Archived: Brierley Court Independent Hospital

We rated this service as good because:

• We observed excellent interactions between staff and patients. Staff were supportive in a compassionate and discreet manner.

• Patients had an ongoing risk assessment and assessment of their needs. Patient involvement in their care planning was evident in the care records.

• Staff managed medication administration correctly, following the provider’s policy and procedures. Staff undertook audits to monitor the levels of stock and medication administration records.

• Staff completed environmental risk assessments to identify, remove or reduce risks to patients. The environment was clean and well maintained, having recently had a refurbishment, which included new furnishings and decoration.

• Managers and clinicians met regularly to review information about the safety and quality of the service. This included staffing levels, incidents, safeguarding alerts, complaints, mandatory training, staff supervision, bed occupancy and patient feedback. When actions were required, action plans were followed up at the appropriate meetings or committees within the organisation. Information was passed to all levels of staff through team meetings, emails, supervision and reflective practice sessions.

• Staff had completed their mandatory training and received regular supervision with an up to date appraisal to support performance objectives.

• The service implemented the Mental Health Act and Mental Capacity Act effectively.

• All patients had their own rooms with en suite bathroom facilities. Patients had access to food and drink between meals. Patients were encouraged and supported to complete activities with a recovery focus. This included preparing their own meals, doing their laundry and going shopping.

• Patients’ care included input from a psychologist, occupational therapists and a psychiatrist. Handovers and care planning were nurse led with the weekly ward round being led by the psychiatrist. Patients’ care records reflected professionals worked together to support decisions to meet patient’s needs within the care and treatment delivery.

However:

• Occupational therapists and psychologists maintained their own treatment records; these were kept separately from the electronic patient record. The electronic patient record had limited entries of the treatment and interventions a patient had received for psychological or occupational therapies. Staff could not see other professionals had engaged with the patient, as there was no indication of the intervention type, date and brief summary held within the main record. This meant information was not readily available for staff to have a clear holistic understanding of how patients’ needs were met or the patients’ progression.

We rated the service as requires improvement because:

Staff did not always assess or meet the physical healthcare needs of the patients. Staff did not undertake comprehensive risk assessments of the patients or develop plans to mitigate these risks.

Other areas for improvement included ensuring mandatory training was completed and that staff had an appraisal and regular supervision. Staff also needed training on how to support patients with diabetes.

The provider also needed to ensure the role of the service was clarified and there were clear measures in place to ensure patients were being supported with their rehabilitation. Plans were underway to complete this work.

Further engagement with patients and staff needed to be implemented such as patient and staff surveys.

However, at the time of the inspection a new provider, Partnerships in Care (PiC) had been managing the service for just over four months. It was evident that the provider had introduced many positive changes and yet there was more to do.

The feedback from patients, carers and external stakeholders was that the staff team were caring and supportive. Patients had a chance to give feedback about the service at community meetings and there were plans for further engagement going forward.

The provider was maintaining a safe environment and safe levels of staff who knew the patients well. Medicine management was done well. Staff knew how to report incidents and had opportunities to learn from incidents, which had taken place.

There was good multi-disciplinary working and effective communication with external agencies and care co-ordinators. Staff morale was good.

The provider had robust governance processes but these needed to be fully embedded in the service.