We rated Abbey House as good overall because:

• Care records were stored securely and contained up to date information. Risk assessment and management plans were detailed and specific. Mental Health Act paperwork was up to date and stored correctly. Medicines management was robust, and staff ensured they completed medicine charts properly and audited them regularly.

• Patients had one to one time with their named nurse. Staff had protected time with patients to complete activities and review patient care. Staff demonstrated that they understood the needs of patients and were empathic. Patients were happy with the way staff spoke to them and said that staff treated them respectfully and were kind.

• Staff monitored and assessed patients’ physical health regularly from admission through to discharge. There was a GP and practice nurse clinic on site and staff supported patients to live healthier lifestyles. Food was freshly prepared on site at Abbey House; patients had a choice of meals from a menu with seasonal healthy choices, often using vegetables grown onsite.

• Patients were involved in their care planning and staff offered patients copies of their care plans. They were involved with decisions about their treatment at regular individual care review meetings and care programme approach reviews. The multidisciplinary team had clear local guidelines about how they should support and work with patients.
• Abbey House worked closely with external professionals and agencies to support patients in their recovery and to become more independent. They had a discharge coordinator who managed patient discharges and worked with external organisations to develop successful pathways out of hospital.
• Abbey House had a wide range of rooms that staff used to support care and treatment. The hospital was in extensive grounds with outdoor space for patients to grow vegetables, relax and take part in animal care.

• Staff enjoyed their jobs and felt supported by their team, managers and the wider multidisciplinary team. They said that they were listened to when they had ideas and that morale on the ward was improving following a period of change when staff had left the hospital and the Priory Group had taken over.

However:

• There were blanket restrictions in place at Abbey House. Patients were required to sign in and out their cutlery before and after meal times; but individual care plans did not describe why this was needed for all patients. This was not in line with the Mental Health Act Code of Practice 2015.
• Staff had not ensured that action points raised in local environmental ligature assessments were always recorded. Managers had not ensured that actions from a fire assessment had been implemented. We observed fire doors were wedged open. Staff did not always record that they had checked fridge temperatures where patients’ food was stored.
• Records of staff supervision were not always completed and where they were completed, they varied in quality and detail.
• Information regarding complaints made to the service in the last year were unavailable to review at this inspection.

The service provided treatment and rehabilitation for men with enduring mental health difficulties. During this inspection we spoke with five people who used the service, the registered manager, the deputy manager, two nurses and two support workers. People we spoke with were complimentary about the care and support that they received. People told us: “I’ve only just come here and I’m already making friends. The staff seem to want to do anything for you that makes you happy, so that’s good. I can’t believe how well they treat you; I’ve never had treatment like it anywhere else. I love the privacy of your own room”. “I go along to the education classes, they do some really interesting things and it’s good to keep your mind busy”.

People told us that they felt involved in any decisions that needed to be made about their care and these were made in their best interests. We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that medicines were prescribed and given to people appropriately that ensured they were managed safely. This meant that people received their medicines as prescribed.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

We found that any comments and complaints people made had been responded to appropriately and ensured that people were listened to.

We inspected the service and spoke with some people who lived there and staff. We found that people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the care and support that they received. People told us that compared to their previous placement Abbey House was, “Calmer, more enjoyable, friendly and free and easy”. People said they had, “Extremely good staff”. One person said, “I have never felt so good”. This meant that people felt their individual needs were being met by the service.

We found that suitable meals were not provided at all times to meet the individual needs and the choice of people who used the service.

We found that people who used the service were protected from the risk of abuse.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

Abbey House is an independent hospital owned by the organisation Partnerships in Care Limited. The service was first opened in 2007 and started admitting people for treatment in 2008. The service provides a ‘low risk’ locked specialised mental health recovery and rehabilitation service for men with enduring mental health difficulties.

This visit by CQC (Care Quality Commission) was conducted as a joint visit with a Mental Health Act Commissioner. We also have a statutory responsibility under the Mental Health Act (MHA) to visit services that are registered with us to provide the regulated activity of assessment or medical treatment for persons detained under the MHA 1983. A separate report has been written for the provider by the Mental Health Act Commissioner.

We carried out this review to check on the care and welfare of people who used this service. When we visited Abbey House we met people who lived there, staff on duty, the registered manager and charge nurse.

People who used the service expressed their satisfaction with the care and facilities provided at Abbey House. People told us that they “really benefitted from being here” and, “It’s much better here than some other places and hospitals I have been to”. We saw that staff interacted with people in a friendly, courteous and respectful manner and that people were very relaxed and at ease with staff.

We looked at care plans and pathway tracked the care for two people. Pathway tracking looks at the experiences of a sample of people who use a service. This is done by following a person’s route through the service to see if their needs were being met. We found that people were receiving effective and appropriate care, treatment and support to meet their personal needs and protect their individual rights.

We found that systems for assessing and monitoring the quality of the services provided were in place and made sure people were being protected from the risk of inappropriate or unsafe care and treatment.

We rated Abbey House as good because:

• Patients had up-to-date care plans. These focused on rehabilitation and helped patients move forward with their recovery.
• Staff carried out good risk assessments for patients.
• All but one patient had received a copy of their care plan.
• There was a wide range of therapeutic activity available for patients, including horse riding, golf and voluntary work opportunities.
• Patients could grow fruit and vegetables, which the chef used to make nutritional meals in the hospital kitchen.
• Patients told us they felt safe, and all but one patient told us they were happy with the service they received at Abbey House.
• Different professionals worked well together to assess and plan for the needs of patients.
• Patients had access to psychology and nurse-led therapies to aid their recovery.
• Managers routinely held supervision and annual performance reviews with staff. These were largely up-to-date.
• Staff had mandatory training, which managers monitored to ensure compliance.
• There was an ongoing recruitment programme to fill vacancies and managers were recruiting a bank of temporary staff to support the permanent team.
• Staff routinely helped patients to address their physical healthcare needs.
• Staff completed advance statements with patients who wanted them. This meant patients could say how they wanted to be supported by people if they experienced a mental health crisis.
• Staff had a good understanding of the Mental Capacity Act and completed mental capacity assessments with patients.
• Staff routinely advised patients of their rights under the Mental Health Act.
• The service had recruited a new hospital director with the skills and experience needed to drive forward further improvements.
• Patients had good recovery and rehabilitation opportunities because Abbey House employed a range of professionals to support them.
• Abbey House was a comfortable and suitable facility for patients.
• The service sought patient and staff feedback then made changes to reflect the feedback.
• The company was responsive to the needs of staff and provided support for them when they needed it.
• Systems were in place that allowed local and national managers to audit the quality of care.
• The service had a good relationship with commissioners and was open to receiving challenge and suggestion.
• Abbey House had a good track record on safety.
• Staff knew how to report incidents. Managers investigated these and shared any relevant lessons learnt with staff.
• Abbey House had safe systems to manage medication.
• A good governance structure ensured safe and effective running of the service.

However:

• Staff did not record mental capacity assessments separately. These were recorded in daily care records, which made them hard to find.
• It was not clear if staff gave patients and other relevant parties copies of their section 17 leave forms.
• Eighty one percent of staff were up-to-date with their mandatory training, but this fell to 50% for basic life support.
• The service did not always advise informal patients about their right to leave the hospital.