We spoke to seven patients when we visited the unit. They told us they were pleased to be getting the specialist input provided by the service and hoped this would improve their epilepsy. They were able to describe to us how they felt the care they were receiving was very good. However, they did express a frustration that sometimes they did not know how long they would have to wait for tests and that there were not always enough staff available to record their seizures.

None of the people we spoke with had any concerns with the cleanliness of the unit.

The people we spoke to told us they felt the food could be better, but were impressed by the effort staff made. For example, one person told us how they had supported her to celebrate a relative’s birthday by preparing them a “special party buffet.”

• We rated caring and responsive as outstanding, effective and well led as good and safe as requires improvement.
• We rated medical care as outstanding and outpatient services as good overall.
• Staff cared for patients with compassion. Feedback from patients and their carers confirmed that staff treated them well and with kindness. We were consistently told by patients that staff were very caring and went above and beyond the call of duty.
• All patients, relatives and carers we spoke with described their experiences as positive and said they were always included in care planning. Patients told us that their privacy and dignity was respected, especially during physical or intimate care or when they were most vulnerable when they had a seizure.
• The service provided care and treatment that was tailored to meet people’s individual needs. The preadmission nursing assessment included detailed questions on the patient’s individual communication requirements and behavioural preferences. Staff we spoke with demonstrated a patient-centred approach to making adjustments to support patients’ admission and a good understanding of caring for patients with a learning disability.
• Mandatory training compliance for nursing staff was above the trust target of 90% for all modules.
• Processes for establishing and addressing clinical risk and safeguarding needs were clearly embedded. There were robust processes to assess patient risk. Patients were triaged by a consultant and pre-assessed by nursing staff prior to admission, and then had through nursing and medical assessments upon admission.
• Systems were in place for recording, investigating and learning from incidents that occurred across the trust.
• Staff we spoke with demonstrated a strong understanding of safeguarding procedures and knew how to raise concerns. They said they felt they could contact the trust safeguarding team when they needed to and were well supported by them.
• There was effective multidisciplinary team working. Relevant professionals were involved in the assessment, planning and delivery of patient care.
• Care and treatment were evidence-based and staff represented the specialty and trust on international expert panels and committees. This enabled them to plan care with the latest available understanding of epilepsy and its treatment.
• Staff demonstrated a passion and commitment to the development of the service. There was a strong focus on research activity to help drive improvement in patient outcomes. Staff were involved in the development of innovative practice including research to eliminate epileptic seizures through improved surgical planning and reduce seizures through innovative diet control.
• There was a clear leadership structure and staff told us they felt well supported by their line managers. There was a strong positive culture and good morale amongst staff at the unit. Staff were proud of the care they provided and had a patient-centred approach.

However:

• Infection control and environmental standards in the outpatients department were inconsistent and did not reflect good practice. The environment was not in a good state of repair, clean and free from infection risks. There was a need for improvement in daily monitoring of cleanliness of these areas.
• The service occasionally admitted children aged 16 and 17 but no staff had level three safeguarding training. However, staff demonstrated a good understanding of safeguarding procedures.
• In outpatients, the pharmacy staff told us there was no coherent medicines management system in place and they had limited access to safety and governance processes, which they said reduced safety. On the inpatient unit, there was no temperature monitoring for the storage of non-refrigerated medications. This meant that medication could be exposed to temperatures above the recommended maximum.
• There were some gaps in the systems in place for staff or patients to call for emergency help and non-clinical staff did not have basic first aid or basic life support training. This presented a risk as outpatients may not always have a second clinical member of staff on shift.
• There were inconsistencies in the standards of patient record completion in relation to the legibility of writing and staff signatures.