10 January 2023, 18 January 2023 and 25 January 2023
During a routine inspection
- Governance processes were not always effective. Managers did not have oversight or take action in line with the providers policy in relation to environmental risk assessments, fire safety and evacuation procedures. We found there was no process in place for managers to ensure that physical health checks were carried out as per national guidance or that medical equipment and devices were in date calibrated and cleaned regularly.
- We found concerns relating to infection prevention and control management, and some of the ward furnishings were not properly maintained within the acute wards. Cleaning records had not been completed in line with the provider's policy. The treatment room on Mulberry Ward was not clean and the fridge used to store specimens was dirty. Clinic rooms were not checked for out of date items regularly.
- We were not assured that if males patients were admitted to the eating disorder service that the service would remain compliant with guidance on mixed sex accommodation. The allocated female lounge could, at times be used by families and carer to visit.
- Within the acute wards and the eating disorder service staff did not maintain the privacy and dignity of patients at all times. In one care plan out of 23 reviewed we found negative and derogatory language which did not promote the patient’s dignity. Nine out of ten bedrooms on Aspen ward did not have curtains to maintain patients privacy. Staff walked through patient visit areas which impacted on the privacy or patients and their visitors.
- Managers of the eating disorder service did not ensure that regular team meetings took place to or minutes meetings of the meeting shared in a timely way to discuss the outcomes of incidents or to provide staff with updates regarding ward processes.
- Not all children and young people’s care plans were personalised, holistic and recovery orientated. Staff did not always actively involve children and young people or their families and carers in care decisions. We spoke with some children and young people who said they did not feel safe on the ward and that they whilst they were on enhanced support they have managed to hurt themselves. We were concerned as staff did not always follow the providers policy and procedures on the use of enhanced support.
- Not all staff had the required training to ensure that they could meet the needs of the patients in their care.
However:
- The service provided safe care. The majority of the wards seen were safe and clean. The service had enough staff. Staff assessed and managed risk well and followed good practice with respect to safeguarding. They minimised the use of restrictive practices and followed best practice in anticipating, de-escalating and managing challenging behaviour. It was evident that staff prescribed, administered, recorded and store medicines safely.
- Leaders had a good understanding of the services they managed and could explain clearly how teams worked to provide high quality care. Leaders were visible in the service and approachable for patients and staff.
- The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with the whole team and wider service.
- 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 training, supervision and appraisal. Staff worked well together as a multidisciplinary team. Ward teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
- With the exception of the child and adolescent ward, staff had developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the clients and in line with national guidance about best practice. They actively involved patients and families and carers in care decisions.