Eleanor

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Key question commentary We assessed all the quality statements from this key question. the rating from the last inspection, was inadequate. Our rating for this key question is good. There were effective governance systems and processes in place to ensure that the provider had appropriate oversight and monitoring of the care and treatment being provided. The systems and processes in place did assist staff in assessing, monitoring, and improving the quality and safety of the services provided. We found systems to address ligature risks, patient risks and fire safety checks were always actioned or recorded. The delivery of quality care was assured by the leadership and governance. There were performance management and audit systems and processes in place which ensured managers had up to date information on the performance of the service. Risks identified within action plans were reviewed or actioned.

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 told us they felt supported and worked well with each other. They knew the managers well. Staff felt morale was good. This was diverse workforce, and they felt there were no incidents of racism, and they would be supported if they raised concerns about practices or individual behaviour. There had a been a number of staff changes recently and reading the exit interviews these mostly were staff leaving as they were concerned about the future of the hospital as they only had one patient. The hospital had recruited to these posts by either encouraging bank staff to become permanent, transfer staff from other locations or by appointing new staff. Staff told us the role could be stressful, but that they were managed and supported by colleagues and senior staff.

The previous registered manager had left the service and been replaced by an experienced manager already registered at another location. The nominated individual, who has a clinical background was supporting the new manager. All staff we spoke with said they felt supported and valued at the service, with both management and staff saying they felt the staff team were happy. Staff told us the role could be stressful, but that they were managed and supported by colleagues and senior staff. There were no reports of bullying or harassment at the service, and all staff we spoke to knew how to use the whistleblowing process. All staff told us that they felt they could raise concerns to management about the service without fear of retribution.

Staff felt respected, supported and valued. Staff told us they had felt well supported when incidents occurred. No member of staff raised incidents of bullying or racism during the assessment. While the provider completed a staff survey this was for the whole provider service and therefore, we were unable to identify core themes from staff at the hospital.

At our previous inspection in June 2023 the hospital director and registered manager had been in post for 10 months. These had recently left the service, and the provider had appointed a new registered manager and psychiatrist. The nominated individual had been managing the service while these appointments became embedded in the service. The senior management meetings had continued as had other management practices such as audits. The nominated individual was able to describe how she had used her own clinical experience to plan the resources required to support the patient and ensure nurses continued to manage the patients care.

Staff felt there was a positive culture on the wards. Managers told us the multidisciplinary team worked well together. We saw evidence that there were regular team meetings for staff to discuss any issues. All the staff we spoke with told us that they were confident they could speak up if they had any concerns about the way they or the patients were treated. The Human Resources manager for the group could clearly outline procedures to protect the identity of whistle blowers and any anonymous reporting would be acted upon.

Equilibrium healthcare had a group speak up champion for its network of healthcare facilities. There was clearly displayed information about the service on display for staff to access. There was a whistle blowing policy and managers confirmed they attended staff meetings. They examined staff surveys and incidents for any intelligence of trends which would identify inappropriate behaviour.

Staff told us they enjoyed working at Eleanor. Staff told us they felt confident that any issues raised would be listened to and considered. Managers had met with staff to ensure they were clear about their rights as employees, and that they understood they could raise any issue at any time.

Processes in place monitored the experiences of staff. Policies, procedures and quality assurance processes sought to consider specific cultural challenges or identify any shortfalls in the experience some staff received.

Senior managers outlined the challenges and potential risks they managed. They could describe how they reviewed these regularly to identify and manage concerns. Managers monitored incidents during clinical governance meetings and identified themes and trends which helped them to understand and reduce risk. They had oversight of governance issues for example, clinical notes, multidisciplinary team and service user meetings, learning and development, physical health, safe staffing and risk. They used the dashboards routinely to monitor performance targets.

There was a clear framework of what must be discussed in team meetings to ensure that essential information, such as learning from incidents, was shared and discussed. The provider had policies to guide staff in the day-to-day operation of the service. There was a standard agenda to ensure consistency, and meetings served a clear purpose and were well managed. Clear governance systems promoted good oversight. Governance was fundamental to service development and was informed by meetings of patients, carers and staff across the service, feedback from surveys, consistent audit and monitoring. Managers made necessary changes and ensured learning was disseminated. Governance and performance processes reflected best practice. They were effective and strong, they identified and addressed issues and were used to make improvements. Managers had ensured the wards were staffed to safe levels and that patients were safe and treated kindly. Staff undertook or participated in regular clinical audits to ensure quality, such as care plans, risk management plans and medicines audits. The audits provided assurance and staff acted on these results when needed. Audit findings were dealt with in a timely manner. Staff understood the arrangements for working together and with other teams, external to the service to meet the needs of patients.

The patient confirmed staff and leaders collaborated with health professionals and supported them with appointments. They felt that this placement was better than any other they had previously received care in. They were included in decisions not only in their care but also about the environment they lived in, for example the patient had expressed a desire to relax in a particular design of chair. The service had risk assessed the chair and approved its purchase. The patient told us the chair, which was egg shaped, enabled her to relax as they felt enclosed by the design.

Staff told us the patient received regular input from community health professionals. Managers were also developing new partnerships within the mental health community to provide support sessions for staff.

We could see that partners including commissioners and carers were consulted about all issues regarding the care of the patient.

There were systems in operation to ensure that patients had regular physical health checks, and these were recorded within the patients’ records, and we could see they attended local surgeries when and if required.

Managers told us about the learning the organisation had done following the last inspection and how that had reshaped management structures and working practices to ensure incidents were investigated and bank and agency staff had complete induction including observational competency.

Management had established training programs to help staff improve their understanding of the care required. These included courses on autism, eating disorders, learning styles, learning disabilities and personality disorders.