Coventry and Warwickshire Partnership NHS Trust

On this page

• 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

Staff assessed people’s needs using a range of assessment tools to ensure people’s needs were reflected and understood. People received care, treatment and support that was evidence-based and in line with good practice standards. Staff ensured plans for transition considered individuals needs and circumstances. Staff involved people in regularly reviewing their health and wellbeing needs. There were effective approaches to monitor people’s care and treatment. People’s views and wishes were considered when staff planned their care. Staff and teams worked together to coordinate people’s care. People consistently experienced positive outcomes. However, people were not always able to make healthier choices in relation to food options.

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.

Most people spoken with were able to tell us how staff made sure they were involved in assessing their needs.

The lead psychologist for Malvern and Janet Shaw Clinic said people have a named psychologist and undergo a 12 week assessment with multi-disciplinary input. The multi-disciplinary team worked with the person to develop the formulation of risk and plot a treatment pathway.

We reviewed care records for people on Malvern ward, Eden ward and Onyx ward. Records reviewed demonstrated that staff assessed and understood individuals’ needs. We reviewed care records for a person at Janet Shaw Clinic, we looked at their Positive Behavioural Support plan which included clear, person-centred information that was respectful to the person and their needs and showed a clear pathway for staff to follow. We reviewed a combination of paper and electronic care records for other people at Janet Shaw Clinic. We found that staff did not always complete care plans in relation to an identified specific risk or need. Staff did not always organise care records and it was sometimes difficult to locate required information.

People on Malvern ward and Janet Shaw Clinic were able to tell us about the treatment pathway they were on and therapeutic interventions they needed to complete to progress and transition out of the service.

Evidence based care and treatment offered included Offender Group Treatment through core treatment interventions. These included enhanced/core thinking skills, Dialectical Behaviour Therapy, Cognitive Behaviour Therapy, emotional regulation/ recognition and pro social interpersonal problem solving. People also accessed the Good Lives programme, which focused on their future. At the end of the admission assessment staff provided people with their own journey/pathway document which plotted out treatments so they could see where they were on their journey. Staff reviewed this regularly and updated if needed. People were also offered trauma support, Eye Movement Desensitisation and Reprocessing, Schema therapy; Psychopathy Checklist revised, Autism diagnostic observation schedule assessment and neurological assessments. Staff told us that a nutritionist had been involved in looking at alternative options to the current food offering, which were due to be implemented soon.

We reviewed information from the provider detailing the treatment pathway for people on their secure wards. The pathway consisted of 7 stages starting with before admission and ending with discharge. The pathway was regularly reviewed to ensure it remained in line with evidence based good practice and required standards, for example, the Transforming Care Agenda, Positive and Proactive Care and reducing the need for restrictive interventions. We reviewed care plans for 3 people on Malvern ward which evidenced staff taking a learning approach and trying new ways of working. An example of this was staff completed an ‘action, behaviour, consequence’ assessment with people, then analysed and used the outcome to update peoples’ care plans. We saw evidence in records of staff using people’s Positive Behaviour Support plans in their day to day support. Staff assessed and met people’s physical health needs, for example, referrals to specialist healthcare services and staff supporting people to access physical health provision in the community. We also saw evidence of speech and language therapy input for people with specific dietary needs, for example, a soft food diet. We saw information displayed for people on Eden ward with specific dietary needs. However, at Janet Shaw Clinic we observed that the guidance for kitchen staff to support 2 people with specific dietary needs was not available as required. One of these people was at risk of choking and there was no information in the kitchen about what was needed for this person. There was also no information about the other person’s physical health condition and the food they needed to avoid. The provider shared copies of physical health monitoring charts used with people. These included bowel monitoring charts, the Bristol stool chart and a stool chart for people to fill in themselves.

One person on Malvern ward told us how staff were working with community teams to help their transition from the service. A person on Onyx ward told us that staff were talking to teams in the community to access funding for their next placement.

Senior leaders told us how staff pulled together following the last CQC inspection to make the changes required to improve the service. Frontline staff were more involved and told us they now feel listened to.

The multi-disciplinary teams consisted of medical staff, nurses (including a physical health matron), a practice nurse team, psychologists, occupational therapists, social worker, dysphagia speech and language therapists, communication speech and language therapists and a dietician. We observed members of the multi-disciplinary team working together during our inspection.

The provider supported multi-disciplinary working though effective recruitment and retention processes. Leaders also implemented meeting structures to ensure effective team working.

People told us about physical activities they were involved in, including gym sessions and walks. Some people said there were no healthy food options available.

Staff told us they referred people to a local GP on admission. Staff offered people an annual health assessment as part of their inpatient stay. Any additional specialist referrals were made via the multi-disciplinary team in conjunction with the GP as required. The provider advised there was a physical health team supporting people to meet their physical health needs. The team reported a recent success story where a female patient attended her cervical screening at the GP after refusing and being very scared, the team supported the patient with education and accompanied her to the appointment. They remained with her, talked her through the process and supported her and the GP nurse through the screening. The team introduced patient education sessions. These included a specialist dentist delivering a session about oral hygiene; a men’s health session for patients at Janet Shaw Clinic where they used models to talk about testicles as well as general health; a women’s health session where the women could use the breast models, look at different urine colours and what they mean and learn about hygiene around safe sex and cervical screening.

The provider shared a copy of the ‘Health Action Plan’ completed with people following their annual health assessment. This was designed to support people to understand what they needed to do to keep themselves healthy. We reviewed a completed ‘Health Action Plan’ for a person at Janet Shaw Clinic which detailed their input, “Tell me step by step what is going to happen. Don't use complex terms. One person voice talking to me. Try not to talk for long periods of time.”

People spoke positively about their outcomes. One person at Janet Shaw Clinic told us “I have achieved a lot this year. My leave is being extended so I can go to a bigger shopping place. I also was involved in doing an interview with people who were looking at experiences of being in services.” Another person told us “I have achieved a lot this year.” A person on Malvern ward told us they had achieved a lot throughout their treatment journey and were getting ready to be discharged.

The provider advised that staff utilised Health of the Nation Outcome Scores- Learning disabilities to measure the health and social functioning of people. Staff measured pre and post therapeutic outcome measures for people who participated in groups facilitated across the site. The clinical psychology team evaluated and reported on the ‘Thinking Skills Offender Programme’, which demonstrated significant improvements in people’s ability to manage their emotions and behaviours. The team also reviewed and evaluated the ‘Cognitive Behavioural Sex Offender Treatment Group Programme’, which showed improvements in sexual knowledge and control of emotions and behaviours.

The Speech and Language therapy team developed and implemented a screening tool alongside training for staff as part of induction. The team developed a swallowing difficulty and choking awareness pack and training for kitchen staff with regards to modified foods. This resulted in an increase in referrals to the dysphagia service which aimed to reduce the risk of choking incidents.

We spoke with a person on Onyx ward who was aware of the section they were on and their section 17 leave arrangements.

Staff described how they would ensure people understood what they were consenting to before providing any care or treatment.

We observed staff checking people’s understanding and gaining verbal consent before undertaking any activities or therapies.

We reviewed care records for people on all wards. We saw staff completed consent to share forms with people. We saw staff completed capacity assessments when required.