Richmond House

We rated Richmond House as requires improvement because:

• There were multiple ligature points (things to which patients intent on self-injury might tie something to harm themselves), in the bathrooms and bedrooms. The provider completed ligature risk assessments, but had no plans to remove or update ligature risks in these areas. There were multiple blind spots around the unit and on all floors, which were not risk managed. There was no nurse call system in any bedrooms or bathrooms, and staff did not carry alarms.
• There was a breach of the Mental Health Act (MHA) code of practice and CQC regulations regarding single sex accommodation. There was no female only lounge.
• Staffing levels at weekends and evenings was not sufficient to manage any serious control and restraint procedures that may be required, or other emergencies.

However:

• The service employed appropriately trained staff and covered vacancies by using regular bank or agency staff. Most staff were up to date with mandatory training, and those who were not had training dates booked. All staff either had, or were studying for, the British Institute of Learning Disability (BILD) care certificate or a diploma in health care. Supervision and appraisals were all up to date.
• All staff had received MHA training. Staff understood the MHA, the revised code of practice and the guiding principles. Staff completed capacity and consent to treatment requirements and reviewed these regularly. Staff explained patients’ rights on admission, and they repeated this information at patients’ reviews. Patients had access to Independent Mental Health Advocates (IMHA’s). Richmond House had no incidents of seclusion, segregation, or deprivation of liberty safeguard applications.
• Robust arrangements were in place for staff to manage admissions and discharges in the hospital. Staff undertook pre-admission assessment visits and patients were encouraged to visit the service prior to admission.
• Patients’ risk assessments were up to date. Staff had completed crisis plans for all patients to address any mental health deteriorated. Care records showed that staff carried out comprehensive risk assessments including physical health care needs. Staff encouraged patients to contribute to their own recovery. Patients had access to an independent advocacy service.
• The hospital had a good track record for managing safeguarding and complaints. The manager used the partnerships in care dashboard to monitor activity on the unit including MHA reviews and section 17 leave. Clinical audits were regularly undertaken by the manager and outcomes shared with other staff. The provider’s policies met best practice guidance. Staff told us they were able to raise concerns without fear of victimisation. Staff told us they were unaware of any bullying or harassment cases.
• Staff knew about and agreed with the organisation vision and values. Staff used clinical practice as recommended by National Institute of Health and Care Excellence (NICE) guidelines. Multidisciplinary team working and information sharing was good. Staff worked closely with external agencies and existing care co-ordinators to identify suitable accommodation, employment, and voluntary opportunities for patients. The provider offered smoking cessation support.