Nottinghamshire Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Patients felt safe on the wards and there were enough staff on the wards to keep them safe. Patients told us they were involved in the development of their care and treatment records and risks were discussed with them. Staff supported patients to go on leave to their place of discharge as often as they needed before discharge and had developed good links with the local community. There was sufficient staffing in place, however, staff did not feel they had the autonomy to increase staffing as required if patient acuity increased.

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.

Patients told us the staff team helped them to share their feelings openly and to recognise when they were feeling unsafe and develop strategies to help them manage them.

Staff we spoke with said local managers kept them fully informed regarding changes and developments regarding the service, however they felt a little isolated. Managers were approachable and available if they needed them. Ward meetings were held monthly and included lessons learned from incidents across the trust. We saw staff had developed a “news on the mount” newsletter for staff and patients which included initiatives to improve patient experience.

We saw both a safety and governance bulletins displayed in staff rest rooms.

Patients told us they valued input from the team including peer workers who were specifically employed to support them towards integrating into the community and eventual discharge. They told us staff supported them to go on leave to their place of discharge as often as they needed before discharge.

Staff we spoke with said they assessed patients prior to admission into the service. We were told staff had developed good relationships within the local community. For example, free transferable gym memberships were available to patients.

Managers worked with the trust around delayed discharge allowing staff to ensure appropriate placements were secured for patients upon discharge. The delays in discharge were reported appropriately.

All patients we spoke with told us they felt safe and staff supported them whenever they needed. They were involved in developing their care and treatment plan and discussed any risks. They could talk to an advocate or a social worker if they needed too.

All staff we spoke with were able to demonstrate how they would identify and raise a safeguarding issue. They told us how they would support the patient throughout the safeguarding process.

When reviewing patient records, we saw where staff had worked in partnership with external stakeholders regarding a complex safeguarding issue to ensure both the patient and public were protected.

The trust had a safeguarding policy in place, we saw a notice board which was dedicated to safeguarding.

Patients told us there were plentiful and varied meaningful activities both on and off the ward, which kept them busy and helped them reach their rehabilitation goals. Patients were complimentary of the support by the activity coordinators, peer support workers, occupational therapy, nursing and psychology staff.

Staff we spoke with said patients are nursed in the least restrictive way possible. They involved the patients in assessing their own risks and recorded this appropriately. Staff held a daily safety huddle where each patient’s risk status was discussed.

All patient care and treatment records we reviewed were comprehensive and had updated risk assessments in place. The records showed patient involvement in 10 out of 12 plans and the patient voice was evident throughout. Whilst risks were assessed appropriately, the patient record did not clearly highlight the current risk level which meant staff who were new or temporary were not immediately aware of the current risk level.

Patients told us they felt safe on the ward, and they had access to their own bedrooms whenever they liked. Staff helped them personalise their rooms and supported them to keep their space clean. There was plenty of space both inside and outside for patients to participate in activities with staff. Patients told us the gardens were lovely quiet spaces and were very peaceful.

Staff we spoke with said they said they worked with patients to be as least restrictive as possible. They told us they were very proud of the work they had done to make the wards as homely as possible.

We saw both units were bright, airy and appropriately furnished. Although none of the patient bedrooms had an ensuite, we saw sufficient bathrooms and toilets were available.

A full environmental and ligature risk assessment was in place on both units, which had been reviewed regularly.

Patients we spoke with told us staff were always available, and they generally knew all the staff. However, staff occasionally became stressed when there was sickness leading them to be short staffed. Two patients told us it was sad that staff had to spend so much time on computers.

Staff we spoke with told us staffing levels were appropriate, however they were able to increase numbers if clinical need increased. Two staff told us they felt vulnerable at night due to the isolated location of the unit. Staff told us sickness and turnover levels were low.

We saw staffing levels met the requirement of 5 on early and late shifts and 4 on night shifts across both units.

A daily huddle meeting was held to look at staffing levels across the units.

Patients we spoke with told us the cleaning teams worked very hard, and the wards were always clean.

Staff we spoke with described how they managed infection prevention control in their respective areas. They had appropriate amounts of personal protective equipment and could access support from infection prevention and control experts within the trust. They told us cleaning staff were an integral and valued members of the ward team.

We saw all staff were bare below the elbows according to trust policy.

Cleaning schedules were completed, and audits of cleanliness had been undertaken. The results of these were displayed on the ward noticeboards for staff and patients to see.

Patients we spoke with told us they were able to talk to staff about any concerns regarding their medications. Patients at Bracken house said they liked the new dispensary system and said staff always gave them their medicines on time.

Staff told us they had recently transferred to using the trust electronic prescribing system. This was working well however they were not able to order take home medications, this had to be completed by a manager. They said this meant that patients had excessive waits to go on leave or had to return to the unit early from leave if staff were unable to get additional medication to them.

We saw all medicines were stored appropriately. Staff completed temperature checks of the clinic room and the medicines fridges. The ward office was used to store and dispense medication in the female area at Thorneywood mount. Medications were stored appropriately and there was a sink in place.

The trust had a up to date medicines administration policy in place. Staff completed the required monitoring of high dose anti-psychotic medications.