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Provider: Tees, Esk and Wear Valleys NHS Foundation Trust Good

Action is being taken against this provider. Find out more

  • We have suspended the ratings for Child and adolescent mental health wards on this page while we investigate concerns about this service. We will publish ratings here once we have completed this investigation.
Read our full service inspection reports for Tees, Esk and Wear Valleys NHS Foundation Trust, published on 11 May 2015.

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 23 October 2018

Our rating of the trust stayed the same. We rated it as good because:

  • We rated, effective, caring, responsive and well-led as good, with safe as requires improvement. We rated three of the trust’s 11 services as good and three as requires improvement. In rating the trust, we took into account the current ratings of the five services not inspected this time.
  • We rated well-led for the trust overall as good.
  • The trust had an effective leadership and governance structure. There were groups and committees at all levels and across the specialities to facilitate this. The trust board and senior leadership team had the appropriate range of skills, knowledge and experience to perform their respective roles. There was appropriate challenge at board meetings which was accepted and responded to in a positive way by the executive team.
  • The trust had a strong quality improvement culture which was well developed and embedded across all services and localities. There were examples of where the trust had developed its services by applying this methodology.
  • The trust had an effective incident reporting system that analysed trends, captured learning and shared this learning across the services and localities.
  • Staff were skilled and supported. Compliance with mandatory training was high. Staff had access to other training suitable for their role and the trust had leadership and development training which targeted specific groups of staff.
  • In wards for older people and child and adolescent services there was good patient risk assessment practice for both formulation and review of risk.
  • Report out meetings were effective and used across the services. They provided an effective system for ensuring care was patient focused, therapeutic, informed by risk and formulated with a discharge focus. They also provided an effective means of information flow through the organisation.
  • Morale was high across the trust. Staff felt motivated, supported, valued and displayed a positive attitude about their role and the trust as an organisation.
  • There was good engagement with patients and carers and the trust sought feedback to inform the performance and development of the service.
  • The trust engaged well with its stakeholders. Stakeholders spoke positively about the trust performance and interactions they had with them.

However:

  • We rated safe as requires improvement in four of the 11 core services and responsive as requires improvement in two of the 11 core services.
  • There were some privacy and dignity issues on some wards with dormitory style accommodation and only a curtain between beds. Although the majority of bedrooms had ensuite facilities not all rooms were ensuite.
  • Some wards were short staffed which had an impact on patients accessing leave from the ward, staff observation of patients and access to meaningful activities.
  • Staff supervision records did not reflect what staff described. Despite some compliance records being low we found that staff were well supported by their managers and received regular supervision. The trust also had a plan in place to address this.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RX3/reports.

Inspection areas

Safe

Requires improvement

Updated 23 October 2018

Our rating of safe stayed the same. We rated it as requires improvement because:

  • Risks were not always managed effectively. In acute wards, some patient risks were not identified and management plans did not always reflect the identified patient risks. Some management plans were generic with minimal strategies to manage risks. In community learning disability services, patient risk assessments were not always updated regularly or when the patients’ presentation changed. Annual ligature risk assessments did not always contain all the ligature risks evident on the ward and the strategies to reduce the risks did not reflect ward practice or were generic and not ward specific. Blanket restrictions were in place on some wards and these had not been identified by staff.
  • There were wards with dormitory style accommodation, some of which had beds only separated by a curtain.
  • Monitoring and audit of services were not always effective. Clinic room temperatures were consistently higher than 25 degrees on a number of wards and no action had been taken to address this. There were gaps in the recording of the checks of daily emergency bags on some wards. In community based mental health services for adults of working age there were inconsistencies in the provision of emergency equipment in clinics.
  • There weren’t always enough staff on the wards. Some wards were often short staffed which had an impact on patient leave from the ward and observation of patients. Some wards did not meet their minimum staff levels for registered nurses.
  • Medicines were not always managed appropriately. Prescription cards for a patient’s covert medication on Meadowfields ward had not been completed for 17 out of 26 administrations. Recording of patients’ physical observations following rapid tranquilisation was not always completed and at times the refusal of monitoring was not recorded. There wasn’t clear instruction or guidance in all care plans for the use of some as required medication although the information was correctly stated in patients’ medication charts.
  • Staff didn’t always complete records effectively. Agency staff did not always have access to the electronic patient records. Where the ward was staffed only by agency staff they relied on a handover from the previous shift and relied on the next shift to complete records. Some seclusion records had information missing and staff did not always carry out reviews in line with the Mental Health Act code of practice.
  • We rated four of the 11 core services as requires improvement for the safe key question. This takes into account the ratings of the core services which were not inspected at this inspection.

