We found the following areas the hospital needs to improve;

• The provider had installed a new training database but it was not fully functional at the time of our inspection. This meant they could not provide us with compliance data for all the mandatory training staff were required to undertake.
• We could not see from care records when and what information staff had provided to patients receiving naso-gastric treatment about independent mental health advocacy. We could therefore not be sure that staff had acted in line with the Mental Health Act code of practice when treating detained patients.
• Not all staff had been trained in the requirements of the Mental Capacity Act, 2005.

However, we also found the following areas of good practice;

• The provider had ensured appropriate training requirements were in place for different job roles and they encouraged staff to place high importance on participating in mandatory and essential training.

• Staff had been trained in appropriate levels of life support depending on their job role and the provider planned to train future staff in-house by adopting a train the trainer model.
• Managers provided staff with regular line management and clinical supervision. They provided relevant training for supervisory staff and made sure staff recorded the frequency of supervision sessions.
• Patients described effective communication between support workers, nursing staff and the therapy team in ensuring coordinated care.
• The hospital provided staff with training in the Mental Health Act and the associated code of practice.
• The provider carried out checks on directors to ensure they were fit and proper to carry out their role.
• The provider’s adult service had been accredited by the Royal College of Psychiatrists’ quality network for eating disorders.

People that we spoke with that were using the service told us that overall they were happy staying at the clinic and were satisfied with the care and support they were receiving. Their comments included, "I know that the staff have my best interests at heart," "it's fine here," "we all get on well together and that helps with our recovery" and "the staff are very good and they're there when you need them."

We found that care and support was offered appropriately to people. We found that staff were skilled, in recognising the diversity, values and human rights of people who used the service.

Each person staying at the clinic had a care plan. We found that the information in these was sufficient and up to date. This meant that the delivery of care to people was safe, effective and appropriate.

Since our last inspection a new system for the safe administration of medicines had been introduced. We found that medicines were being obtained, recorded, handled, dispensed and disposed of in a safe way.

Staff that we spoke with said they were very well supported by the registered manager to carry out their role. Staff said they were up to date with all mandatory training and we saw confirmation of this.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.

We spoke with several patients, on both the adult side and the adolescent side, who were receiving treatment at Riverdale Grange Clinic. They mostly spoke positively about their experience. Patients told us that they found the regime within the hospital to be "difficult at first", but several patients said to us "we understand that the rules are put in place so that we can get better". One patient that we spoke with told us that they found the complementary therapies within the hospital to be "excellent". Other patients told us that they felt all the staff team were very supportive and that they all had "very good" relationships with their named nurse and named support worker.

We found that patient's needs were identified in care plans. Patients had been involved in writing their care plans. Patients told us that following consultation with "key staff" they were able to make changes to their care plan at any time.

We saw that medication was not always recorded at the time it was administered. This meant it was not clear if patients always received medication as prescribed. We found that although this had been identified as an issue, following medication monitoring checks, appropriate action had not been taken to rectify this.

Staff that we spoke with said they felt "well supported" by their line manager and received regular training, supervision and appraisal.

Patients told us they were aware of how to make a complaint if they wished to do so.

We spoke with several people who were receiving treatment at Riverdale Grange Clinic. They mostly spoke positively about their experience. Some patients told us that they found the regime within the hospital to be challenging, but one patient said to us “it’s challenging for a reason, it’s to get me better”. One patient that we spoke with told us that they found the activities within the hospital to be “brilliant”, and another told us that she felt all the staff team had been very supportive to her.

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.