We inspected this service to follow up compliance from our last inspection in August 2014. We spoke with eight patients, seven members of staff, looked at nine patient’s records and five records of staff who worked there.

We found that improvements were needed to ensure the service was safe. We found the provider had policies and procedures in place to protect people from abuse or harm. However, the provider did not have a suicide prevention strategy and records did not show that the effects from patients taking medication had been monitored. Three patients told us they did not feel safe at the hospital.

Improvements were needed to ensure the service was effective. We found that restrictions were placed on all people who used the service.

We observed that most staff interacted well with patients and patients told us that staff were caring. However, patients' privacy and dignity was not always respected.

Improvements were needed to ensure the service was responsive.

Improvement was needed to ensure the service was well led. Systems were not in place to ensure that regular audits were completed to measure the quality of care.

There were 20 people using the service on the day of our inspection. All people who used the service were detained at the hospital under the Mental Health Act 1983. We spoke with eight people who used the service and seven members of staff.

We observed good interactions between staff and people who used the service throughout the day.

People told us that they were involved in their care plans and had agreed to their treatment. We found that people did not have regular access to an advocate to ensure their views were expressed.

We saw that activities were provided however, people told us that there could be more to do at weekends. This was being addressed so that activities would be available seven days a week.

People told us that they felt safe at the hospital.

Staff received the training they needed to ensure they had the skills and knowledge to safely meet the needs of people who used the service.

We saw that action was taken to improve the service as a result of listening to the views of people who used the service and staff.

Records were not always accurate which could impact on the safety and wellbeing of people who used the service.

We spoke to six people, reviewed three care records, five staff files and spoke to five staff. We also spoke with one visitor and looked at other documents used in the running of the service.

People were given information to be able to give informed consent to treatment. The service had arrangements in place where all decisions were made in partnership and recorded. One person told us: “I am aware of my drugs and am happy to take them.”

People received care and treatment that met their needs. There was a large therapeutic team in place to support people. Treatment plans were in place and followed. Staff demonstrated that they understood the care that people required. Activities formed a large part of the therapeutic environment. One person told us: “I go out regularly, the activities are really good. There’s dancing today and nails and massage tomorrow.”

Staff recruitment practices ensured that people received care from staff of good character. Staff had skills and qualifications to occupy the roles they held. Prior to recruiting staff police checks had been undertaken.

The service had enough staff to meet people’s needs. Staff told us they were not concerned about the number of staff on duty for each shift. We saw that people received the care and treatment they needed from staff skilled and qualified to do so.

The service undertook auditing but this did not always result in positive change. We noted that the monitoring activities did not always identify the areas which needed to be addressed. We did see some positive monitoring such as feedback sought regarding activities delivered within the social inclusion programme.

During the inspection we spoke with five people who used the service and also spoke with two relatives. We found that the service ensured that people were respected and involved in aspects of the home that had a direct impact on them. People’s views were sought and acted upon where possible.

The care and treatment people received was consistent and followed research and guidance. Relatives told us they were happy with the level of care given. One relative told us “I can only praise the place”.

Staffing levels ensured that peoples’ needs were met most of the time. People told us that the staff usually had time for them, but sometimes they did not if a crisis occurred in the home. Staff were qualified, skilled and motivated to give a good level of care.

Medications were managed to a standard that met the regulations We saw that the service had identified people who could be helped to self administer. This promoted people’s independence.

The service had good arrangements for handling complaints. The complaints procedure ensured that people and their relatives felt safe to make complaints and comments and to bring this to the attention of the service. The procedure was audited, which meant that the service could make improvements if the audit demonstrated a need for improvement

Due to the complexity of peoples’ needs we did not talk to the people who use the service. Discussions were held with the registered manager who provided further documentation to enable us to have a clear understanding of the concerns that had been brought to our attention.

We rated Beverley House as good because:

• The hospital had significantly reduced the incidents of restraint and use of rapid tranquilisation since the previous inspection. They had trained staff and worked with the local authority to improve the way safeguarding referrals were made and to ensure they were appropriate. The clinic room was in good order and medication was well managed.
• Staff showed high levels of support and care towards patients. They included patients in decisions about the hospital and everyone worked in a way that was collaborative and inclusive. Patients had access to a work start programme, which gave them the opportunity to develop skills and build confidence. They stated this gave them a sense of self-worth and a purpose in life.
• Paperwork relating to the Mental Health Act was in good order and checked regularly by a Mental Health Act administrator. Staff followed guidance from the National Institute for Health and Care Excellence when prescribing medication.
• Patients had access to a range of activities designed to support them in their recovery. Staff encouraged them to access the local community to prepare them for the future. Patients could personalise their rooms and had been encouraged to do this. The hospital had information available on treatments and services in the local community.
• The hospital was well led. Managers had the authority to do their jobs and staff stated they were well supported and could access managers for advice and guidance, as they needed to. Staff morale was high and staff supported each other to ensure the smooth running of the hospital.

However:

• We could not easily locate information in a patient records how best interests’ decisions had been made for a patient who lacked capacity under the Mental Capacity Act. Staff demonstrated an understanding of this but could not show where they recorded it on the electronic system.