However:

  • Environments for patients were clean and well maintained. Environmental risk assessments were in place, comprehensive and updated regularly. The trust reduced the number of mixed sex wards and the remaining wards complied with national guidance.
  • Staff had a good understanding of risks and how to manage them. Staff knew how to report incidents and acted on lessons learnt from incidents, complaints and feedback. Staff had a good understanding of safeguarding and their responsibilities. The trust supported staff throughout the process. In wards for older people and child and adolescent services there was good patient risk assessment practice for both formulation and review of risks.
  • Compliance with mandatory training was generally high across the services.
  • Staff were following best practice guidance when using mechanical restraint and were making positive steps in trying to reduce its use.
  • The trust had made some positive moves in monitoring and improving staffing in some areas. The trust had reviewed and increased the numbers of staff nurses on the psychiatric intensive care units in line with national guidance and planned to increadisclse staffing establishments on the 20 bed acute wards.
  • There was good medicines management in the community services and the child and adolescent wards.

Effective

Good

Updated 23 October 2018

Our rating of effective stayed the same. We rated it as good because:

  • The multi-disciplinary team worked well together and linked to other areas of the trust and external teams. The teams included or had good access to a range of specialists to meet the needs of patients. Report out meetings were effective and used across the services. They provided an effective system for ensuring care was patient focused, therapeutic, informed by risk and formulated with a discharge focus.
  • Patients’ care plans were generally person centred, covered all aspect of the patients’ needs and were up dated regularly. Care planning had significantly improved at Roseberry Park Hospital. Staff used a range of recognised rating scales to measure the effectiveness of interventions and patient recovery.
  • Staff generally had a good understanding of the Mental Health Act and Mental Capacity Act and put this into practice. There were effective policies and procedures in place as well as an effective administration team.
  • Staff received regular clinical supervision and appraisal and felt supported in their roles. Morale of staff across the trust was very positive and they were motivated to provide quality care.
  • There was good access to physical healthcare across the services and monitoring of patients’ physical health was generally good. The services encouraged and promoted healthier lifestyles for patients including physical activity and diet.

However:

  • Recording of supervision was not always accurate. Although staff reported they received regular supervision and were supported by managers and colleagues, the trust data did not reflect this in some teams.
  • Staff didn’t always follow the Mental Capacity Act. At The Orchard, staff were not carrying out mental capacity assessments for patients even when capacity was in question for medication decisions. On Baysdale ward staff were not considering mental capacity for patients who were 16 years old or over. In some acute wards and psychiatric intensive care units, staff did not always record capacity assessments or best interest decisions. In older people wards there was no record of staff considering a patient’s capacity when delivering personal care.
  • Staff did not always complete patient monitoring or assessments. At The Orchard staff were not consistent in using the national early warning scores tool with all patients. In forensic services staff did not revisit annual health checks until the next year if the patient refused it.
  • There was inconsistency with care planning on some wards. In some acute wards and psychiatric intensive care units care plans were not personalised, holistic or recovery orientated. Some wards had standardised generic templates. They did not always reflect the involvement of the patient or meet all needs identified in the assessment. There was also a lack of clarity about the process of assessment and review when patients moved between wards.
  • Not all staff groups were integrated or represented in the multidisciplinary team. Cedar ward had limited occupational therapy and psychology input and no representation at report outs.

