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Provider: Affinity Healthcare Limited Good

Inspection Summary


Overall summary & rating

Good

Updated 3 August 2015

The hospital had environmental challenges on some wards due to the age, design and fabric of the building. However; the provider had an improvement plan in place to address these issues which included refurbishing some wards and up-grading the seclusion rooms to ensure they complied with current guidance. These issues were escalated onto the providers' risk register. Some of the improvement work had been completed.

The hospital had an open and transparent culture to reporting and learning from incidents. Safeguarding was embedded in clinical practice.

Medication management was good across the service.

Staffing levels and skill mix were good across the services. The hospital had taken action to recruit more medical staff for the Psychiatric Intensive Care Unit wards in line with best practice guidance.

Patients were able to access a range of treatments to support their recovery within a multidisciplinary team approach. Staff had access to the support and training required to provide care and treatment to patients.

However, on the in-patient Child and Adolescent wards, some staff did not have a good understanding of issues relating to caring for young people with an autistic spectrum disorder.

The hospital had a good governance structure in place to monitor the use of the Mental Health Act and Mental Capacity Act across the wards and identify any themes or issues which required addressing.

Feedback from patients was positive overall. Staff were praised for their caring attitude and were considered approachable and friendly. The majority of patients we spoke to felt involved in their care. Patients were supported to maintain and develop their relationships with those close to them, their social networks and community.

The hospital involved patients in the recruitment of new staff including being part of the interview panel. An ex patient was also a member of the hospital wide governance group.

The service was responsive to meeting patients' needs. The hospital admitted patients primarily from the North of England. However; due to the specialist nature of some of the services such as the Child and Adolescent Mental Health Service and eating disorder wards, patients residing outside of this area could be admitted if they met the criteria for admission. Discharges were planned through the Care Programme Approach framework.

The wards provided a range of activities and facilities to meet patients' needs.

All complaints or compliments a ward received were discussed locally at the ward team meetings. The ward managers analysed all complaints to identify any trends or themes.

The service was well-led locally and at senior management level. The provider’s visions and strategies for the services were evident and staff understood the vision and direction of the organisation. Senior managers had a visible presence within all clinical areas.

There was an effective embedded governance structure in place which was based upon a quality improvement agenda.

Staff morale across the hospital was very good, teams were proud of their work and felt supported by their managers.

Inspection areas

Safe

Good

Updated 3 August 2015

We rated the location as 'Good' because;

  • The hospital had environmental challenges on some wards due to the age, design and fabric of the building. However; the provider had an improvement plan in place to address these issues which included refurbishing some wards and up-grading the seclusion rooms to ensure they complied with current guidance. These issues were escalated onto the providers risk register. Some of the improvement work had been completed.

  • The hospital had an open and transparent culture to reporting and learning from incidents. Safeguarding was embedded in clinical practice.

  • Medication management was good across the service.

  • Staffing levels and skill mix were good across the services. The hospital had taken action to recruit more medical staff for the Psychiatric Intensive Care Unit wards in line with best practice guidance.

Effective

Good

Updated 3 August 2015

We rated the location as 'Good' because;

  • Care and treatment was provided in line with best practice guidance.
  • Patients were able to access a range of treatments to support their recovery within a multi-disciplinary team approach.
  • Staff had access to the support and training required to provide care and treatment to patients.
  • The hospital had a good governance structure in place to monitor the use of the Mental Health Act and Mental Capacity Act across the wards and identify any themes or issues which required addressing.

However, on the in-patient Child and Adolescent wards, some staff did not have a good understanding of issues relating to caring for young people with an autistic spectrum disorder.

Caring

Good

Updated 3 August 2015

We rated the location as 'Good' because;

  • Feedback from patients was positive overall. Staff were praised for their caring attitude and were considered approachable and friendly. The majority of patients we spoke to felt involved in their care.
  • Patients were supported to maintain and develop their relationships with those close to them, their social networks and community.
  • The hospital involved patients in the recruitment of new staff including being part of the interview panel. An ex patient was also a member of the hospital wide governance group.

