Berkshire Healthcare NHS Foundation Trust

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last assessment we rated caring as good. At this assessment the rating has remained good. Staff treated people with compassion and kindness. They respected people’ privacy and dignity. They understood the individual needs of people and supported people to understand and manage their care, treatment or condition. Staff involved patients and relatives in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately. This meant people were supported and treated with dignity and respect; and involved as partners in their care.

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.

Quality Statement Score: 3.
We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.
The quality of relationships was evident from feedback received by relatives. Staff monitored patients closely while prompting dignity. Kindness was a common theme from feedback from patients and relatives.
We observed interactions where staff engaged with patients warmly and respectfully. Staff knocked before entering bedrooms, introduced themselves and maintained privacy during personal care and clinical procedures. Relatives said staff were professional, kind and very attentive. There were privacy shutters on all bedroom doors and we observed that staff always knocked before entering.

We observed mealtimes, which were busy but gave the sense of a calm atmosphere. We observed staff offering options of different foods and supporting people with respect if they needed support or assistance to eat, giving people time, and they had adequate time to swallow each mouthful. This was specifically important for people with difficulty swallowing. Both water and squash were available outside of mealtimes in the lounge and fruit bowls were visible in communal areas.

Patients were not routinely given keys to access their rooms. This means that independence of choice was dependent on staff being available to open doors.
 

Quality Statement Score 3.
We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Through the admission process life history, interests likes and dislikes and communication preferences were obtained. This information was captured through a form of life-story/personhood and incorporated into care planning. Staff adapted their communication depending on the individual: some patients benefitted from being offered choices, while others become more confused and needed simpler, more direct support.
Staff were able to support clinical recommendations for menus including soft foods for those patients who could not swallow or chew to prevent choking. Food choices include vegetarian and specialist food consistencies and supplements to meet assessed needs, e.g. soft, pureed, finger foods, thickened fluids
We observed that communication needs were assessed and met.
The bedrooms on both wards were described as clean and tidy however those on Rowan ward did lack personalisation which we were told was due to renovations taking place. Both wards could benefit from dementia friendly improvements to reduce confusion and physical risk for patients by providing a calm, and intuitive environment that supports physical and psychological safety with familiarity, personalisation of rooms and clear communication in picture and written format. We were assured this would be put in place once the improvements to the wards were completed.
 

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.
The service supported people to maintain independence and exercise choice and control within the boundaries of clinical safety. People detained under the Mental Health Act were supported to access an independent mental health advocate (IMHA). Those eligible for IMHA were told about this right and helped to use it. Advocacy had been accessed and was viewed positively by relatives. One member of staff emphasised that dementia or mental illness does not remove a person’s identity, preferences or right to communicate and exercise choice and this was supported by feedback from families.
Community meetings were held on the wards, and minutes from both wards showed a structure and ability for patients to have a voice. In addition, a range of activities were offered that could be self-initiated such as a breakfast club where patients can prepare their own breakfast or be supported by staff. This reflected the individual ability of patients. Staff offered chair exercising for those less mobile. Staff told us that they have a pop-up pub and in there that they have non-alcoholic beers and wine, or they had parties for patients’ birthdays. We were told there are also quiz afternoons and music. Staff told us about the happiness programme described as an interactive night screen that could go anywhere around the world that has got activity with games and radio stations, and was used both as part of 1:1 time and in groups. It has games like fishing games or horse racing games, stories including traditional stories that patients would have heard as part of their childhood and may recall memories for them. Some family members told us that more stimulation was required and that more activities could be provided. However, our observations and overall feedback was that a wide range of activities were available and provided but due to a lack of activity coordinator on Rowan ward this maybe having an impact on some of the feedback provided and the patient experience. An Occupational Therapist and Occupational Therapy Assistant were available to support people with activities on the ward.
The wards were part of the organisational accreditation with carers trust, the triangle of care.Staff supported carers by providing them with a letter when their relative was admitted to the ward and providing opportunities for one to one sessions with ward managers or clinical leads. Managers told us that they had tried groups but privacy and confidentiality was not working. The ward also fed into the wider carer support within the trust.
We noticed there was a room that although unoccupied, had somebody's clothes and possessions in it. The nurse explained that the person had moved rooms because of the renovations and was not coping well with this move. Staff adjusted the storage in the new bedroom to help with this, and allowed the patient to keep their belongings in their old room.
 

Quality Statement Score: 3.
We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.
Staff were observant and proactive. They noticed changes in presentation and acted without being asked.
On Rowan ward, we observed one patient, who was doing some colouring in the activities room. They tried to get out of their wheelchair but couldn't get a grip on the floor. The staff who supported them, assured them that they were safe if they sat back down in the chair, which they then did. The staff told them what they were doing all the time, reassuring them throughout the process informing them of each step taken.

Patients told us physical needs were dealt with promptly. The escalation process for physical health concerns was clear. Observations were done at the required frequency and reviewed by the clinical team in good time if a deterioration was indicated or at weekly MDT meetings. On-call medical cover was available quickly when needed. When a person became distressed, staff carried out de-escalation using the least restrictive techniques in the first instance. Staff were trained in de-escalation and this was evidence in the responses we observed.
 

Quality Statement Score: 3.
We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.
Staff said they felt well supported by their managers. The service manager was visible, approachable and interested in the wellbeing of the team. Staff felt able to raise concerns or ask for support without fear of judgment. The freedom to speak up culture extended to personal wellbeing, not just clinical and safety issues.

Staff received monthly supervision. Rowan ward had improved supervision compliance in the 6 months before the inspection from 89% to 97% of staff. Orchid went from 91% to 84% for the same period however, we were told there were absent from work who did not receive supervision.
Sickness absence fluctuated across the two wards. The average staff sickness levels were 7% on Orchid Ward which was higher than the 5% on Rowan ward. This meant 10-13 staff members were absent from work each month. Short term sickness and long-term sickness was addressed appropriately through formal sickness case management. The trust recognised that "Overall, the data indicates a sustained impact from long-term sickness absence across the reporting period, with occasional short-term sickness episodes with sustained impact from long-term sickness absence. The majority of these absences were covered by bank staff who were familiar with the service.
Staff felt enabled in their roles. Staff were encouraged to develop professionally with leaders telling us that they could undertake leadership training.. Senior colleagues actively supported their learning and progression.