Castle Lodge Independent Hospital

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The service involved people in the planning of their care and treatment which included what was important to them. Care and treatment was delivered in line with legislation and current evidence-based good practice and standards. The service ensured people knew their rights, carried out capacity assessments and delivered person-centred care and treatment in line with people's best interests.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

People we spoke with told us the service involved them in the planning of their care and treatment. The service held monthly community meetings for patients and the service ensured people had access to activities and local community groups. The service also invited carers, past and present, to a monthly forum and produced a regular carers newsletter to keep them up to date on any activity or changes within the service. The service had arranged a weekly GP ward round within the hospital to review patients' phsyical health needs. The service had an art psychotherapist within the team and individual patients were referred for psychology input, when required. One example of a patient who experienced pain was assessed by a specialist psychologist in pain management. The psychologist inputted directly into the patient’s care plan so staff could work with them effectively.

The service used a range of evidence-based tools and rating scales recommended by the National Institute for Health and Care Excellence. Nurses were trained to carry out a recognised wellbeing assessment tool and a scale for recognising depression in dementia. We saw examples of these in care records. Staff also use a pain tool to monitor pain where patients could not verbalise. Staff we spoke with also told us they were encouraged to learn about new approaches and attend training that could improve the way care was delivered to people. As a priority for improvement the provider was in the process of introducing the Safewards model in the providers hospitals (the objective of the model is to reduce conflict and containment within mental health services). The hospital manager reviewed good practice through a number of regular audits and senior leaders sent regular bulletins to managers regarding good practice updates. The service had also completed a patient survey in December 2023 regarding activities available for patients. As a result of this survey the service had created an action plan and were implementing changes. The service linked in with a local dementia charity and they would attend the hospital's monthly carers forums to provide support and information.

We saw evidence that people's needs were met in line with current guidance and by undertaking capacity assessments and best interest decisions when appropriate. Multi-disciplinary team discussions involved the patient and patient's family in decision making and planning care and treatment. During our site visit we observed an occupational therapy meeting that focussed on a holistic view of patient's needs, patient's independence and meaningful occupations. Carers and families' views were considered and external referrals made, when appropriate. The service valued feedback by conducting regular surveys and provided updates for patients as part of the 'You said, We did' initiative. The service had audits in place to ensure staff provided evidence-based care and treatment, including treatment under the Mental Health Act 1983. This ensured all detained patients were aware of their rights and patient restrictions were regularly reviewed to maximise their independence.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Both patients and carers told us they were able to raise concerns and complaints and these were acted on. Carers, families, and patients told us they are given information regarding their rights. Patients had access to advocacy. The independent advocate we spoke with told us that patients were supported to maintain relationships and understand their rights. The advocate confirmed that people who lack capacity were always auto referred to the service.

Staff received training in Mental Capacity Act and the Deprivation of Liberty Safeguards. Training matrix showed 94% and 93% compliance, respectively. Staff we spoke with had a good understanding of consent including the Mental Capacity Act. Patients were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with people's best interests. This included the use of a recognised pain tool to enable staff to monitor pain when patients could not verbalise.

During our site visit we completed a SOFI (a short observational framework for inspection). which is used to capture the experiences of people who use services who may not be able to express this for themselves. Our observations showed good interactions between staff and people and that staff promoted independence to deliver person centred care and treatment.

We looked at 5 care records which demonstrated consideration of a patient's capacity to consent. Capacity assessments were carried out as appropriate and were both time and decision specific. Records demonstrated that best interest decisions were carried out, when appropriate and involved the patient's family or advocate. The service conducted a regular review for people who required a modified diet, use of safety interventions or restrictive items such as chair belts and bed sensors. This was evaluated by nursing staff at least monthly and audits were in place to monitor consent and Mental Capacity Act practices.