We rated Ashwood Court Nursing Unit as good because:

• The environment was safe, and where there were risks these were identified and managed. The service complied with guidance on mixed sex accommodation. All patients had their own bedroom, and there were designated corridors for men and women. The clinic room was clean and appropriately stocked. Medical devices and resuscitation equipment were readily available.
• The service did not use restrictive interventions such as restraint and seclusion. One-to-one observations and rapid tranquillisation were rarely used. Staff were aware of the safeguarding policy, and knew how to raise concerns. Incidents were reported and responded to appropriately.
• The service had enough staff with the right skills, training and experience. Patients received care and treatment from a multidisciplinary team of staff which included occupational therapy and psychology. All staff received supervision and appraisal.
• Medication was safely prescribed, administered, stored and managed by the service. All patients had an assessment of their needs, and care plans developed in response to identified needs. All patients had a physical examination on admission, and ongoing monitoring of their physical health. Staff used rating scales to monitor patient’s progress.
• Patients were mostly positive about the care they received and the service that was provided. The service held weekly community meetings, where patients gave their opinions about the service, and raised their concerns. Patients had access to an advocacy service. Patients were involved in their care, and this was reflected in some of the care records.
• All patients had a key to their own room, and access to a phone, computer and wifi. Patients had access to outdoor, space, and were encouraged to engage in activities inside and outside the unit. Food was prepared and cooked in the onsite kitchen. Patients could make hot and cold drinks when they wished.
• The Mental Health Act was implemented effectively. Staff were trained in the Mental Health Act and the Mental Capacity Act. They could access additional advice and support when required. There were systems for the implementation and monitoring of the Mental Capacity Act and Deprivation of Liberty Safeguards.
• The building was accessible to people using a wheelchair. The service had carried out care and treatment reviews for patients with a learning disability, in accordance with national guidance.
• There were governance structures in place. These ensured that key elements of the service were monitored, and areas for improvement identified and action taken. Regular audits were carried out, and the findings reviewed and implemented at both local and board level. Key performance indicators were used to monitor the service both inside the organisation, and by external bodies such as the clinical commissioning group.

However

• The quality of the care plans varied and they were not consistently person centred.
• There was no specific documentation in patient’s records regarding the use of high dose antipsychotic therapy.
• New medical equipment had not been routinely checked in accordance with the manufacturer’s instructions. Some of the disposable items in the clinic room were beyond their printed expiry date.

We rated Ashwood Court as good because

:

• Effective systems were in place to monitor and manage environmental risks

• There were enough staff to meet patients’ needs and minimal bank and agency staff were used which provided consistency in the care delivered. Mandatory training was completed in line with the organisation’s requirements. Staff were knowledgeable about safeguarding procedures, and knew how to raise any concerns appropriately.

• Restrictions were individualised and based on a clear risk assessment for individual patients.
• Initial assessments, care plans and risk assessments were individualised, recovery focused and took in to account patient views. There was a clear physical health care pathway and staff prioritised patient physical health care.
• Staff received supervision and a yearly work performance appraisal in line with their organisational requirements. Team performance was managed through supervision.
• There was a wide range of multi disciplinary professionals, and effective multi disciplinary team meetings including care programme approach meetings took place. Recognised rating scales were used to measure outcomes for patients.

• Patients told us that they were treated in a kind and supportive way, and they felt safe within the hospital. Staff were knowledgeable about their patients’ care and treatment.

• Patients felt involved in their care planning and could have a copy of their care plan if they wished.
• There was a clear governance structure in place and the registered manager had oversight of the performance of the service through key performance indicators.

However,

• Care plans were not written from the patient perspective.

We met with six patients who told us that they were treated with respect by staff and other professionals who visited the hospital. They told us that they were provided with clear information about the service prior to admission. They said they were asked what they wanted from the service and what goals they wished to be set. Everybody we spoke with said they felt that their dignity was not compromised in any way by the staff. Comments included "I have been in many hospitals over the years but they don't compare to Ashwood Court. This place is wonderful, they do their best to get us better and ready for life in the community. God bless them."

Care files held relevant information, however they were being reviewed to ensure they were indexed and easy to access.

Staff were trained and supported to provide needs led care and treatment to the patients. Comments from staff included "I love my job and enjoy working with the team", "I feel supported in my role and get good training in anything I feel I need."

The organisation had effective quality assurance systems in place to enable patients and other people who accessed the hospital to have their say about the staff and services provided.

We visited Ashwood Court Independent hospital and asked patients to tell us what it was like living there.

We spoke with five patients who said that they understood the care and choices available to them and that they were involved in making decisions about the treatment and support they received. They told us that they were provided with clear information about the service prior to admission. They said they were asked what they wanted from the service and what goals they wished to be set.

Everybody we spoke with said they felt that their dignity was not compromised in any way by the staff. They said staff always knocked at the door before entering their room and maintained their dignity when providing treatment or support.

Patients told us that when they were assessed for a placement at the unit they were invited to visit as many times as they wanted to make sure it was the right place for them. They said that they were asked what they wanted to achieve and how they would like their care to be delivered. One person told us that they felt that staff understood them and made them feel better. Other comments included “staff treat me well”, ”staff make time for us all although they are very busy people”, “Staff are very kind and caring”, “ We can have visitors anytime we want”, “We have just been on holiday look at the photographs, it was great.”

Patients said that they would raise any concerns they had with the care staff or the manager as appropriate. Comments included “We feel safe here”,” Staff protect us from harm.”

Patients said they felt fully supported by the staff.

Comments included “I trust the staff. I don’t really want to be here but I know they will do their best to make me better”, “staff are kind and supportive and help us to achieve our goals”, “staff have good skills and can help us to understand our problems and hopefully overcome them.”