Millbrook

Updated 16 August 2022

Millbrook provides services for male and female patients with mental health needs who required mental health rehabilitation. It is managed by the Alternative Futures Group which is a registered charity who have several other mental health hospital and community services within the north west of England.

Millbrook is a 12-bed ward and provides rehabilitation to both patients detained under the Mental Health Act and informal patients. It provides community based inpatient mental health rehabilitation.

There is an interim manager in place who had made an application to be registered manager, accountable officer and nominated individual for this location.

The service is registered to provide the following regulated activities:

• assessment or medical treatment for persons detained under the Mental Health Act 1983,
• treatment of disease, disorder and injury, and
• diagnostic and screening procedures.

The local clinical commissioning group block purchases all of the beds. Any referrals from outside the local area would be funded by the patient’s local clinical commissioning group.

Millbrook has been registered with CQC since December 2010. There have been six previous inspections at Millbrook, the most recent being January 2019. On that inspection, we rated Millbrook as good overall and across all five key questions we asked (whether services are safe, effective, caring, responsive and well-led).

Staff were ensuring that ratings were displayed in a prominent place as required. The provider has a duty to ensure the ratings we give are displayed appropriately so patients, visitors and the public can easily see the hospital’s ratings. On this inspection, we found that the current ratings were displayed on the provider’s website. The current ratings were also displayed near the hospital’s reception area.

What people who use the service say

We spoke with six patients who used the service and three relatives. All of the patients were very complimentary about the standards of care and about staff that provided the care and treatment. They reported the hospital had excellent, caring and professional staff. They stated that there was a wide range of activities including days out, restaurant trips, shopping trips, cookery sessions and money management sessions. They reported that the occupational therapist was brilliant and had made a massive difference to the quality of care at the hospital.

Patients stated they received recovery-focused care which helped them to develop their independent living skills. They stated staff provided a holistic approach to care which focuses on mental well-being as well as physical well-being.

Where patients reported less positive feedback, it was mostly relating to the provider’s recent decision to remove the facility of the hospital car which was used for appointments and days out. We spoke with managers about this who explained that the decision was made to support and encourage patients to use the very good transport links to travel as part of maximising their rehabilitation and equip them with independent living skills on discharge.

We spoke with three relatives. Family members were extremely positive about the quality of care their loved ones received at Millbrook. Family members told us that they were very confident and highly satisfied with the service. They felt listened to and stated there was great family involvement. Family members told us they were made to feel welcome when visiting for example they were offered refreshments.

Updated 16 August 2022

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

• The ward environment was clean.
• Staff assessed and managed most risks well and stored medicines safely. Staff kept the use of restrictive practices to a minimum.
• Staff developed holistic, recovery-oriented care plans using the recovery star. Patient goals were now more clearly identified and detailed in the recovery star outcomes.
• There were good systems to ensure that staff oversaw and promoted patients’ physical health.
• While there were some staff vacancies, managers had filled most of these posts and they got regular agency and bank staff to cover the shortfalls
• Staff screened patients for any psychological needs and, when patients needed psychological input, this was provided or considered.
• Staff provided recovery-focused care which helped patients to develop their independent living skills and in line with national guidance about best practice.
• Managers ensured that staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
• Patients were exceptionally positive about the care they received from staff and felt actively involved in care decisions. All the patients interviewed felt safe. Carers were also highly satisfied with the service.
• The service had successfully discharged several patients with complex needs with better than expected rehabilitation outcomes for these patients.
• There were good links with the local community and the newly appointed occupational therapist was working to develop these further.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. Where discharge was delayed, this was outside of the hospital’s control.
• Managers had a vision for the model of mental health rehabilitation they wanted to provide. Staff felt the new managers were very approachable. Staff reported improved morale and were now confident and optimistic that they were being managed by staff who knew Millbrook well.

However:

• Staff had not acted quickly enough to resolve an issue relating to the fire safety risk audit from December 2021. For example, a drum-coiled electricity extension lead was still in use despite advice stating this should not be used due to the risk of overheating. In addition, you did not have a personal evacuation plan for a patient who refused to evacuate during a recent fire drill. These were addressed during the inspection.
• Staff had not notified us of a recent safeguarding incident. This was addressed shortly after the inspection.
• Staff were not always recording the expected or actual return time and/or outcome of agreed leave for detained patients. There had been a small number of instances where patients had been slightly late from their specific authorized section 17 leave. It was not clear that staff had discussed lateness as part of the outcome of leave to promote adherence to any conditions of leave in the future.
• There was no formal review of treatment for one relevant detained patient which should have been done when the patient’s detention had been renewed as evidenced by a completed section 61 review form.
• One patient who had been at the hospital some time did not have an initial or substantive care plan, risk assessment or recovery star. They did have a detailed assessment and some care documentation from the previous provider when they were in the NHS acute wards. This was addressed shortly after the inspection.
• A small number of audits had not identified issues we found on inspection or did not reflect fully the provider’s own findings. They did not always clearly record what action had been taken to show shortfalls had been fully addressed or to prevent a reoccurrence. The provider had recently introduced a new system to better record evidence that actions have been completed.

Updated 16 August 2022

See overall summary detail above