Eleanor

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• 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

We assessed all the quality statements from this key question. Effective was not rated at the last inspection but had a rating of requires improvement from previous inspections. Our rating for this key question is good. Staff assessed the mental and physical health needs of patients on admission which meant staff had identified key needs to developed a comprehensive care plan. The service provided a full range of treatment for patients. The patient had access to a psychologist. They had up to date care plans in place, these were personalised, and the patient confirmed they were always involved in the development of their care plans. For example, care plans reflected the patients wish to prepare their own meals. Staff always supported patients to lead healthier lives. We saw activities which reflected the wishes of the patient. Staff offered activities and advice to support healthy eating and to take more exercise.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff assessed the physical and mental health of patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patient needs, and were personalised, holistic and recovery oriented. For example, the patient confirmed they had developed care plans with staff that allowed them to cook their own meals and to take part in their favourite physical activity, cycling. They also reflected their desire to attend Halloween events such as Scare Fest.

Staff had completed a comprehensive mental health assessment for the patient. While the providers previous psychologist had left the service and been replaced with an externally commissioned service the senior leaders were able to articulate that the patient had a full formulation and how the new team were assessing the patients’ needs and how best they could support their development. Assessments considered the patients’ health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. Staff could tell us how they would support anxiety and use different tactics to distract the patient.

At the last inspection we found that staff developed comprehensive care plans that met the patients’ mental and physical health needs, and that care plans were personalised, holistic and recovery orientated. We also found this during this assessment. Staff regularly reviewed and updated care plans when needs changed, and nurses regularly audited care plans in the records we reviewed.

The patient told us there was a broad range of treatment options available to them. They told us, and we saw them, plan meals with the chef and what ingredients they needed to order for the coming week. They confirmed they were involved in the development of their care plans. They understood what care they were receiving and how they were progressing towards their goals. For example, they had wanted to attend a Scare Fest event, which was where actors tried to scare visitors in a Halloween themed event. One part was a scenario that involved visitors entering a hospital ward environment. Staff had discussed this with them, and they agreed they still wanted to attend but miss this part of the attraction. The patient had felt in control and had enjoyed the experience. Patients told us staff had supported them to understand their prescribed medicines.

Managers and staff could outline how they supported the patient. The occupational therapist and assistant could detail how they assessed the patient whilst engaged in community activities such as navigating public transport as well as on the ward where they assessed the patient’s ability to plan and carry out daily tasks. They used recognised screening tools such as Model of Human Screening Tool (MOHOST).

Managers ensured staff had the right skills, qualifications and experience to meet the needs of the patients in their care, including bank and agency staff. Staff were trained in a range of modules suitable for their roles. The lowest compliancy rate for training was 89% with several other training modules at 100%. Managers gave each new member of staff a full induction to the service before they started work. Staff received a thorough induction package prior to commencing work. Staff also had a local induction on the ward.

There were several different professionals who provided care. The patient told us that they felt all of them understood their needs and they knew what progress they were making or if changes to their care had been agreed.

Staff held regular multidisciplinary meetings to discuss the patient and improve their care. These meetings were structured around the needs of the patient. Staff made sure they shared clear information about the patient and any changes in their care, including during handover meetings. We also saw staff discussing their welfare not only at MDT meetings but on daily briefings and ward staff were able to change observation levels immediately.

We saw that service provided a range of care from different services, and it was co-ordinated effectively. All relevant staff and services were involved in assessing, planning and delivery patient care and treatment and staff worked collaboratively to understand and meet those needs.

We saw that staff had access to the information they needed to appropriately assess, plan and deliver care, treatment and support. There were plans for discharge and these showed the provider working closely with other external providers to ensure they reflected the patients’ individual needs, circumstances, ongoing care arrangements and expected outcomes. When patients were due to move between services, all necessary staff, teams and services are involved in assessing their needs to maintain continuity of care.

The patient told us they were supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. They could tell us about how they were supported to change diets or to exercise. They told us their health and wellbeing needs were regularly discussed in meetings about their care and in one to ones with their named nurse.

Staff made sure there was access to physical health care, including specialists as required. We saw that the patient had access to dentists and opticians. Staff met patient’s dietary needs and assessed those needing specialist care for nutrition and hydration.

Staff identified patient’s physical health needs and recorded them in their care plans. Nurses were using standardised tools to carry out an assessment to understand the patients’ physical health needs. The patient on the ward had an up to date physical health plan. These health screening tools included NEWS2, Malnutrition Screening Tool (MUST), as well as assessments for diabetes, cholesterol and hypertension. Staff ensured dietary needs of patients were met and assessed those needing specialist care for nutrition and hydration. The clinic room had space and equipment to undertake physical observations, and electrocardiogram monitoring. Staff followed National Institute for Health and Care Excellence (NICE) guidance when using rapid tranquilisation. In the three months prior to our assessment there had been seven incidents of rapid tranquilisation. Two for the current patient. We found that physical health checks were being completed following rapid tranquillisation except for one incident. There was evidence that this had been done in daily notes but no formal recording.

There were regular community meetings, and we saw the patient discussing everyday activities with staff. They responded to the patients requests and had arranged different activities because of those requests.

Staff told us they took part in clinical audits, benchmarking and quality improvement initiatives. Local audits took place such as audits of clinic room fridge temperatures, compliance with malnutrition screening, and infection control. Staff were also involved in service improvement projects in areas such as care planning. Managers told us they had overhauled the auditing process following the previous inspection to improve performance and accountability.

Managers used results from audits to make improvements. The service had implemented a new audit procedure to improve quality assurance. Audits now covered reducing restrictive practice, record keeping and medicines management. We saw that these audits were discussed in senior management meetings.

The patient understood their rights and had consented to treatment. They had easy access to information about independent mental health advocacy and they confirmed that they regularly attended, and they spoke to them.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. There was external Mental Health Act administration support. The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles.

Staff stored copies of detention papers and associated records correctly and could access them when needed. We examined the mental health paperwork and found them to be correct. Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings. We looked at an audit that confirmed this. Staff gave patients all possible support to make specific decisions for themselves before deciding if they did not have the capacity to do so. Staff assessed and recorded capacity to consent clearly each time they needed to make an important decision. Consent to treatment and the patient’s capacity were clearly recorded in all records.