients’ nutritional status.

Staff used the national early warning score (NEWS) to assess and track the severity of physical health symptoms and deterioration in patients.

The physical health nurse ensured patients with skin integrity issues were assessed, monitored and interventions were put in place to maintain skin integrity. Staff used the Waterlow assessment tool to assess for any pressure ulcers. Interventions included skin care, regular repositioning, providing appropriate mattresses and equipment. Referrals were also made to tissue viability and wound care as appropriate.

Occupational therapy staff completed functional, community, vocational and sensory assessments of patients on admission to understand their needs, their level of independence and confidence, and to provide relevant plans and strategies to support them. Patients with mobility issues were assessed by occupational therapy staff and supported with appropriate mobility aids.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. Managers provided new staff with appropriate induction. Topics covered a wide range of areas to ensure staff understood the service, how to ensure safety and meet the needs of the patient group.

Managers provided staff with supervision and appraisal of their work performance. The percentage of staff that had had an appraisal in the last 12 months was 92% across the hospital. The percentage of staff that received regular supervision was 92% across the hospital.

Managers ensured that staff had access to regular team meetings. We reviewed team meetings and saw examples of improvements and learning shared with staff to ensure best practice.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Staff spoke positively of the opportunities they had available to develop professionally.

Managers ensured that staff received the necessary specialist training for their roles. Staff had completed trauma informed training, and managers had added face to face physical health and falls training to ensure staff were competent to meet the needs of the patient group at the service.

Managers dealt with poor staff performance promptly and effectively. Managers were able to give examples of where poor performance had been addressed by human resources or disciplinary processes.

Staff worked 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.

Staff held regular and effective multidisciplinary meetings. Staff reviewed the patients care, treatment and risks and staff from all disciplines provided feedback on the patient’s progress.

Staff shared information about patients at effective handover meetings. Handover records showed detail of needs and risks of patients and any changes to these. Nurses and healthcare assistants held a handover meeting at the start of each shift. The multidisciplinary team met each day to review risks and incidents.

The teams had effective working relationships, including good handovers, with other relevant teams for example, care co-ordinators and community mental health teams.

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

The service supported 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.

Staff supported patients to live healthier lives for example, through participation in smoking cessation and healthy eating advice. Staff created care plans to support patients engaging in self-harm through food and fluid restriction and offered specific guidance to diabetic patients on managing their blood sugar levels.

Staff ensured patients could access a full range of specialists by referring to these when required. For example, access to a dentist, chiropodist, audiologist and podiatrist was arranged if required.

The physical health nurse completed a resource folder for staff to better understand chronic and acute physical health conditions and how to complete tools to assess this effectively and manage risks. Information was also provided for patients to support their understanding of physical health concerns.

The service had a general practitioner (GP) who would review patients weekly. The general practitioner also reviewed all blood and electrocardiogram (ECG) results (a simple test that records the electrical activity and rhythm of your heart to help doctors check for problems or monitor heart health). The general practitioner worked with staff at Baldock Manor to complete any capacity assessments and best interest meetings if a patient did not have capacity to make decisions about their physical health.

Ward activities helped promote a healthy lifestyle for patients. Groups included nature walks and bird watching, trauma informed yoga, creating healthy habits, relaxation, mindfulness and personal trainer sessions.

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.

Staff used recognised rating scales to assess, record severity, track progress and outcomes. For example, Health of the Nation Outcome Scales (HONOS) and Clinical Outcomes in Routine Evaluation (CORE-OM) to monitor progress and outcomes of patients. This was reviewed in multi-disciplinary meetings for individual patients and overall, in clinical governance meetings to ensure effectiveness of care and treatment outcomes.

Staff used technology to support patients effectively. For example, the physical health nurse was able to access systems to obtain blood test results to ensure effective monitoring of physical health.

Staff told people about their rights around consent and respect these when they delivered person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. We saw an advance decision for one patient where their decision not to contact or share information with a relative was in place.

If a patient was detained under the Mental Health Act 1983, the arrangements for their detention and treatment were consistent with the requirements of the act and accompanying code of practice. Staff supported patients to understand how the Mental Health Act applied to their situation and that patients understood their right to appeal.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. We saw evidence of this in patients records for capacity to consent to treatment. We also saw best interest decision meetings where relatives had been invited to ensure the person’s wishes and views were included in decisions about their care and treatment. Staff did this on a subject-specific basis with regards to significant decisions.