Overall we found that The Aspens Hospital, Mexborough, Doncaster was safe, effective, caring, responsive and well led.

Overall patients spoken with gave positive feedback regarding staff saying they could approach them with any issues they had, and that staff treated them with respect. Patients and staff told us they felt safe in the hospital. Care plans were holistic and reviewed on a regular basis.

Although there had been 196 shifts covered by bank staff in 3 months prior to the inspection, the duty rota for 2015 showed that all shifts had been covered and staffing levels were adequate and adjusted appropriately to accommodate patient numbers, activity level and level of patient acuity. There were 4.5 nursing vacancies but 3 had been appointed and were awaiting start dates.

Staff assessed all patients prior to admission, this included a full risk assessment. Risks were also discussed on a daily basis in the weekday morning meeting by the Multi Disciplinary Team.

The clinical workforce had been extended and a range of allied professionals dedicated to each ward. All staff groups felt supported by managers and welcomed the changes that had been implemented in the last six months. All staff now have access to supervision sessions and a new appraisal system is in place. Mandatory training was above 80% in all areas with many areas at 100% compliance.

Staff understanding of the organisations vision and values were mixed, however all staff felt involved in changes within the hospital which appear to be positive. Clinical governance systems were in place which assisted the provider to monitor and improve the quality of care.

But we also found:

The Aspens is a rehabilitation service and there were concerns regarding the lack of evidence to support the involvement of patients in the planning of their care and discharge. Ward rounds comprised of a professionals meeting prior to inviting the patient into the room. This did not allow for the patients to be fully involved in discussions about their care, treatment and discharge planning. There was limited evidence of patient involvement within care plans. Some patients told us they just get asked to sign and it feels like a tick box exercise.

All fridges that contain medication were not kept securely locked. This was highlighted during the inspection and rectified immediately.

There was no central risk register to identify risks, actions taken and how this was being managed, monitored and implemented.

The key for the controlled drug storage was held on the same key ring as other medication storage keys. This is in contradiction to policy and was highlighted during the inspection and rectified immediately.

The appraisal and supervision system is still in its infancy with only 25% of staff having an appraisal in the last year.

People’s social, psychological and physical needs were assessed and care was delivered in collaboration with people. However; we found people’s physical observations were not always taken as needed. The wards did not have emergency drugs to deal with possible medical emergencies. The provision for out of hours medical cover could result in long delays in the attendance of a doctor when needed in an emergency.

We found evidence of overly restrictive practices which did not promote people’s rights.

Staff were trained in safeguarding.

The hospital had made some improvements regarding medication however; further improvements were required to ensure that people received medication safely.

The service had implemented an action plan which effectively addressed recent staffing concerns. There were enough suitability qualified staff to meet people’s needs.

The service had a complaints policy however; we found that recently, this had not been effectively followed.

Prior to the inspection, we had been made aware by the service that they had an action plan in place to improve the quality monitoring of the service however; we found inconsistencies in relation to the monitoring of equipment which could pose a risk to people.

We reviewed the maintenance of care records. Care records were kept safety and securely. Staff knew where to access information relating to people’s needs. However; we found information missing in some of the records we looked at.

We spoke with patients and observed day to day interactions between patients and staff within the hospital. Patients spoke entirely positively about their experience. One patient told us: “We get loads of activities, such as the gym and swimming.” Another patient told us that they had previously been in another hospital but that The Aspens was much better. They said: “There are more activities, it’s a lot better.”

Patients at Aspen Lodge told us they felt their needs were being met. One said: “I am well looked after here.” However, many of the patients of Aspen House we spoke with did not describe their experience of receiving care at the hospital in positive terms. One patient said: “I’ve been making so much progress, but this place is putting me back to square one.” Another told us that the impact of another patient’s behaviour on her meant that she had moved bedrooms. She told us that she found the atmosphere in the hospital to be so unsettled it was affecting her wellbeing.

Most of the patients we spoke with said they felt respected by staff. One patient said: “They are all very good, all of the staff. I couldn’t choose between them. If you get upset about anything, they really do care about what happens to you.”

All staff had received training in abuse awareness and protecting vulnerable adults in the previous year. The provider was in the process of making arrangements for all staff to undertake the local authority’s safeguarding training, to enhance their understanding of local safeguarding processes.

We spoke with staff who told us that they felt supported by the senior staff at the hospital. They said they could not praise the head of care and the deputy manager highly enough for the support they provided. They told us they were always available to talk to about issues and said this had helped a lot. They added they found the group supervision a very positive development, as they could discuss issues honestly.

The provider had a compliance team whose remit covered several other locations in addition to this one. This team carried out quality monitoring and reporting, using information from a range of areas, to assess the quality of service provision within the hospital. Any issues of concern were addressed by action plans which were monitored within the provider's corporate governance arrangements.

