Cheadle Royal Hospital

Updated 25 October 2023

Cheadle Royal Hospital provides mental health services to adults, and to children and young people. It has 13 wards that provide inpatient services across the following core services: acute wards for adults of working age and psychiatric intensive care units (PICU); child and adolescent mental health wards; and specialist eating disorder services.

This inspection was of the 7 acute and PICU wards:

• Alder – acute ward for up to 14 men and women
• Maple – acute ward for up to 15 men and women
• Featherstone – PICU for up to 10 men
• Pankhurst - PICU for up to 10 women
• Willows - PICU for up to 10 men
• Fern – ward for up to 10 women with an emotionally unstable personality disorder
• Mersey Lodge – bespoke service for one person.

Cheadle Royal Hospital registered with the Care Quality Commission in December 2010. It is provided by Affinity Healthcare Limited, operating as the Priory Group. It is registered to provide the following regulated activities: Assessment or medical treatment for persons detained under the Mental Health Act 1983; and Treatment of disease, disorder or injury.

This was an unannounced comprehensive inspection of the acute and PICU wards. It was carried out in response to information of concern about the service.

Acute wards for adults of working age and psychiatric intensive care units were last inspected in April 2022, as part of an inspection of the whole hospital. Acute wards for adults of working age and psychiatric intensive care units were rated as good overall; with a rating of good for the safe, effective, caring and responsive domains, and requires improvement for the well-led domain.

All patients on the acute and PICU wards were funded by the NHS.

The service had a manager registered with the Care Quality Commission.

At the last inspection the service received requirement notices for breaches of Regulation 17 (Good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach of regulations had still not been fully met. The detail of this is included in the report.

What people who use the service say

Patients and family members we spoke with were mostly positive about the service. Most patients told us they felt safe, and that most staff were kind and supportive.

Most patients and family members felt able to raise any concerns they had. Some patients felt that their individual needs were not attended to, and they had raised complaints about this. Patients were aware of the community meetings on the wards - where they could raise concerns - and of the advocacy service.

Patients told us that staff could be busy, but generally did not raise any concerns about staffing levels. They told us there were less staff at night, and although there was the occasional staff member there had been problems with, they were mostly positive.

Patients felt involved in their care and had access to activities, though there was less to do at weekends. They were provided with information about their care and medicines, and participated in their weekly ward round.

Most patients said the environment was clean and maintained. However, some highlighted that parts of the building were old and worn. Some patients reported that other patients could be messy, but that this was usually quickly cleaned up.

Patients who were detained under the Mental Health Act were made aware of their rights.

Updated 25 October 2023

Our rating of this location stayed the same. We rated it as requires improvement because:

• On this inspection we inspected the acute wards for adults of working age and psychiatric intensive care units. We rated these as: requires improvement overall; inadequate for safe, requires improvement for well-led; and good for effective, caring and responsive.
• We have used ratings from previous inspections of other core services to aggregate ratings to location level in line with our guidance.
• This inspection did not change the overall location rating which remains as requires improvement. However, the location rating for safe went down to inadequate. The location rating for well-led remains as requires improvement. The location rating for effective, caring and responsive remains as good.

Updated 18 July 2022

Our rating of this service improved. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• The service clinic rooms were safe with all equipment regularly serviced.
• 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. All patients had been assessed by a dietician within 24 hours. 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. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare. New staff had been employed to work in the dining areas only to offer more support to patients.
• 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. Patients thought staff cared about them.
• Leaders were visible in the service and approachable for patients and staff. The ward managers were experienced and skilled and performed their role well. Staff told us they were visible, approachable, listened and supported them in their day to day tasks.

However;

• Patients told us that issues connecting to the internet were still unresolved from our previous inspection.

Updated 26 May 2023

Our rating of the core service of child and adolescent mental health wards went down. We rated it as inadequate because:

• The service did not always provide safe care. The ward environments were not always well maintained. The wards had high vacancy rates and were reliant on agency and bank staff.
• Staff assessed and managed risk well but did not always update risk assessments after incidents.
• The service recorded high levels of restraint and seclusion.
• Staff did not always ensure they monitored young people’s physical health. Staff did not ensure that physical health monitoring took place after every incident of rapid tranquilisation. They did not always ensure that medication side effects were monitored.
• Young people and their families told us they were not always involved in investigations.
• Managers did not ensure that staff received training, supervision and appraisal. Mandatory training, supervision and appraisal figures were below the providers target.
• Some young people told us that agency staff did not always treat them with dignity and respect.
• Some carers told us they did not feel supported by the hospital. They told us that communication was not always good, they were not informed about incidents and were not supported during home leave.
• The ward environments did not ensure that the care environment was dignified. There were broken windows, graffiti to some doors and the décor was not therapeutic and aligned to the needs of children and young people.
• Young people did not have easy access to outside space.
• Discharge planning was generic and only developed as children and young people approached discharge.
• The service was not well led and the governance processes did not ensure that ward procedures ran smoothly. Audits had not ensured ward environments were maintained and trends in incidents were not identified.
• Competency check lists and agency profiles outlining staff training were not always available so managers could not reassure themselves the agency staff working were suitably trained.