Caring

Good

Updated 23 October 2018

Our rating of caring stayed the same. We rated it as good because:

  • Staff understood the needs of patients and patients felt listened to. Staff worked in partnership with patients and carers, and demonstrated understanding of the needs, likes and dislikes of individual patients. Care planning at Roseberry Park hospital detailed patients’ preferences, views and thoughts and engagement was positively encouraged.
  • Patients were treated with dignity and respect. We saw positive interactions between staff and patients. Patients and carers were actively involved in multi-disciplinary and care programme approach meetings.
  • Patients and carers were actively involved in the service and how it was developed. They could provide feedback about the service through surveys and regular meetings. In older people wards carers workshops were held quarterly. In acute and psychiatric intensive care units there were carers leads and carers gave positive feedback about their involvement in care. There was good support for carers. Patients and carers felt confident to raise concerns and staff acted on these.
  • In community learning disability service staff were described as going the extra mile to support patients. Staff showed determination and creativity in overcoming obstacles to care delivery.

However:

  • In forensic services some patients said that staff could be abrupt at times.
  • Some care plans in acute and psychiatric intensive care units did not always show the involvement of patients and some contained clinical terminology and abbreviations.
  • In children and adolescent mental health services some timetabled activities did not take place.

Responsive

Good

Updated 23 October 2018

Our rating of responsive stayed the same. We rated it as good because:

  • Services effectively and actively worked with patients to support meaningful admission and discharge planning. The wards followed the purposeful inpatient admission process to ensure every patient had a clear reason for admission, a formulation and clear goals to achieve to support discharge. Community services had clear referral criteria, waiting time and access to services was generally good. In community learning disability service, the team made follow-up contact with patients who did not attend appointments and offered flexibility in the time and location of appointments to facilitate attendance.
  • The services met the needs of patients. They offered services to address individual requirements such as interpreters, written information in different formats, building access, and access to other services. Staff supported patients of different sexual orientation, ethnicity and religions. Some wards had access to multi-faith rooms. The clam boxes on Cedar ward contained prayer mats and a copy of the Koran.
  • Staff felt respected, supported and valued. They had the opportunity to input ideas and contribute to the development of the service. Staff were positive about working for the trust and spoke highly of their colleagues and team.
  • Leaders were visible in the services and staff felt supported by their managers. Locality managers and modern matrons visited the services regularly.
  • On Ward 15, an innovative recovery at home service worked with patients to support them in their home and local community before discharge. There had been a 30 per cent reduction in the average length of stay for patients.

However:

  • The trust had some wards with dormitory style bed bays and some of the beds were only separated by a curtain which sometimes did not maintain the dignity of the patients. Not all bedrooms had ensuite facilities.
  • In older people wards leave beds were used at times for admissions and the average bed occupancy was above 85 per cent.
  • Activities were not always available for patients. In forensic services there were no scheduled meaningful activities taking place on a weekend, there were no outcome measures for activities and the activity room at Northdale centre was difficult for patients to access. In some acute and psychiatric intensive care units there was limited meaningful activity when occupational therapy staff were not present.
  • There was over restrictive practice on some wards in forensic services such as access to snacks and snap locks on doors.
  • West Lane hospital patients sometimes said the standard of meals provided was poor.
  • There were long waiting times at Lancaster House autism service.

Well-led

Good

Updated 23 October 2018

Our rating of well-led stayed the same. We rated it as good because:

