7 - 9 March 2023
During a routine inspection
This service has now been removed from special measures.
Our rating of this service improved. We rated it as requires improvement because:
- The ward environments needed redecoration and refurbishment. Seclusion suites did not have easy access to bathroom facilities and fresh air. Risk assessments were not always updated following incidents.
- The patient care record system was a mixture of electronic records and paper records. This meant some documents were difficult to locate and paperwork was duplicated.
- An epilepsy care plan was not detailed enough to ensure staff responded appropriately.
- There continued to be medicine management concerns. There were medicines on Upper East ward with no expiry dates. This meant that staff could not be assured that these medicines were safe to administer.
- Patients felt the quality of food was poor.
- There were gaps in governance processes that failed to identify areas of concern.
However:
- The wards had enough nurses and doctors. The service had significantly improved its recruitment and retention rates. They minimised the use of restrictive practices and followed good practice with respect to safeguarding and complaints. The safeguarding and complaints processes had been improved and were now working effectively.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
- Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
- Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
- There were now more audits in place and there were processes for considering and feeding back lessons learnt. The service had been successful in implementing a co-production approach to quality improvement.