14 and 15 August 2018
During a routine inspection
We rated Riverdale Grange Clinic as good because:
- Patients had access to a wide range of therapies and professionals within an effective multi-disciplinary team. Patients and carers told us that therapy was personalised and specific to individual need. Families and carers were encouraged to be actively involved in patient care, and were offered support and education programmes.
- Staff morale was high and staff told us they felt well supported and valued in their roles. Staff supervision and appraisal rates were above 80% across both units.
- Patients had access to a timetable of activities on both units and were encouraged to complete individual weekly planners detailing activities they intended to attend. Patients were also involved in a social enterprise which encouraged them to try new activities whilst raising awareness of eating disorders in the local community.
- Robust physical health monitoring was in place throughout patients’ admission, overseen by two general practitioners. There was an on-call rota for managers and consultant psychiatrists for support and advice out of hours in order to maintain the safety of staff and patients.
- Adolescent patients could access an on-site education provision during term-time, with school staff maintaining contact with the patient’s education provider outside the hospital.
- Staff at the hospital were involved in peer review of other eating disorder services; allowing them to share knowledge and engage in learning opportunities.
However:
- Staff did not consistently complete patient medication cards following the administration of medication. Fridge temperatures in the adolescent clinic room regularly exceeded the recommended range. It was not clear that emergency medication, namely EpiPen’s, were stored in line with manufacturer’s guidance, and one of the emergency bags did not contain the correct equipment identified on the equipment check-list.
- Mandatory training compliance for eating disorders awareness and therapeutic observation training modules was low. This meant that staff may not have been aware of the specific risks and complications associated with eating disorders in order for them to safely care for patients.
- Adolescent patients had not been individually risk assessed to establish whether they required supervision whilst accessing the hospital garden. Patients’ rights under the Mental Health Act were not clearly displayed on the adolescent unit.
- Staff could not identify where consent to share information was stored within patient notes and we could not see evidence of a clearly documented assessment of capacity for a patient who had been deemed not to have the capacity to make a specific decision.
- Governance structures in place at the hospital did not effectively manage all of the concerns identified.