Staff we spoke with could describe the complaints procedure and were confident in their knowledge of how to raise concerns or make a complaint, although one patient told us she found the complaints documentation too complicated and therefore did not make a complaint when she had wished to. She added that after speaking with management staff, the situation about which she wished to complain had improved. She told us: “They have listened to what I said, and addressed it.”

When we asked patients about their experience of the care they received at the hospital they gave us a positive picture. One said “I prefer one to one’s instead of groups and they accommodate this” and another said “all my leave is planned. I go horse riding and I really enjoy that.” One patient told us “there’s a good mix of things to do” but others said they felt there wasn’t enough to do at weekends.

There were enough qualified, skilled and experienced staff to meet people’s needs, although most staff and patients we spoke with told us that the staffing arrangements were put under pressure when incidents occurred or where patients experienced periods where they required a high level of staff input. We asked patients about the staff. One said they were a “good bunch of staff, they are very nice people.” Another patient said: “Staff have a nice attitude and are always here to help.”

Steps needed to be taken to improve the way complaints were handled .The information the provider held in relation to complaints was not accurate and did not give a clear picture of the progress of complaints.

The provider had appropriate policies and procedures in place to ensure that staff were aware of when they were required to gain consent from patients, and how to support patients who wanted to change decisions about their care.

Patients held varied views about their experience of receiving treatment at Cambian The Aspens. One patient told us “I’ve come on in leaps and bounds” and another said “the activities are really good”. However, others were not as positive. Some patients told us they didn’t think there was enough to do at the weekends.

The premises were clean and fresh throughout. The communal rooms and bathrooms were clean and well maintained. None of the patients we spoke with highlighted any concerns regarding the cleanliness of the hospital.

Appropriate checks had been undertaken before staff began work and there were effective recruitment and selection processes in place.

When patients were admitted to the hospital they were given information about the provider’s complaints arrangements. This was also available throughout the hospital in the form of posters and leaflets. A thorough investigation was carried out by the provider in response to any complaints received, although the provider’s central complaints records did not always evidence the response given to patients.

Patients we spoke with gave us a mixed picture of their experience of receiving treatment at The Aspens. One patient said “staff always good, like a family they speak to you properly”. Another said “a lot better than it was before”. However, two patients said that they were “told off” if they did not get up at a specified time on a morning, and the majority of patients we spoke with told us there were not enough activities available at the weekend.

We spoke with patients who were broadly positive about their experience of being treated at Cambian - The Aspens. One patient told us that she had been very ill when she arrived at the hospital and had been supported to get better during her stay there. Others told us that they felt safe at the hospital and felt that staff treated them well. Some patients we spoke with raised concerns about limited activities available to them within the hospital, however one patient told us that there was "plenty to do".

Patients told us that they enjoyed the activities that took place at Cambian - The Aspens, and that the staff were friendly. We saw that staff treated patients with dignity and respect, and that interaction was supportive and encouraging.

People we spoke to were positive about their experience of receiving care, treatment and support at Cambian - The Aspens. In particular people praised the activities available to them, both within the hospital and outside it. People were enthusiastic about the support that staff provided to them, and one person told us that she felt she was getting much better with the help of staff.

People we spoke to told us that they thought that when they made complaints or suggestions, then at times their feedback has resulted in changes being implemented. People told us that they understood how to give feedback to the provider, and that staff supported them to do so if they wished to have help.

We rated Aspen as good because:

• The hospital was clean, well maintained and had good furnishings. Patients had access to good facilities and took part in meetings and activities including at weekends. Staff updated risk assessments frequently and patients told us they felt safe in the hospital.

• There were enough suitably qualified staff so the provider did not have to use agency staff. Patients reported the staff were caring, approachable and skilled. Staff were well trained and they had access to supervision, appraisal and team meetings.

• Patient care plans were holistic and contained personalised recovery goals. Staff used a range of tools to assess and monitor patient outcomes. They involved patients in their treatment and empowered them to make decisions about their care. Staff involved patients’ carers where appropriate.

• Staff encouraged patients to become involved in activities aimed at maintaining their independence and preparation for discharge. Patients could choose activities on the timetable and had a say in some of the hospital’s routines.

• The hospital had few complaints and patients and their carers knew how to access advocacy support. Staff regularly carried out patient and carer surveys and responded to feedback.

• There was an open culture where patients and staff could report concerns and share lessons learned from incidents. Staff surveys showed high levels of job satisfaction and staff were motivated to deliver high quality patient care.

However:

• Staff did not always take proper steps to control the spread of infection when administering medication.
• Staff did not always ensure the safe management of medicines. They did not record the current temperature of the medications fridge and did not always store controlled drugs correctly prior to disposal.
• Staff did not store emergency drugs together with other emergency equipment.
• Staff did not always administer patients’ medication in a way that ensured their privacy and did not always encourage patients to carry out medical self-testing in a private area.