We spoke with three patients about their medicines and the care they received.

Comments from patients included:

‘’I feel safe here, everything is fine’’

‘’I have been told about my medicines I know what they are’’

‘’Sometimes other patients frighten me but I can go to my own room where I feel safe’’

Overall we found good improvements in the management of medicines.

When we visited only one person on the Willow Unit wanted to speak to us. They told us that they “felt safe” and that it was a “good environment”.

An inspection team, including a pharmacist and two compliance inspectors visited Cheadle Royal Hospital on 18/6/12. We visited four wards across the hospital, which included Orchard unit, Pankhurst, Elmswood and The Meadows. Our report relates to our findings and observations of these wards and units.

We spoke with some of the patients at Cheadle Royal Hospital.

Some of the comments from people included:

“The food and the staff are ok.”

“Have been doing the care plan with staff.”

“Can talk to staff and doctor if not happy about anything.”

As part of this review process we saw a draft report following a visit to the service from Stockport Local Involvement Networks (LINks). LINKs are groups of individual members of the public and local voluntary/community groups who work together to improve health and social care services. They gather the views of local people and use them to influence how health and social care is commissioned and delivered. No concerns were raised in the report.

We spoke with a representative of Pennine Foundation Trust who monitors the care of the people who have been placed at Cheadle Royal Hospital by the Trust. She told us that she was happy with the care and attention people received and had no concerns.

An inspection team, including a pharmacist and two compliance inspectors visited Cheadle Royal Hospital on 13/09/2011. We visited several wards across the hospital including Orchard unit, Pankhurst, Elmswood and The Meadows. Our report relates to our findings and observations of these wards and units.

At the same time a Mental Health Commissioner colleague was also doing an announced inspection of The Willows ward.

Patients using the service told us that they were treated with kindness, dignity and respect. We observed that staff took time to communicate with patients in a respectful and compassionate manner. Patients were empowered to become active participants in their care which required good communication skills from staff to enable them to address patient needs effectively.

All patients underwent a thorough assessment of need, care plans were holistic and recovery oriented and included physical health assessments, these were completed in collaboration with the patients, progress was regularly reviewed. Regular multidisciplinary meetings were held and attendance by outside agencies was encouraged. Good communication was evident with external agencies such as local authorities and community mental health teams. Families and carers were involved in this process where appropriate. Advocacy services were accessible and available to support patients.

The hospital followed national guidelines on cleaning standards and monitoring procedures to provide and maintain a clean and appropriate environment to prevent and control healthcare associated infection. The wards were clean and tidy and there was an established cleaning regime. All clinic rooms were fully equipped with accessible emergency equipment which was maintained appropriately. Medicines were dispensed and stored securely and weekly audits were undertaken to ensure safe practice.

There were arrangements in place to provide safe and effective care in the event of a failure in major utilities, fire, flood or other emergencies. We had sight of the hospital's fire risk assessment, service evacuation plans and details of fire training for staff.

The ward environments were situated in older buildings and were subject to constraints in observation. These were effectively managed and risks mitigated with the use of observation and individual risk management planning. Regular environmental quality checks were conducted and patients were able to discuss and resolve environmental issues in community meetings. Ongoing refurbishment plans had seen improvements to the ward environments.

Staffing levels were determined using a staffing ladder model. Electronic rostering was used to support staff management and staffing was reviewed regularly to ensure there was enough staff with the relevant skills to deliver safe patient care. Patients were supported by a skilled multidisciplinary team of staff which included nursing, psychiatric, psychological, occupational and dietetic support. Staff were supported to deliver effective care and treatment they told us that they received meaningful and timely supervision and were supported to maintain their professional skills and experience.

Treatment practices including physical health care and prescribing practices were based on nationally recognised guidance. Care planning was holistic and positive risk management was evident. Care planning, risk and review were undertaken regularly and patients and their carers were involved in this process. Any identified spiritual needs and cultural requirements were supported and families and carers groups were active in the service.

Safeguarding processes were in place which reflected national guidance, and understood by all staff. There was a clear structure of reporting and responsibility for safeguarding adults and children. Any concerns relating to adult and child protection were communicated to the relevant protection agencies.

Restrictive practices were reviewed regularly and patients were involved in the process, the service had a patient representative who met with patients regularly and acted as their voice in communication with senior managers. Regular patient surveys and community meetings informed improvements in patient care across the hospital.

Referral systems and admission criteria were in place and admission waiting times monitored. Delayed discharges and length of stay was also monitored, procedures and strategies were in place to reduce the length of stay.

Staff were trained in and had a good understanding of the Mental Health Act and Mental Capacity Act. Staff followed local procedures and support was available from Mental Health Act administrators. Patients were given information and support to ensure appropriate representation and aid understanding of their rights.

There was an established governance structure with a defined hierarchy of reporting and decision making within the service. There were clear systems of accountability and senior managers were actively involved in the operational delivery of the service. There was a clear statement of visions and values, staff knew and understood the vision, values and strategic goals of the service. Processes and systems of accountability and governance were in place and performance management and quality reporting was clearly set out. Risks were identified and monitored. Performance issues were escalated and discussed at relevant governance forums and action taken to resolve concerns.

All staff we spoke with were positive about their roles and were passionate about service development. Staff felt able to raise concerns without fear of victimisation and spoke positively about the organisation. They told us that they felt valued, had input into the service and were consulted and involved in service quality developments. The service was committed to improving the services on offer and continually improving the quality of care provided to patients.

However:

The hospital had a policy and action plan in place regarding reducing the use of restrictive practices including the use of restraint in line with national guidance. However on the child and adolescent mental health wards two patients reported painful holds were used during restraint. This raised concerns about the use of pain compliance in the form of wrists holds being taught to staff in the management of violence and aggression training.

• On the acute wards for adults of working age and psychiatric intensive care units and the child and adolescent mental health wards there was inconsistent monitoring and recording of physical observations following the use of rapid tranquilisation.
• On the acute wards for adults of working age and psychiatric intensive care units staff had not received training around personality disorders.
• Within the psychiatric intensive care units there were higher levels of seclusion reported than levels of restraint.
• On the long stay/rehabilitation mental health wards for working age adults, staff were not always specifying clearly the decisions leading to capacity assessments and recording the decisions made in patients’ best interests when patients were assessed as lacking capacity.
• Food in the patients’ kitchens was not always stored in a way that minimised risk of food borne viral infections.