This was a focused inspection relating to issues identified at a previous inspection where warning notices were served. Ratings have not been given for this inspection.

The hospital was inspected in July 2016 and an overall rating of inadequate was made, with the hospital placed in special measures. Five warning notices were also issued. These related to safe care and treatment, complaints, care of informal patients, governance and staffing.

At this inspection, we assessed whether issues identified in four warning notices had been addressed. We found improvements had been made in terms of staffing, complaints, care of informal patients and safe care and treatment and that these warning notices had been met.

The service will continue to be monitored closely whilst in special measures and a further comprehensive inspection will take place to inspect and re-rate the service.

At the last inspections in December 2013 we had concerns regarding consent to care and treatment and safeguarding of people who lived at the hospital.

The provider had prepared an action plan to make improvements within these areas. At this inspection undertaken in June 2014 we saw that improvements had been made.

We spoke to two people who lived at Arbour Lodge and three relatives of people currently residing at this hospital. People we spoke with told us they were very comfortable and they felt, “Very safe”, they both told us the staff was, “Brilliant” and that they got on well with staff.

One relative we spoke to told us the, “Staff do their best and they keep me updated, the staff are all very good”. Other comments relatives told us were, “The consultant psychiatrist is very approachable and my relative always looks clean and he is looked after well” and “The hospital is absolutely fantastic, the care is super, the personal care given to xxxx is also fantastic”. We were also told that their relative had really settled at this hospital and the staff were very willing to listen and spend time with xxxx.

Another relative told us the communication they received about her relative from the hospital “Is not good and they don’t update me enough”, but they did confirm that they did not visit regularly enough to make any further comment about the hospital.

We found that Arbour Lodge Independent hospital had a relaxed, sociable and welcoming atmosphere. All the patients we spoke with during our visit praised the staff, standard of care, and facilities and services provided.

We observed staff carrying out their duties and responsibilities in good humour and in a relaxed and positive manner. We could see that staff enjoyed good relationships with patients and had ample time to meet their health and social care needs without hurrying. There were enough qualified, skilled and experienced staff to meet patient’s needs.

We looked at the care records for three of the patients and could see that arrangements made for their care, treatment and support were centred on their individual needs and personal preferences.

We could see that records were stored safely and managers, nurses and support staff were aware of the importance of confidentiality. We found that records relevant to the management of the services were accurate and up to date.

We found that there were areas where improvements were needed including consent to treatment and care and safeguarding vulnerable people to ensure that patients received safe and appropriate care that protected their rights.

In this report the name of a registered manager appears who was not in post and not managing the hospital at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection.

We spoke with four people who used the service. All the people spoken with told us they were happy with the care and treatment they received in Arbour Lodge. One person commented, "Staff are good. They treat me well”. Another person told us, “Staff help me. I’m better than when I came in”.

We reviewed the care files held for five people who used the service and found evidence that appropriate arrangements were in place to ensure consent was gained from people in relation to their care and treatment. Where people were detained under the Mental Health Act 1983 we saw evidence that there were systems in place to ensure they were informed of their rights.

We saw that care plans identified the needs of individuals and included some information for staff as to how support should be provided.

We found that people were provided with appropriate nutrition and had a choice in relation to the food available to them at mealtimes. We also observed that people had access to drinks and snacks throughout the day.

We found staff had received training on safeguarding vulnerable adults and had access to appropriate policies and procedures. All the people we spoke with who used the service told us they felt safe.

We found there were sufficient numbers of staff on duty to meet the needs of people in Arbour Lodge.

We found that suitable arrangements were in place to manage an effective process for identifying, receiving and handling complaints from people in Arbour Lodge.

One person living in Arbour Lodge told us that he was happy living there.

We observed people to be settled and contented during our visit. Staff had formed good relationships with the people they supported and they treated people with respect and upheld their rights to privacy and dignity.

Care plans provided evidence that people using the service received safe care and support in a person-centred manner. Staff had received appropriate training and support from their line managers.

Arbour Lodge was being managed in the best interests of the people accommodated. The views and suggestions of people using the service and their representatives were listened to and adjustments had been made to continually improve the service provided.

At the same time a Mental Health Commissioner colleague was also doing an announced

inspection of Arbour Lodge.

We rated Arbour Lodge independent hospital as good because

There has been continued progress and improvement over time in this hospital.

Staff working within the service were aware of the risks presented by the environment. They completed individualised patient risk assessments. Staff were up to date with mandatory training, including life support training.

Staff within the service completed careplans which were indiciudalied and they e reviewed these regularly. Staff were regularly supervised and appraised. There was good knowledge and application of the Mental Health Act and Mental Capacity Act.

Patients and carers fed back positively about their care and treatment and short observational framework observations were used to record positive and caring interactions.

The service had incorporated elements of a dementia friendly service and all staff had received training in dementia. Occupational therapy staff organised a range of activity including art based activity, practical sessions such as gardening and exercise based activities. There were also regular community activities planned including trips to local museums, parks and garden centres.

However, there were concerns about falls risks not being addressed effectively. Moving and handling assessments were not sufficiently detailed to offer practical guidance to staff. Two patients had plans for repositioning if they were sat for extended periods, but there were no charts in use to show when this had happened.