Cheshire and Wirral Partnership NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed a total of 5 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was requires improvement. Our rating for this key question is Requires Improvement.

Staff showed good understanding of the Mental Health Act and Mental Capacity Act and this was integrated in to their every day practices. Staff had a clear understanding of patients' risks and care requirements.

Staff could not observe patients in all areas of the ward, staff told us this was mitigated by patient observations. Patients that required a personal emergency evacuation plan had one in place, however these were not personalised or immediately available in an emergency. However, we found issues around the administration and management of medication on Cherry ward.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People had no specific feedback on this area.

Staff had a good understanding of the process of risk assessment and when/how these should be completed.

The service reviewed risk daily for all patients in relation to their observations on the ward. All staff were made aware of any ongoing or changing risk through the daily handovers on the wards.

Appropriate systems were in place around care planning and risk assessment. However, we found that risk reviews and safety plans in case notes were inconsistently completed and did not always reflect the level of care that was being provided.

People told us there were happy with the ward environments and found them clean and tidy.

Staff demonstrated that they knew about any potential ligature anchor points and lessened the risks to keep patients safe.

Staff had easy access to alarms and patients had easy access to nurse call systems so they could summon assistance when needed. All bedrooms were fitted with alarms. Staff always carried personal alarms on them.

Staff could not observe patients in all areas of the wards. There were procedures to minimise risks where they could not easily observe patients. However, there were concerns of being able to effectively use these procedures due to staffing levels.

Access and signage for fire extinguishers on the wards was inconsistent. Meadow Bank ward's fire equipment was stored behind a trolley. Cherry ward did not have the correct signage for fire extinguishers, meaning people would be unable to locate the equipment.

None of the wards had a dedicated activities room for patient. Cherry ward had a sensory room however, this was being used as a storeroom. The ward also had a reminiscence room which was not fit for purpose.

All wards were clean, tidy and well maintained.

Each ward we visited had safe systems and processes in place to support staff to keep patients safe. Processes in place included a ligature management plan, ligature risk snapshot report and ligature risk dashboard. In addition, there were ward observation layouts to identify areas of risk and audit of communal areas and bedrooms highlighting where ligature risks were present. Staff reduced identified risks and used ward-based heat maps, which detailed were all the ligature risks were located on each ward.

Where a patient was identified as needing personal emergency evacuation plans, these were not up to date, personalised or readily available for staff to access.

Many patients told us that there were ‘plenty’ of staff on the wards and that they were supportive. However, some patients identified that night shifts had ‘skeleton staff’. Patients also told us that they had seen staff ‘shouting at each other’ or if staff got busy, they ‘can get irritated’. One patient told us that staff ‘have a habit of not turning up and leave us in the lurch’.

Carers spoke highly of the staff on the ward and the level of care and engagement they provided.

Staff we spoke with commented on a recent positive change in staffing pressures, specifically for Silk ward. However, all staff we spoke to raised concerns over the movement of staff to cover other wards at the same site. They informed us that the level of personal care required for their patients was not being considered when looking at staffing levels on the wards. This was also echoed by ward managers, who had raised with senior leaders that personal care was not taking place as immediately as needed.

Staff raised concerns around the levels of staffing on the wards at night, believing that if there was an unexpected increase in observations or an incident there would be insufficient staffing. Managers and Occupational Therapists informed us that they were often used in the numbers for the ward, with no change in their day-to-day activities.

Staff also informed us that patient activities and appointments were regularly cancelled or not attended due to staffing pressures on the wards. As well as staff conducting back-to-back observations with no breaks, as per national guidance and trust policy.

Staff were concerned that when receiving staff from other wards, they did not have the correct knowledge or training to manage the patient group.

All staff we spoke with informed us that they were up to date with their mandatory training and supervisions. Staff were offered additional development and training opportunities through the service.

We observed sufficient staff to allow continuity of care and this was evident in care observations where patients were very familiar with staff, allowing for positive relationships to be built. However, we found this was not the case on our evening visit. There was minimal staff on the ward and there was limited patient interactions.

We observed the staffing meeting for the wards, all staffing for the week is reviewed daily and rag rated in terms of risk. This was a comprehensive meeting.

Staffing levels for each ward were managed centrally to ensure safe staffing levels across all sites.

Overall mandatory training completion rates varied from 71% to 97% across all three wards, the trust compliance target for mandatory training was 85%.

Appraisal and clinical supervision compliance ranged from 40% to 87% for appraisal and 25% to 94% compliance for clinical supervision.

Staff on the wards were qualified, skilled and experienced and had access to support. New staff on the ward were oriented to the ward and provided key information on all the patients.

Meadowbank ward had the highest vacancy rate across all wards of 18%. Silk ward’s turnover rate was 11%, the highest of all wards. The sickness rate for Cherry ward was 17%, the highest on all of the wards.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.