However:

• Most staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood their individual needs.
• The service provided a range of treatments suitable to the needs of the children and young people 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 the children or young people on the wards. 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 mainly understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment. However, in one case we found that a best interest decision had not been completed for a young person.

Updated 16 March 2018

We rated long stay/rehabilitation mental health wards for working age adults as good because:

There were enough staff for patients to receive the care and treatment they required.

Staff identified ligature points (places where someone intent on self-harm might tie something to strangle themselves) and took action to remove or minimise risks.

The wards were clean and tidy and maintained to a high standard.

Staff were caring and treated patients in a respectful and dignified manner.

There was good multidisciplinary team working and staff engaged well with community teams as well as outside organisations.

There had only been one formal complaint in the last twelve months and patients told us that they were cared for by caring staff.

The clinical leadership on the ward was clear and all staff said that they felt supported and listened to.

Staff were aware of the provider’s vision and values and were committed to providing good care in line with this.

However:

Staff were not always specifying clearly the decisions leading to capacity assessments and recording the decisions made in patients’ best interests when patients were assessed as lacking capacity.

Food in the patients’ kitchens was not always stored in a way that minimised risk of food-borne viral infections.

Updated 25 October 2023

Our rating of this core service went down. We rated it as requires improvement because:

• The service did not fully use effective systems and processes to safely prescribe, administer, and record medicines. Physical health screening and monitoring was not always carried out in accordance with national guidance.
• Staff were not always completing and recording physical health monitoring after the use of rapid tranquilisation, in accordance with national guidance. Records were not always completed correctly, or consistently.
• The service was not always well led and although there were governance processes, these did not always identify, resolve and monitor gaps in the provision of care. There were breaches of regulations at the last inspection in April 2022 under well-led. There had been progress in some of these areas, but they had not all been addressed.
• Staff had not always completed the necessary training and received an appraisal.

However

• The ward environments were mostly safe and clean. The wards usually had enough nurses and doctors. Staff assessed and managed risk. They minimised the use of restrictive practices, and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards, although there were vacancies across the service. 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.

Updated 16 March 2018

The Wellbeing Centre was located within the grounds of Cheadle Royal Hospital; the building was clean and pleasant and decorated to a high standard. Environmental checks were regularly undertaken, health and safety, risk assessments and monitoring was undertaken in line with hospital policy. Lone working procedures were in place.

Patients were protected from avoidable harm, and staff were supported to fulfil their responsibilities to raise concerns, report incidents and monitor and review risk. Lessons were learnt and communicated to all to improve services. Improvements to safety were made and changes monitored.

Safeguarding processes were in place which reflected national guidance, and understood by all staff. There was a clear structure of reporting and responsibility for safeguarding adults and children. Any concerns relating to adult and child protection were communicated to the relevant protection agencies.

Staffing levels and skills mix was planned, implemented and reviewed to keep people safe.

The service delivered a range of psychological therapies and had skilled staff to deliver these services. Risk to people who used the service was assessed and monitored, risk assessment was person centred and reviewed regularly. Plans were in place to respond to emergencies and major incidents.

The service was accessible and responsive and there was no delay from initial referral to assessment to treatment. Waiting times for patients wanting to access appropriate psychological therapies through the service, as part of their treatment were minimal.

Patients using the service told us that they were treated with kindness, dignity and respect. We observed that staff took time to communicate with patients in a respectful and compassionate manner. Appointments were scheduled at the patient’s convenience and the service was open to patients in the evenings to support working patients.

Patients care and treatment was planned and delivered in line with current evidence based guidance. Information about patients care and treatment was routinely collected and monitored. It was easy for patients to complain or raise a concern about the service; complaints were taken seriously and responded to in a timely manner. Improvements were made to the quality of care in response to complaints to the service.

Staff were supported to deliver effective care and treatment they told us that they received meaningful and timely supervision and were supported to maintain their professional skills and experience.

There was a clear statement of visions and values, staff knew and understood the vision, values and strategic goals of the service. Processes and systems of accountability and governance were in place and performance management and quality reporting was clearly set out. Risks were identified and monitored. Performance issues were escalated and discussed at relevant governance forums and action taken to resolve concerns.

Staff we spoke with were all positive about their roles and were passionate about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments. The service was committed to improving the services on offer and was looking at increasing accessibility of the service.