Crossley Place

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• 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 the best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained 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. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. 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 and the Mental Health Act Code of Practice and discharged these well.

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 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. Before admission all patients had a detailed assessment to determine if the service could meet their needs. Following admission, all patients were assessed by the multidisciplinary team. Patient records we reviewed confirmed this.

Staff developed care plans that met the needs identified during assessment. Staff developed a bespoke package of care that was tailored to the individual needs of the patient. Care plans focussed on key areas, and within these each patient had individual care plans to meet their needs. The format of some care plans was adapted to meet the requirements of commissioners.

Care plans were personalised, holistic and recovery-oriented, and developed in discussion with the patient, where possible. Staff updated care plans when necessary, and they were reviewed as least monthly in the multidisciplinary team meeting.

Staff assessed patients’ physical health needs in a timely manner after admission. All patients had initial and routine monitoring of their physical health. They had access to a practice nurse in the service and an Advanced Nurse Practitioner or GP from the local GP surgery. When concerns were identified these were promptly followed up, with specialist medical or allied health professional input when required.

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. This included those recommended by, and delivered in line with, guidance from the National Institute for Health and Care Excellence (NICE) and the Royal College of Psychiatrists. These included medicines, psychological and other therapies, and activities, intended to help patients develop their living skills. Each patient had a bespoke package of care that was tailored to their individual needs and provided by a multidisciplinary team of staff.

Staff used recognised tools and approaches to respond to patients’ needs. All patients we reviewed had individual care plans and positive behavioural support (PBS) plans. Staff were responsive to people’s needs, for example staff used recognised psychological approaches for working with people who were having nightmares.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. The practice nurse attended the morning handover and led on ensuring patients’ physical health needs were met. Patients had physical health checks at least every 6 months, or more often if required by their healthcare needs or medicines. All patients had physical health care plans. Staff recorded patient’s physical health observations (such as blood pressure) using the National Early Warning Score (NEWS2) system. This made it easy to see changes in observations, and where action should be taken. The NEWS2 charts were reviewed in the daily senior management team meeting, and any gaps or actions were identified.

All patients were registered with a local GP. An Advanced Nurse Practitioner or GP from the practice provided a surgery every week, alternating between a face-to-face and remote session. Patients had an annual health check and were given access to health screening such as smear tests. Staff were trialling accessing patients’ online medical records from the GP practice at the time of our inspection, which included patient’s blood test results, so the information could be obtained more quickly.

Blood tests were carried out onsite for all patients on high dose antipsychotic therapy or HDAT (prescribed medicines that are above the usually recommended limits), and for specific medicines that required additional monitoring. Electrocardiograms (ECGs) were also carried out onsite. Staff completed the Lester Tool, which is used for assessing patients’ cardiometabolic health and risks, particularly for people with mental health problems who are taking anti-psychotic medicines. All patients had had a venous thromboembolism (VTE) assessment in line with national guidance, to determine their risk of developing blood clots.

Staff assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. Staff used rating scales such as the Malnutrition Universal Screening Tool (MUST) when necessary. Food was cooked onsite and was adapted to meet people’s nutritional needs and preferences, such as for diabetic patients. Staff monitored patients’ weight and had developed a weight-loss programme. This included supporting patients with diet and exercise, and to access weight-loss services and medicines 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, nurses and support workers patients received care and support from occupational therapists, registered practitioner psychologists, and social workers. Patients could access other health professionals when required, such as dietitians, physiotherapists, podiatrists, and speech and language therapists. Patients had access to primary healthcare including dentists and opticians. Patients could access urgent and specialist healthcare when required.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. For example, staff were working to develop a trauma informed approach within the service, which was led by the psychology team but involved all staff and patients. This included assessments of the environment, talking with staff and patients, and training.

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 an appropriate induction, adapted for permanent and temporary staff.

Managers provided staff with supervision and appraisal of their work performance. 89% of staff were up to date with their supervision sessions, and 97% of staff had had an appraisal in the last year. Managers ensured that staff had access to regular team meetings. Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. Managers ensured that staff received the necessary specialist training for their roles.

Managers dealt with poor staff performance promptly and effectively.