  • The trust board and senior leadership team had the appropriate range of skills, knowledge and experience to perform their respective roles. There was appropriate challenge at board meetings, these were accepted and responded to in a positive way by the executive team.
  • The trust had an effective leadership and governance structure. There were groups and committees at all levels and across the specialities to facilitate this. The trust had leads for each speciality and the executive director of nursing was the lead for safeguarding adults and children.
  • The trust leadership team had a comprehensive knowledge of current priorities and challenges and acted to address them. Issues were effectively identified, discussed and escalated where necessary through the daily huddles at all levels of the trust.
  • The trust had a clear vision and set of values with quality and sustainability as the top priorities. Staff knew and understood the trust’s vision, values and strategy and how achievement of these applied to the work of their team.
  • Leadership development was available to staff, a strong focus being placed on creating a coaching culture that supported recovery and wellbeing. The trust was introducing a programme for staff from a black, Asian and minority ethnic background. The trust introduced a bespoke coaching service called ‘TEWV-Think-On’ in July 2017.
  • Succession planning was in place throughout the trust. Trust strategies had a focus on creating a coaching culture that supported recovery and wellbeing. The head of organisational development and talent management lead monitored the recruitment of leaders and managers in the trust to highlight any succession planning issues. The trust had a talent management system which was an integral part of appraisal.
  • Managers had access to information on dashboards covering incidents, safeguarding, staffing and patient experience.
  • Staff were regularly involved in audits and quality improvement projects to improve the quality of the service. The trust had a strong quality improvement culture which was embedded into all levels and services of the organisation.
  • Staff felt respected, supported and valued. Staff were positive about working for the trust. There was range of programmes to support staff including mindfulness course, trust retreats, and employee psychology service.
  • Positive feedback was received from external stakeholders such as local authorities, clinical commissioning groups, quality surveillance groups and third sector organisations.
  • The trust had an effective approach to investigating and learning from complaints and incidents. They encouraged feedback for patients and carers and used this information to inform service development.
  • Appropriate governance arrangements were in place in relation to Mental Health Act administration and compliance. Oversight of the Mental Health Act was provided through the mental health legislation committee and direct to the board, this also included the Mental Capacity Act monitoring.
  • The trust had systems in place to identify learning from safeguarding alerts and make improvements. There was a clear ‘think families’ focus across the safeguarding team and the trust.
  • The trust had a comprehensive digital transformation strategy which aimed to address some of the areas in the services where information technology and equipment was slow and cumbersome.
  • The trust had a structured and systematic approach to engaging with people who use services, those close to them and their representatives and were using this to make improvements.

However:

  • The ratings in some of the core services had declined. There were a number of differences in the processes locally and the trust were not always identifying issues when they occurred. The use of mechanical restraint was not being regularly reported to the board from the quality assurance committee or quality assurance groups. The board did not have a good understanding of how often or when this was being used in the trust. The quality assurance systems had not identified inconsistencies in the quality of care across the region in a range of areas in acute wards and psychiatric intensive care units. There were inconsistencies in the ligature audits, risk management plans, personalisation of care planning and privacy in shared dormitories.
  • There were safety concerns such as shared sleeping arrangements in dormitories.
  • Some black, Asian and minority ethnic staff described some bullying and harassment experiences of a racial nature and experience of racial abuse from patients. The trust was aware of the issues and were acting to address this.
  • The trust had not made good progress in engaging all their staff in the Disclosure and Barring Service update. They had identified a shortfall in the September target and trajectories for improvement were in place.
  • Supervision records did not always reflect what was occurring in the core services. Staff felt supported and supervised but records showed low compliance.
Checks on specific services

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

Requires improvement

Updated 23 October 2018

  • Staff did not adequately identify and mitigate all the risks to patients. Some ligature risk assessments were incomplete and mitigations were not specific to the ward.
  • Risk management plans did not address the risks identified in assessments, were not person centred, were of very poor quality or were absent. We had concerns about physical health monitoring after rapid tranquilisation and recording of seclusion.
  • Care plans were not always personalised, holistic or recovery-oriented. They contained generic statements, clinical terminology and did not reflect the patient’s voice.
  • Recorded clinical supervision attendance was low. There was no standardised approach for feeding information on clinical supervision from ward level into locality reporting systems for senior management oversight.
  • Activity provision on wards varied. On some wards, there was limited activity for patients when occupational therapy staff were not present. Cedar ward at West Park Hospital had very limited occupational therapy and psychology input and these disciplines did not attend report outs.

