Nightingale Hospital

Patients confirmed that their physical and mental health needs were assessed and treated in consultation with them. Staff regularly reviewed and updated care plans when patients' needs changed, and attempted to make these personalised, holistic and recovery orientated. Care plans indicated that patients were involved in making decisions about their care and support and were written from their perspective. Staff assessed and monitored physical health needs arising from patients’ eating disorders, such as a fast heart rate, and urinary symptoms. They carried out blood tests and checked patients’ vital signs on a regular basis. They also provided support with wider physical health needs such as diabetes. Records showed that staff assessed patients for the risk of refeeding syndrome, which can include heart, lung and neurological symptoms. When required they carried out appropriate monitoring and treatment. As required at the previous inspection in June 2022, staff were undertaken assessments of tissue viability to reduce the risk of patients with low weights, developing pressure ulcers. We still found that new care plans for day patients did not always take into account their new circumstances (after being discharged from the ward). However, patients we spoke with said that staff had prepared them for the transition to day patient status and provided appropriate support. Following the inspection, managers provided an example of an updated day care plan which took account of risks when patients were not at the service. Patients spoke about accessing a wide range of psychological interventions. At the previous inspection in June 2022, we recommended that patients be aware of who their named nurse was, have regular one-to-one sessions, and that these sessions be recorded. Most patients knew who their named nurse was, but they said that they could not always see them if they were on leave. However, they did say that they could speak to other members of staff instead. Staff provided patients with a meal planning group and a nutrition group each week, as well as supporting wellbeing activities such as mediation, yoga, groups on body image, psychoeducation, and self-compassion. As recommended at the previous inspection in June 2022, staff had access to the results of recent audits. These included monthly patient care audits, including the patient treatment pathway, admission process, dignity and respect, collaborative care, and patient and family involvement. There was an annual audit plan for the hospital. Since March 2023 the service was taking part in research studies in collaboration with a local university and another healthcare provider. As recommended at the previous inspection in June 2022 managers assessed staff competencies in areas including mealtime supervision, and better engagement with patients. They had also been provided with more specialised training including motivational interviewing training for people with eating disorders, and more training in working with autistic people. Staff had access to reflective practice sessions with the frequency increased to twice monthly, facilitated by a psychologist. Nursing staff confirmed that they received clinical and management supervision monthly and felt supported. Managers made sure staff attended regular team meetings. Patients were aware of and understood their rights around consent and the care and treatment they received.