Responsive

Good

Updated 3 August 2015

We rated the location as 'Good' because;

  • The hospital admitted patients primarily from the North of England. However, due to the specialist nature of some of the services such as the Child and Adolescent Mental Health Services and eating disorder wards, patients residing outside of this area could be admitted if they met the criteria for admission. Discharges were planned through the Care Programme Approach framework.
  • The wards provided a range of activities and facilities to meet patients needs.

  • All complaints or compliments a ward received were discussed locally at the ward team meetings. The ward managers analysed all complaints to identify any trends or themes.

Well-led

Good

Updated 3 August 2015

We rated the location as 'Good' because;

  • The service was well-led locally and at senior management level. The provider’s visions and strategies for the services were evident and staff understood the vision and direction of the organisation. Senior managers had a visible presence within all clinical areas.
  • There was an effective embedded governance structure in place which was based upon a quality improvement agenda.

  • Staff morale across the hospital was very good, teams were proud of their work and felt supported by their managers.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 3 August 2015

We gave an o

Overall, on the

 

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r child and adolescent mental health inpatient wards we found that:-

Wards provided safe environments for patients.

Staffing levels were sufficient to meet patient needs and keep them safe.

The service analysed incidents to identify themes and trends to look at ways to reduce the use of physical intervention.

Patients had access to psychological therapies as part of their treatment and psychologists were part of the multi- disciplinary team (MDT).

Staff worked collaboratively with the patient, families and local agencies to understand and meet the range and complexity of patients’ needs.

Where patients were detained under the Mental Health Act 1983, their rights were protected and staff complied with the MHA code of practice.

Most patients spoke positively the service. The service included the views of patients and relatives  in decisions about care and treatment..

Patients could make a complaint or raise a concern and these were responded to.

Staff felt supported by the organisation and their line managers. Staff morale was good.

The service ensured that learning from serious incidents was always shared and improvements made.

The service had been innovative by developing its own approaches to managing self harming behaviours.

However; staff were not appropriately qualified and competent in providing treatment and care to patients with autism .

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 3 August 2015

The services had reliable systems, processes and practices in place to keep people safe and safeguard people from abuse. There was an openness and transparency about safety. Staff understood their roles and responsibilities to raise concerns and report incidents and near misses.

Individual and environmental risks were monitored and managed appropriately. Comprehensive risk assessments were carried out for patients and risk management plans developed in line with national guidance. Monitoring and reviewing risks enabled staff to understand risks and give a clear, accurate and current picture of safety.

There was a holistic approach to assessing, planning and delivering care and treatment for patients. Patient’s individual care and treatment was planned using best practice guidance with the outcomes being monitored to ensure changes are identified and reflected to meet their care needs.

Consent practices and records were monitored and reviewed to improve how patients were involved in making decisions about their care. Patient’s consent to care and treatment was sought in line with legislation and guidance of the Mental Capacity Act 2005. Patients who were subject to the Mental Health Act 1983 were assessed, cared for and treated in line with the Mental Health Act and Code of Practice.

Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff were supported by means of supervision and appraisal processes, to identify additional training requirements and manage performance.

Feedback from patients was continuously positive about the way staff treated patients and their families. We observed patients being treated with dignity, respect and compassion whilst receiving care and treatment. Patients and the ones who were close to them were involved in their care decisions. Patients and their families or carers told us they were supported emotionally during the care and treatment process.

Services were planned and delivered to take into consideration patient’s individual needs and circumstances. Access to care and treatment services were timely. Effective management of waiting times and delayed discharges meant there was minimal impact on the patients’ care and the service delivery.

The services managed complaints and concerns effectively. They listened to patient’s concerns with a view to improving the services being provided.

The services had a good structure, processes and systems in place to monitor quality assurance to drive improvements.

The services had the processes and information to manage current and future performance. The information used in reporting, performance management and delivering quality care was timely and relevant. Performance issues were escalated to the relevant monitoring committee and the board through clear structures and processes.