However:

  • Staff knew and understood the provider’s vision and values and these were evident in how staff worked with each other and patients. They were discreet, respectful and responsive. Staff were skilled at de-escalation, knew the patients they worked with well and provided personalised, compassionate care.
  • Staff had high training compliance, received yearly appraisals and felt supported by managers and the teams they worked with. Staff had access to a range of support programmes including mindfulness courses, trust retreats, and an employee psychology service.
  • The wards followed a purposeful inpatient admission process to ensure that every patient had a clear reason for admission, a formulation and clear goals to achieve to support discharge.
  • The trusts quality improvement system was embedded across the service and we saw outstanding and innovative practice including the PICU pyramid, the recovery at home service and report outs.
  • The service followed the ‘Triangle of Care’. Carers felt involved and attended meetings related to their loved ones. They felt supported by staff.

Child and adolescent mental health wards

Inadequate

Updated 21 August 2019

Due to the concerns we found during this inspection, we used our powers under Section 31 of the Health and Social Care Act to take immediate enforcement action and placed conditions on the provider’s registration. We also issued a warning notice using our powers under Section 29A of the Act in response to other concerns we had at the time of inspection.

Because of the enforcement action we have already taken, the ratings for some key questions are limited to a rating of inadequate.

We rated child and adolescent mental health wards as inadequate because:

  • The service was not delivering safe care. Patients were not safe and were at high risk of avoidable harm. Substantial and frequent staff shortages increased risks to people who used this service. Staff did not adequately assess, monitor or manage risks to patients and opportunities to prevent or minimise harm were missed. Where patients demonstrated higher levels of risk, staff did not follow processes and procedures to mitigate these through appropriate observation and engagement. Staff did not follow the trust’s policy or the Mental Health Act Code of Practice when using restrictive interventions. People were at risk because staff did not store medicines safely and there were out of date medicines still in use. Staff did not report all incidents or categorise the level of harm correctly and did not always learn from incidents. There was little evidence of learning from events or action taken to improve safety. Blanket restrictions were in place that were not based on an individual assessment of risk and need.
  • The service was not always delivering effective care and treatment. Care and treatment did not always reflect current evidence-based guidance, standards or best practice. The provider did not offer sufficient therapeutic activity to patients. There were vacancies in the multi-disciplinary team and the service did not have a social worker as recommended by national guidance. Not all staff had the right qualifications, skills, knowledge and experience to do their job. Staff awareness and understanding of the Mental Capacity Act and Gillick Competence was limited. Staff were not sufficiently skilled to support patients with a diagnosis of autism spectrum disorder. Compliance rates for supervision were low. Staff did not always complete and store Mental Health Act documentation in line with the Act and the trust’s policy.

  • The service was not always caring. There were times when people did not feel well-supported or cared for. Staff did not always involve patients in their care and treatment. Carers at West Lane Hospital reported they did not feel involved in their relatives care and that staff and managers did not communicate effectively with them. Patients and carers were not always involved in the development of their risk assessment, which was not in line with trust policy. However, patients on all wards said staff were kind and caring. On Holly Unit and Baysdale Unit, carers felt fully involved and spoke of the service as being like part of the family.

  • The service was not responsive to the needs of individual patients. Staff at West Lane Hospital did not make reasonable adjustments for patients with a diagnosis of autistic spectrum disorder. Patient attendance at education was poor at West Lane Hospital.

  • The low secure ward, Westwood Centre, admitted patients who had not been assessed as requiring a low secure ward. Carers reported that despite raising numerous complaints with the service, they did not feel their concerns were addressed. The positioning of some of the closed circuit television equipment at West Lane Hospital did not protect the privacy and dignity of patients.

  • The service was not well led. Systems and processes were not effective in ensuring that wards were safe and clean and that patients were assessed and treated well. Managers did not have sufficient oversight to enable them to assess and monitor issues and identify areas to improve the service. Staff did not feel respected, valued, supported or appreciated. There was poor collaboration and cooperation between teams. The service strategy had not been translated into meaningful and measurable plans and was developed without staff engagement.

