The Retreat - York

Updated 2 October 2019

The Retreat York opened in 1796. William Tuke and the Society of Friends (Quaker) set up the hospital to provide compassionate care in contrast with the treatment that was being provided at that time. It continues to operate as a voluntary sector provider of community based mental health services. The Retreat York have been registered with the CQC since October 2010. In 2018 they withdrew from delivering inpatient services. In January 2019 The Retreat York revised their registration with the Care Quality Commission (CQC) to provide the regulated activity of treatment of disease, disorder or injury for their outpatient services. Although The Retreat has provided Attention Deficit and Hyperactivity Disorder (ADHD) assessments to adults since 2014, this was the first inspection of the service due to a change in the commissioning contract.

The Retreat York offers NHS and privately funded community services that include the assessment, diagnosis and treatment of adults with ADHD. NHS ADHD services were commissioned by the Vale of York, Harrogate and Ripon District, Scarborough and Ryedale and Hambleton, Richmondshire and Whitby clinical commissioning groups.

Additionally, The Retreat York offer assessment and psychological therapies for trauma and stress, eating disorders and counselling via the therapy services and Autism Spectrum Disorder assessment, diagnosis and treatment at Aldgarth House. These services are not within the CQC’s scope of regulation.

We inspected the adult ADHD service at Aldgarth House only.

There was a registered manager in post at the time of the inspection.

Updated 2 October 2019

We rated The Retreat York as requires improvement because:

• Clinical premises where patients received care were not compliant with internal fire safety processes and did not maintain the confidentiality of patients. Clinic rooms were not soundproof so confidential conversations could be overheard.
• Staff had not completed all the necessary checks on blood pressure monitoring and weighing equipment that was used in the service. The service did not have effective processes in place to safely manage a medical emergency.
• Staffing levels were not high enough to meet the demands on the service. There was not a fully integrated system between primary care and the attention deficit hyperactivity disorder (ADHD) service to ensure patients received all care and treatment identified at the assessment.
• Mandatory training was not well managed in the service. The service was unable to evidence if staff had met the service’s training requirements.
• The service did not manage risks to patients or staff in line with organisational policies. Staff did not always use the format specified or update risk assessments in the timeframes stated.
• Staff could not access all patient information quickly. Staff were not always able to locate paper or electronic files that held patient information.
• Access to the service was difficult. Patients were not able to contact the service easily on the phone and staff didn’t always respond to patients that left messages.
• Waiting times to access an assessment were 18 months and the referral criteria excluded patients that would have benefitted from care. The 'did not attend' policy and the process to expedite patients was not considerate of the challenges faced by this patient group.
• Leaders lacked the skills and knowledge to oversee and implement daily operational tasks. There was a lack of clarity and ownership about the responsibilities of managers, clinical staff and business support staff.
• Not all staff felt respected, supported and valued. They did not always feel able to feedback honestly to managers in the service. The service’s lone working protocols and policy were not fully implemented and did not offer support to all staff groups. The induction process did not meet staff needs.
• Governance processes did not operate effectively, and processes were not always well managed.

However:

• Clinical premises where patients received care were clean, well-furnished and well maintained. There were enough clinic rooms at the service and the service had made adjustments for disabled patients.
• Staff worked with patients, families and carers to develop individual care assessments that were personalised, holistic, function-based and recovery-oriented. Staff supported patients to live healthier lives
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
• The service used systems and processes to safely prescribe, secure and audit prescriptions. Staff reviewed the effects of medicines on each patient’s mental and physical health.
• Staff from different disciplines worked together as a team to benefit patients. Staff were supportive of each other and understood the challenges the different roles faced.
• Staff had the skills, or access to people with the skills, to communicate in the way that suited the patient. Reports were easily understood by patients. Staff supported patients to access additional treatment out with the contract. They recommended that patients seek additional funding from the local clinical commissioning groups via their GP for additional services.
• The service managed complaints well and shared learning with staff. Managers supported staff with appraisals, probationary reviews, supervision and opportunities to update and further develop their skills.
• Managers from the service worked with commissioners, local authorities and mental health providers to try to improve services for the local population.

Updated 8 June 2016

We rated The Retreat - York (Naomi Ward) as good because:

• the service used well-established evidence-based guidance for care and treatment of patients, with clear pathways
• staff were respectful and empathetic, and provided emotional support
• patients told us staff were caring
• staff understood the local procedures for safeguarding patients from abuse, what their responsibilities were and how to raise their concerns
• staff completed comprehensive assessments of patients’ needs and their care plans demonstrated meeting patients’ physical and mental health needs
• staff kept care records up to date and stored them safely.

However:

• the hospital had no robust medicines management process and there were problems in the service level agreement for the safe and effective disposal of medication and care plans did not always contain sufficient detail for patient as prescribed PRN medication, medication taken when it is required
• staff were not following the care programme approach (CPA) or sharing information for discharge planning in a timely way, which meant services were not working together to deliver effective care and treatment
• senior management had not consulted adequately with staff regarding alterations to the ward that affected patient care, which meant staff and patients had not been fully involved and engaged in the planning and delivery of services on the ward.

Updated 29 January 2018

Updated 29 January 2018

Inspected not rated

Updated 2 October 2019