Victoria Gardens

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 inspection we rated this key question good. At this inspection the rating has remained as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. Staff assessed the physical and mental health of all patients on admission. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

However, care plans and discharge plans were not always personalised, did not always include the patient’s voice and were not recovery focused.

We have not awarded this service a score for Effective.

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

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

During the inspection we reviewed 14 care records.

Care plans were not always personalised, holistic and recovery oriented. Most care plans did not always reflect patient’s individual strengths, areas for skill development or the patient’s voice, even when MDT notes showed patients were engaging in discussions about their care and treatment. Most care plans did not establish how activities linked to rehabilitation goals, which meant that they were not clearly recovery focused. Discharge plans were not personalised, and in some care plans the same statements were used. For one patient who was currently transitioning into a placement, there were detailed discharge meetings and information about the patient’s progression, however this was not reflected in the discharge plan. Managers were aware that care plans were not as robust or reflective of patient’s ongoing care and treatment as they could or should be, as this had been picked up in quality audits. Managers had an ongoing open action to help improve the quality of the care plans.

However, risk assessment and risk management plans were comprehensive, and physical health care was robust.

Staff completed a comprehensive mental health and physical health assessment of the patient in a timely manner at, or soon after, admission. The service had an admission checklist to ensure that assessments were completed, within the expected timeframe. For example, physical health observations, and care plans such as observation care plans, risk and physical health were expected to be completed in 24 hours. The Recovering Quality of Life (ReQol) tool was expected to be completed within 72 hours, and tasks including START assessments, additional care plans and PBS plans were to be completed within 7 days. The admission checklist had a monthly audit completed by staff to ensure assessments had been completed within the specified time.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. 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 provided a range of care and treatment interventions suitable for the patient group. The interventions were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE). The service had recently introduced a trauma recovery care model, with training provided by the service’s psychology team. The model compromised of 3 stages:

Stage 1 – Safety, stabilisation and building trust, which focused on developing therapeutic trust, stabilising risk and establishing safety.

Stage 2 – Skill discovery and self-development supported the developing emotional regulation and coping strategies.

Stage 3 – Reconnection and integration which supported patients to increase their autonomy, reintegration into the community and begin transition planning.

Each stage gave established MDT goals, and expected interventions from each staff discipline. This included medication and psychological therapies and activities, training and work opportunities intended to help patients develop through each stage. The model of care was underpinned by 6 principles: safety, peer support, transparency, collaboration, empowerment, and cultural and gender considerations.

The service had group and individual activity timetables. Sessions included cooking groups, exercise groups, gardening and outings. Groups were well attended, and most patients spoke positively about the activities that were available. However, one patient said they felt activities were more suited to younger patients. An OTA was assigned to each ward which had increased the activities available on the ward. Patients were aware of the team, and staff spoke positively about their inclusion on the ward.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. A GP visited the service every two weeks, with an Advanced Practitioner visiting on the alternative week. The GP service is accessible outside of these visits. The service had an onsite practice nurse as well. In the care records, we reviewed physical health monitoring and found it robust. There were also service level agreements with dentists, local opticians and podiatry, with patients being encouraged to access them in the community as part of their rehabilitation, where appropriate.

The team included or had access to the full range of specialists required to meet the needs of patients in the service. As well as doctors and nurses, there were occupational therapists, psychologists, and social workers. There was good MDT working in the service, however staff reported that there were some difficulties if there were short notice meetings because the lead and senior OTs and psychologists worked across Victoria Gardens and another Elysium service. This meant they were not always available to input quickly, or their days onsite were spent in ward rounds rather than ward-based activities.

Staff participated in clinical audit, benchmarking and quality improvement initiatives.

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 and provided staff with supervision (meetings to discuss case management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance. The service had a target of 90% for supervision and appraisals. The percentage of staff that received regular supervision was 95%. The percentage of staff that had had an appraisal in the 12 months prior to inspection was 93%. Bank staff were also offered regular appraisals.