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 3 August 2015

Systems were in place to monitor and manage patient risk. Comprehensive assessments were carried out in a timely manner, regularly reviewed and reflected in care plans. There was a programme of ligature risk assessment in place and policies to support the management of this risk. Safeguarding was embedded within the service and the processes to support safeguarding were robust. Staff displayed a good understanding of their roles and responsibilities in this regard.

There was an open and transparent culture within the service. Staff were aware of the incident reporting procedure as well as the provider's complaints process. Staff received feedback when things had gone wrong and were encouraged to make suggestions for service improvement.

Ward shift establishments were developed using an accredited tool and actual staffing levels matched the identified need. There was access to a regular cohort of bank staff and external agency use was low.

There was a multi-disciplinary and holistic approach to the delivery of care. Care was delivered in a compassionate manner and in line with current best practice guidance. There was an audit programme to provide assurance in this regard and outcome measures were used to monitor treatment effectiveness.

There were effective systems in place to ensure adherence to the Mental Health Act 1983, the Code of Practice, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Patients were informed of their rights under section 132 on admission and capacity to consent to care and treatment was sought in line with legislation.

Feedback from patients on the service was positive. We observed patients being treated in a respectful manner and with a caring and empathetic approach. Patients were involved in their own care and the wider running of the wards. Patient attendance at multi-disciplinary team meetings was facilitated and patients were given space to provide their opinions.

Senior management were a visible presence and had effectively embedded the vision and values of the provider within the service. Staff felt supported in their roles and were confident in approaching their line manager. There were good governance structures in place to support the delivery of care and to monitor quality assurance.

We identified a concern regarding one of the seclusion rooms. Senior managers were being proactive in addressing this issue. It was captured on the risk register and an action plan was in place.Senior manages provided assurance formally supported by the provider's chief executive that planned works to upgrade the seclusion facility would be expedited and completed by the end of June 2015. A recruitment plan was also in place around medical staffing. Recruitment had already begun and appointments had been made.

Specialist eating disorder services

Outstanding

Updated 3 August 2015

The services had reliable systems, processes and practices in place to keep people safe and safeguard people from abuse. There was an openness and transparency about safety. Staff understood their roles and responsibilities to raise concerns and report incidents and near misses.

Individual and environmental risks were monitored and managed appropriately. Comprehensive risk assessments were carried out for patients and risk management plans developed in line with national guidance. Monitoring and reviewing risks enabled staff to understand risks and give a clear, accurate and current picture of safety.

There was a holistic approach to assessing, planning and delivering care and treatment for patients. Patient’s individual care and treatment where planned using best practice guidance, with the outcomes being monitored to ensure changes are identified and reflected to meet their care needs.

Patients were active partners in their care, with staff being fully committed to working in partnership with patients. We saw evidence that patients, carers and family members were involved in the decisions about the care and treatment planned. Consent practices and records were monitored and reviewed to improve how patients were involved in making decisions about their care. Patient’s consent to care and treatment was sought in line with legislation and guidance of the Mental Capacity Act 2005. Patients who were subject to the Mental Health Act 1983 were assessed, cared for and treated in line with the Mental Health Act and Code of Practice.

Staff were highly motivated and inspired to offer care which was kind and promoted patient’s dignity.

Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff were supported by means of supervision and appraisal processes, to identify additional training requirements and manage performance.

Feedback from patients was continuously positive about the way staff treated patients and their families. We observed patients being treated with dignity, respect and compassion whilst receiving care and treatment. Patient’s emotional and social needs are valued by staff and are embedded in their care and treatment.

Services were planned and delivered to take into consideration patient’s individual needs and circumstances. Access to care and treatment services were timely. Waiting times, delays in discharge were minimal and managed appropriately.

There was a proactive approach to understanding the needs of the different groups of patients and to deliver care in a way that met these needs.

There was an active review of complaints and how they were managed and responded to with improvements being made across the service as a result. The service listened to the patient’s concerns with a view to improve the services being provided. Patients were involved in that review and resolution.

The services had a good structure, processes and systems in place to monitor quality assurance to drive improvements.

The services had the processes and information to manage current and future performance. The information used in reporting, performance management and delivering quality care was timely and relevant. Performance issues were escalated to the relevant monitoring committee and the board through clear structures and processes.