Forensic inpatient or secure wards

Requires improvement

Updated 23 October 2018

Our rating of this service went down. We rated it as requires improvement because:

  • Low staffing levels impacted on section 17 leave and restrictions on the wards.
  • The service did not always reflect safe practice in their processes and adhere to the trust policies in relation to medicines management. Clinic room temperatures were consistently high with no action taken.
  • There were no activity schedules or therapeutic activities taking place on the weekend on the majority of the wards, which goes against National Institute for Health and Care Excellence Guidance. There were no processes in place to measure the outcomes of activities being carried out or what impact they were having on the patients.
  • There were blanket restrictions in place on two of the wards. The restrictions were not reviewed as part of the trusts restrictive practice monitoring process.

However:

  • The service encouraged and promoted healthier lifestyles for patients. There was good access to exercise equipment and physical healthcare. The trust had implemented changes throughout the service to try and support patients in making healthier food choices by using a traffic light system in vending machines and cafes.
  • The service had regular input from a full multi-disciplinary team, offered a range of psychological therapies to patients and involved the patients in their care.
  • Service and ward managers had good oversight on key performance indicators. Staff felt supported, respected and valued in their roles and felt they contributed to change throughout the service.

Wards for older people with mental health problems

Requires improvement

Updated 23 October 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • There were gaps in the recording of the administration of a patients’ covert medication.
  • Nurse call alarms were not present in all patient bedrooms.
  • Some beds were provided in dormitory style accommodation, separated only by a curtain.
  • Refusal of observations were not always recorded in line with the trust policy following the administration of rapid tranquilisation.
  • The consideration of patient’s capacity and best interest decision was not always reflected in patient records.

However:

  • There was positive practise in the formulation and review of patient risk assessments.
  • There was a daily multidisciplinary review of all patients.
  • There was effective psychological input in the development of individual formulation from the point of admission.
  • There were effective practices in the monitoring of patients physical and mental health.
  • Care planning extended beyond the ward and in to discharge, staff supported and trained other care providers in the patient’s needs to support effective discharge.
  • Quality improvement systems were embedded across the service and all staff were encouraged to be part of a quality improvement project.

Community-based mental health services for adults of working age

Good

Updated 23 October 2018

Our rating of this service stayed the same. We rated it as good because:

  • The services ensured their community environments were clean, well maintained and appropriately risk assessed. The service used a staffing tool to ensure caseloads were manageable and all patients’ records we reviewed had appropriate risk assessments and crisis plans. Staff understood their responsibilities under safeguarding, and there were appropriate processes to support them doing so. We saw staff were regularly reporting and learning from incidents.
  • The service used a range of biopsychosocial interventions recognised by best practice, with good access to different types of psychology, occupational therapies, education, and medication. There was robust physical health monitoring for patients who required this and staff had access to specialist information systems which meant they could access blood results. There was a wide range of skilled staff who worked closely in a multidisciplinary setting. Staff received regular supervisions and annual appraisals, they felt well supported through these processes.
  • Staff had a good working knowledge of the Mental Capacity Act and Mental Health Act. We found the Community Treatment Order documentation was up to date and appropriately documented within care plans. Staff were regularly discussing issues around patient capacity and least restrictive practices.
  • We spoke to 40 patients and 18 carers, all of whom were positive about the care and treatment received by staff. We observed kind and compassionate care through interactions between staff and patients within their homes and community bases. The service offered a holistic service which ensured patients and carers were at the centre of their treatment. Patients and carers were involved in the delivery and improvement of services through various platforms.
  • The community mental health services for adults had a clear referral criteria and care pathway into the service. Services were meeting their 28 day referral to assessment target, and there was no wait times to access support once the patient met the criteria. Access to psychology was excellent across the community teams with a maximum wait time of three weeks. The service was learning from complaints and improving their services as a result. The teams were able to meet patients’ disability, accessibility, learning disabilities, cultural and religious needs.
  • The service was well led. Staff, managers and senior managers told us how supported they felt within the organisation. Staff were able to demonstrate the values and understood the direction in which services were going. Teams had good oversight of risk and there was an escalation process. The trust had a clear governance structure which demonstrated how information flowed up the organisation to the executive team and back down to operational staff.