Managers ensured that staff had access to regular team meetings, and minutes of these meetings were also shared with staff who were unable to attend. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge and dealt with poor staff performance promptly and effectively.

The service admitted patients under the Mental Health Act 1983. Staff received training on the Mental Health Act as part of their mandatory training, the current compliance rate was 96.9%. They had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. The service had easy onsite access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice and relevant policies and procedures that reflected the most recent guidance.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand and repeated this as necessary, this was recorded appropriately in care records. Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) when this has been granted. Escorted leave was rarely cancelled and always re-arranged as soon as possible if unable to go ahead. The provider had relevant policies and procedures that reflected the most recent guidance.

Each ward had patient information boards, which included how to access independent Mental Health Advocacy (IMHA). There were no informal patients during our onsite inspection. Staff understood that informal patients could leave at any time and described how they would manage this situation.

Regular audits were completed to ensure that the Mental Health Act was being applied correctly. This included a consent to treatment audit and section 132 (ensuring detained patients understand their rights) audits. These audits highlighted when new issues were identified, resolved or had been repeated.

We scored the service as 3. The evidence showed a good standard. 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.

Staff had regular and effective multidisciplinary meetings. We observed a daily morning Senior Management Team (SMT) meeting which included wards managers, responsible clinician, a nurse from each ward, as well as MDT members. The meeting was used to discuss the previous 24 hours in the service, including pre-admission assessments, incidents, clinical concerns and risk management in a brief but effective way. There were regular ward rounds which included full MDT input, as well as external stakeholders such as care coordinators, patients and families, which gave them an opportunity to feedback on their care and treatment. The wards also had regular MDT meetings as and when needed to promptly discuss changes in patient’s risk and presentation.

We also observed a morning handover between shifts, which was an extended handover as it was also a handover between shift patterns. The meeting was comprehensive, and staff were knowledgeable about patients.

The teams had effective working relationships with teams outside the organisation, working closely with a local GP and a third-party pharmacy supplier.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. The site was smokefree regarding tobacco products, but patients had access to vapes when in the courtyard of the service. Staff could also provide patients with nicotine replacement options.

The service had an ‘Achieving a Healthier Lifestyle’ group, which had a focus on weight management. Patients were also being encouraged to only have takeaways at weekends to encourage healthy eating and self-catering. This had been discussed in community meetings and was noted on each ward risk register as a potential restrictive practice. The service had regular group therapy sessions to support patients dealing with issues relating to substance misuse.

Each ward had information boards with information supporting their physical health, such as tips on fitness, healthy eating and cancer awareness. On the female patient ward, Dovecot, they had an information board specifically about female health.

Ward activities helped to promote a healthy lifestyle for patients such as gym, swimming, and as part of the sustainability project, outdoor walking and orienteering. The service also had a football team and the previous year they had competed in a tournament with other local hospitals. Wards also had cooking groups which promoted healthy eating, and when there were concerns regarding a patient’s BMI then referrals to dieticians were considered.

We scored the service as 3. The evidence showed a good standard. 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.

The overall average length of stay in the service was 21.7 months, with an average for male patients of 20.1 months, and 26.7 months for female patients.

Staff used recognised rating scales to assess and record severity and outcomes such as Health of the Nation Outcome Scales (HoNOS). Occupational therapy also used the Model of Human Occupation Screening Tool (MOHOST), to set goals for patients by evaluating patients’ participation in daily life. Outcomes and outcome measures were regularly reviewed at local and regional clinical governance. For example, increased patient engagement and activity participation through OTAs being assigned to the wards.

Staff used technology to support patients. The service had introduced an electronic record system to centralise records, this helped managers have more effective oversight when completing audits.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. When a patient might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Advocacy was available should patient representation be needed.

All assessments were made on a decision-specific basis regarding significant decisions. If a patient lacked capacity in more than one area of decision making, staff ensured decisions were considered independently. Staff ensured that when a patient was being assessed, they had captured and up to date view of the patient’s current capacity and took any improvements into account.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. Staff included families and carers, as well as external stakeholders such as care coordinators where appropriate.