Broomhill

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

While we identified there had been some improvements in this key question there was still a lack of a clearly defined model of rehabilitation which staff and patients understood. In rehabilitation services we expect staff to place emphasis upon gaining skills and knowledge which will help people to achieve optimal independence and ultimately to live in an enabling environment that promotes optimum independence. The provider had identified a model of rehabilitation but had yet to fully implement this. This is an area of concern CQC have identified in the previous two inspections. Neither did staff have the skills or knowledge to encourage patients to be motivated to engage in meaningful day activities. For example, we observed some patients remained in bed at 11 am. Staff had prompted them to get up and they had declined. Staff we spoke with did not know what to do about this. Six out of 10 care records we viewed lacked evidence of recovery orientated care, particularly in the areas of self-direction, empowerment, person centred care and hope. Integrated recovery and discharge plans were incomplete. While it was evident some staff did try to involve people in their care and treatment, this needs to be improved for truly collaborative care. Several staff we spoke with were under the impression that many of the patients at Broomhill were not able to engage in shared care planning and it would take too long. Assessment for admission did not involve psychology or OT staff, which for a rehabilitation service, was unusual and not best practice. We will require an action plan under the quality statements of assessing needs and delivering evidence based care. However, provider policies and procedures contained relevant references to evidence-based practice as well as relevant legislation and national guidance.

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients said they could get information about their conditions, both physical health conditions and mental health conditions from staff. Patients said staff worked together to provide the care they needed, which included input from the occupational therapist, doctor and psychologist. Not all patients said staff routinely discussed their care and treatment plans with them, although did say care was discussed regularly at the multi-disciplinary meetings held.

Staff told us that all newly admitted patients were fully assessed by nursing and medical staff in the first instance. Staff said they would try to involve patients as much as possible, while respecting that some patients did not wish to discuss some aspects of their life, care and treatment with them. Staff told us that care plans were comprehensive and included mental health, physical health, spiritual needs, religion and general wellbeing. Staff explained that different members of the multi-disciplinary team would be involved with providing care and treatment as appropriate. Staff did not seem to be aware that full assessment should be a multi-disciplinary team approach from pre assessment, and that rehabilitation needs were distinct from the other listed needs, and equally important in their recovery.

The preadmission assessment which occurred before patients were accepted to the service did not routinely involve an occupational therapist or psychologist. This is unusual for a rehabilitation service, as often patients would benefit from a multi-disciplinary approach with tailored care focused upon recovery and the development of further life skills. Communication was assessed at the point of admission, with any additional support sourced, for example if a patient needed a translator.

Patients said they did tell staff what was important to them. For example, one patient liked to keep in regular contact with family members. Most patients we spoke with did not express any aspirations they had for their future and gave very little indication that becoming more independent, moving forward and discharge were realistic goals for them. One relative we spoke with commented that their relative was always in bed when they visited and appeared to have lost motivation. However, patients we spoke with did say that staff seemed to have the skills and knowledge to look after them, and no one raised concerns around poor or disrespectful practice.

Staff were aware of some best practice guidelines, such as those produced by the National Institute for health and care excellence (NICE) around restrictive practice and management of violence and aggression. Some staff said they have found it difficult to motivate patients who sometimes chose to stay in bed, rather than attend planned activities. Staff were clear in that they could not force patients to get out of bed but were at a loss with how to support them further. Overall, we did not feel that the focus was upon active and ongoing rehabilitation.

The hospital had identified a preferred model of rehabilitation to use called “individual recovery outcome counter (IROC). Staff had identified there were four phases for its implementation. This was introduced in February 2024 and the hospital had moved into phase 2. Leaders told us it is likely this model will take up to a year to get fully operational and embedded into practice. Most staff were yet to receive training. This concern has been raised with the provider during two previous inspections. It was disappointing to see that progress had been slow.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.