However:

  • The service was in the process of reviewing its use of emergency equipment during clinics therefore most of the clinics within the community mental health teams did not have emergency equipment in place. The trusts senior leadership team and oversight of the risks and had a process in place to mitigate them.
  • Teams within Durham and Darlington did not always accurately document information on patients’ paper medical records in line with their electronic records.
  • The trust had recently introduced Mental Capacity Act and Mental Health Act training in April 2018 as mandatory. Although staff had a good working knowledge in both areas, the community mental health teams had not yet achieved the trusts target of 90%. The trust projected this would be complete in May 2019.
  • Although staff received regular annual appraisals and regular annual supervision, recording of clinical supervision was not always accurate, the trust figures did not reflect what staff told us in some teams.
  • The trust did not use a recognised risk assessment tool in line with best practice.

Community mental health services with learning disabilities or autism

Good

Updated 23 October 2018

Our rating of this service stayed the same. We rated it as good because:

  • There were sufficient numbers of trained, supervised and appraised staff to meet the needs of patients within the service.
  • Staff made safeguarding alerts, reported incidents where appropriate and received relevant lessons learned. Staff understood the duty of candour and were open and transparent with patients. Staff and patients knew how to complain and received feedback following complaints made. Staff knew how to contact the trust Freedom to Speak Up Guardian and could access the trust whistleblowing policy.
  • Staff interacted with patients in a kind and caring manner. Staff involved patients in decisions about their care and treatment and communicated with patients using their preferred communication methods. Carers were positive about the service and told us they felt involved in patients’ care. Teams had effective working relationships with both internal and external providers in order to enhance patient care.
  • Consultant psychiatrists did not prescribe or recommend antipsychotic medication for behaviour as a first response and would only prescribe if other non-medical interventions were insufficient. When medicines were administered on site staff followed good practice in medicines management.
  • Staff understood and applied the trust vision and values in their work and engaged in quality improvement work to improve the service for patients. Effective systems ensured good governance.

However:

  • At The Orchard capacity assessments were not always completed or documented and staff did not regularly or consistently use the National Early Warning Scores tool to monitor patients’ physical health. Also risk assessments were not always updated following a change in risk presentation or reviewed within the required timescales. At Lancaster House adult autism service patients were waiting an average of 13 weeks for an appointment, with the longest wait being 58 weeks, which is not in line with the National Institute for Health and Care Excellence guidance.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 2 October 2018

We found the following areas of good practice:

  • Staff had the experience, skills and qualifications to do their jobs, received an induction, mandatory training, regular supervision and were appraised. Staff risk assessed patients, were kind and caring, encouraged patients to lead healthier lifestyles, used de-escalation techniques to reduce the need for restraint, were knowledgeable about the Mental Health Act, Mental Capacity Act, safeguarding and the duty of candour and knew how to handle complaints.
  • Staff helped patients to access education and work opportunities and supported patients during referrals and transfers to other services, catered to patients’ specific communication needs and received feedback on lessons learned from incidents and complaints which they used to improve the service. Staff implemented recommendations from reviews of deaths, incidents and safeguarding alerts and engaged in clinical audits.
  • Staff were respected, supported and valued. Staff spoke positively about working for the trust, felt supported in their career progression and were aware of the trust’s vision and values. Staff could provide input and contribute to changes within the service and were given time and support to consider opportunities for improvements and innovation.
  • The wards had input from psychiatrists and junior doctors. There were effective working relationships with teams, both within and outside the organisation.
  • The people who used the service could provide feedback on the service they received and were involved in decisions about care and treatment. Patients could personalise their rooms, had access to outside space and quiet areas, snacks and drinks at any time and had food choices to meet their dietary needs. Patients could make calls in private, were given information to help them orient to the ward and knew how to make a complaint about the service.

We found the following issues the service needs to improve:

  • Staff had not identified ligature risks and patients did not have access to nurse call points.
  • On one of the wards, there were gaps in the recording of temperatures and no examination couch in the clinic room.