Mental Health Act

All patients were all under some form of legal framework for their stay at Crossley Place. This was the Mental Health Act for English and Welsh patients, but different legislation was applied for patients from the Republic of Ireland, Northern Ireland and Scotland. Staff worked with commissioners and statutory bodies from other countries to ensure the law was applied correctly, and patients’ rights were upheld.

Staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Training in the Mental Health Act had been completed by 98% of staff.

The provider had relevant policies and procedures that reflected the most recent guidance. Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Staff had easy access to administrative support and legal advice on the implementation of the Mental Health Act and its Code of Practice.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated this as required and recorded that they had done this.

Patients had easy access to information about independent mental health advocacy (IMHA). Patients could access an IMHA through the local authority. A non-IMHA advocate, with experience of working with mental health patients attended the service every week. The advocate met with patients individually and provided support in multidisciplinary team meetings. They attended safeguarding and best interest meetings when necessary. Information was displayed informing patients how to contact the different types of advocacy services. Common concerns raised were about restrictions and access to items, or changes in staff. The advocacy service provided a quarterly report summarising themes for the managers.

Staff followed the correct procedures to ensure that patients were lawfully given medicines under the Mental Health Act or equivalent. Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff ensured that patients were able to take Section 17 leave (permission for patients to leave hospital) or equivalent when this had been granted.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.

Staff carried out regular audits to ensure that the Mental Health Act (or other legislation) was being applied correctly. Findings from these audits were reviewed at the monthly clinical governance meetings. Staff at the daily management meeting checked for any pending actions required such as renewal of consent to treatment.

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 held regular and effective multidisciplinary meetings. Each patient had a multidisciplinary team meeting every 4 weeks, or more frequently if required.

Staff shared information about patients at effective handover meetings within the team. Staff provided a verbal and written handover of information between shifts.

A multidisciplinary team meeting took place every weekday morning. This was attended by managers and leads from all the professions in the service, including medical, nursing, psychology and occupational therapy. Any significant events were discussed, and the necessary actions identified. Actions from previous days were followed up at this meeting.

Staff worked well with the commissioners who purchased and managed each patient’s care package. Staff worked with the multiple commissioning bodies to provide feedback and information about individual clients and the wider service. This took account of the different regulatory frameworks and ways of working that were required due to some commissioners being from other countries such as Wales, Scotland, Northern Ireland and the Republic of Ireland.

Managers shared information with host-commissioners, who had oversight of the service as it sat in their local area. Feedback was positive, and no significant concerns were highlighted by commissioners or stakeholders.

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. This included through regular physical health monitoring and managing cardiovascular risks. All patients had their physical health routinely monitored and had the necessary healthcare screening. All patients were registered with a local GP, and there were a practice nurses in the service who led on physical health care. All patients had a 6-monthly or annual health check within the service and with their GP.

Staff encouraged patients with healthier lifestyles. This included physical activities such as walking and other sports activities and promoting healthier snacks and meals. Staff monitored patients’ weight and had developed a weight-loss programme. This included supporting patients with diet and exercise, and to access weight-loss services and medicines where appropriate.

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.

Staff used recognised rating scales to assess and record severity and outcomes. Staff used a variety of recognised tools to monitor patients depending on their needs. These were recorded in each patient’s care records and used to review and direct their care. For example, patients had their routine physical health observations monitored and recorded using NEWS2 (National Early Warning Score), which highlighted if further action may be required. Staff used tools to monitor the effect of medicines such as the Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) which is used to assess the side effects of antipsychotic medicines. Staff completed Health of the Nation Outcome Scales (HONOS) every 3 months. This is a standard measure for monitoring the health and social functioning of people with mental health problems over time.

Staff used other evidence-based tools to monitor people’s mental and physical health, risk, and other aspects of their care as required. The psychology and occupational therapy teams used various rating scales with patients to monitor their mental health and progress over time.

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 as much as possible. When this was not possible, they followed the provisions of the Mental Health Act (or equivalent legislation) and the Mental Capacity Act. Staff had easy access to Mental Health Act and Mental Capacity Act policies, procedures and advice.

Staff assessed and recorded each person’s capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. When patients lacked capacity, staff made decisions in their best interests whilst recognising the importance of the person’s wishes, feelings, culture and history.