Mildmay Oaks

We rated Mildmay Oaks as good overall because:

• Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that young people had good access to physical healthcare and supported young people to live healthier lives. The service had enough nursing and medical staff, who knew the young people and received basic training to keep young people safe from avoidable harm. Staff used recognised rating scales to assess and record severity and outcomes.
• The ward teams included or had access to the full range of specialists required to meet the needs of young people on the wards. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain young people’ rights to them. Staff supported young people to make decisions on their care for themselves proportionate to their competence. Staff assessed and recorded consent and capacity or competence clearly for young people who might have impaired mental capacity or competence.
• The ward was were safe, clean, well equipped, well furnished, well maintained and fit for purpose.
• Staff assessed and managed risks to young people and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff understood how to protect young people from abuse and the service worked well with other agencies to do so. Managers ensured there were always lessons learnt in relation to incidents
• Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for young people and staff. Governance processes operated effectively at ward level and performance and risk were managed well.

• Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

However:

• There was not a policy abut young people visiting the wards to ensure their safety.

We rated Mildmay Oaks as good because :

• The service managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability and/or autism and in line with national guidance about best practice.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

However:

• Procedures for checking emergency equipment and fire safety plans were not fully understood by the staff teams. The hospital ligature assessments had not considered the risk associated with patient belongings. Staff had not reported all the damage on the wards, so it could be repaired. There was not a procedure for checking alarms issued to visitors.
• Ward staff were not aware of patients’ discharge plans and how their work related to this.
• Not all staff knew where easy read care plans were stored.
• Patients had long lengths of stay due to issues finding future placements.
• Governance systems had not found the issues with emergency bag and defibrillator checking and fire safety plans.

During this inspection we found:

• The wards had enough nurses. Staff managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to work with patients who displayed behaviour that staff found challenging.
• Managers ensured that permanent staff received an induction to the hospital and training.
• Staff treated patients with compassion, kindness and respected their privacy and dignity.
• The service treated concerns and complaints seriously.
• Leaders had the right skills and made staff feel supported and valued. Mangers took action to address performance concerns.

However:

• Not all agency staff had received an induction to the hospital.
• Some patients told us that staff could be abrupt when they were busy.
• None of the agency staff had received documented training in learning disabilities.