Ellern Mede Ridgeway

Updated 9 May 2022

We undertook this short notice announced comprehensive inspection of Ellern Mede Ridgeway as part of our ongoing monitoring and inspection of registered services.

Ellern Mede Ridgeway is a hospital run by Oak Tree Forest Limited. It provides eating disorder inpatient services for children and young people aged 8– 18 years. This hospital is for children and young people of all genders. However, at the time of our inspection the young people were all female.

The hospital has two wards and two cottages, each of these areas provides a different treatment programme.

• Lask Ward has 10 beds and offers high dependency intensive treatment for children and young people with highly complex eating disorders. This ward can support children and young people with nasogastric feeding.
• Nunn Ward has 12 beds and is a general eating disorder ward. It provides a recovery focused programme for children and young people who are stabilised and require ongoing support.
• Cottages are pre-discharge areas. Each of the two cottages have space for three children and young people who have been assessed as low risk of harm to self or others and are physically stable.

At the time of inspection, there were 25 young people aged between 12 and 18 admitted to the service.

The hospital has an on-site school to provide children and young people with an education during their admission. Ofsted were carrying out an inspection of this school at the time of our visit. The school was previously rated as outstanding in all areas in 2018.

The service has a registered manager in post and is registered by the CQC to provide assessment or medical treatment for persons detained under the Mental Health Act 1983 and treatment of disease, disorder or injury.

We last inspected this service in January 2020. The service was rated as good overall, with the safe domain being rated as requires improvement. We issued two requirement notices to the service following this inspection stating actions the service must take:

• The provider must ensure that staff complete the required physical health observations on young people following administration of rapid tranquilisation or record reasons why this was not done in accordance with best practice and the service guidelines.
• The provider must ensure that medication for young people is administered as prescribed and that adequate precautions are taken to ensure medication does not go out of stock.

What people who use the service say

Young people reported the majority of staff were kind, thoughtful and supportive. Young people commented their recovery was due to the permanent staff members. One young person commented when they were upset staff were able to comfort them and help them feel safe.

However, young people reported some agency staff were not empathetic and felt they needed more training in meal support techniques. All young people reported there were not enough staff, especially at nights and weekends.

The majority of carers spoke with very high praise for the staff and the care that had been offered at this hospital. One carer said the service went above and beyond, and another said they looked at their child as a whole person, supporting their individual needs.

The service had received 19 compliments within the last six months. These included compliments from young people who have left the service and were thanking the service for the support in their recovery.

Updated 9 May 2022

Our rating of this location stayed the same. We rated it as good because:

• Staff assessed and managed risks to children, young people and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
• Staff understood how to protect children and young people 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 had named safeguarding committee for safeguarding concerns.
• Staff assessed the physical and mental health of all children and young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected children and young people's assessed needs, and were personalised, holistic and recovery-oriented.
• Managers supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the service they managed and were visible in the service and approachable for children, young people, families and staff.
• Staff felt respected, supported and valued. They could raise any concerns without fear.
• The service managed safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave children and young people honest information and suitable support.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Staff explained children and young people's rights to them.
• The majority of staff treated children and young people with compassion and kindness. They respected children and young people's privacy and dignity. They understood the individual needs of children and young people and supported them to understand and manage their care, treatment or condition.

However:

• The provider did not have a comprehensive documented risk assessment of night time staffing levels across the two wards and the cottages outlining how risks were managed and mitigated to ensure that young people remained safe at all times.
• Although some recent appointments had been made, there were vacancies in some key multidisciplinary roles, such as an occupational therapist and a senior social worker. This limited the professional expertise available to the service and the young people. Turnover of staff was high within this hospital, especially for non-registered nurses
• Young people did not always feel they were involved in decisions about the service. Young people did not always get regular updates and timely information on the progression of the issues they had raised, such as information on timescales for the completion of repairs, from senior managers.
• Reflective practice groups were not regularly taking place on all wards. When they did occur no more than two or three staff were able to attend the group because the wards were unable to release staff.
• Staff were not recording clearly on the medicine administration records which route the medicine has been administered by, for example orally or by nasogastric tube. Staff did not always label opened liquid medicines with the date opened and new expiry date. The service did not always report incidents of omitted doses of medication. Incidents involving medicines were not always thoroughly investigated, there was therefore a risk that learning was not identified and shared with staff.
• Whilst wards were safe, clean, well equipped and fit for purpose, furnishings were not always well maintained.
• There was nothing on display in the wards that indicated the wards were inclusive environments looking to meet the needs of those young people with protected characteristics.
• Young people were not told routinely about the closed circuit television (CCTV) cameras throughout the hospital on admission.

Updated 9 May 2022

• The rating for this hospital remained the same. We rated this service as good.