We rated Cedar Vale as good because:

• The service provided safe care. The ward environment was safe and clean. There were enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients with autism and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward team included access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with those outside the service who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service worked to a recognised model of mental health rehabilitation. It was well led and the governance processes ensured that ward procedures ran smoothly.

However:

• Staff did not always record that they had checked and cleaned equipment.

Prior to our inspection we reviewed all the information we had received from the provider. We used a number of different methods to help us understand the experiences of people who used the service, because people had complex needs which meant they were not able to tell us about their experiences.

We spoke with the registered manager and three support workers. We also spoke with the relatives of two people to establish their views on the quality of service provision. We looked at some of the records held in the service including the support files for three people. We observed the support people who used the service received from staff and carried out a brief tour of the hospital.

Relatives of people residing at the hospital told us they felt fully involved in the support planning process and felt their views and opinions were respected at all times. Comments included, “I am very much involved in my son’s care. If there are any changes in his activities timetable I am always informed, I am always kept in the loop.”

We found that systems were in place to identify the holistic needs of people and strategies were in place to ensure their needs could be met. One person’s relative told us, “I am really impressed. It’s the first home that has met my son’s needs. It makes a big difference for him being able to access the community, he has a better quality of life.”

We established that people were protected from the risk of abuse as staff had been trained to identify the possibility of abuse and prevent it from happening. Furthermore, a relative of a person told us they were confident that people were well cared for and safe, they told us, “I can sleep easy at night as my son is safe.”

We found that people were supported by staff who had undergone a robust recruitment process to determine their suitability to work with vulnerable adults.

We found that comprehensive quality auditing procedures were in place to monitor the quality of service provision. Furthermore people residing at the hospital, and their representatives, were encouraged to contribute to the auditing process.

We rated Cedar Vale as requires improvement because:

• There was a high use of agency staff.
• There were high rates of sickness.
• Staff turnover was high.
• Staff knowledge of the Mental Health Act (MHA), Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS) was variable.
• There was one delayed discharge although all patients had received a community review and recommendation from that meeting was to discharge. Discharge plans were not robust.
• The alarm system was not autism friendly; it was loud and used frequently to call staff as well as for emergencies.
• Staff supervision and appraisal only happened regularly since October 2015.

However:

• Staff told us that morale was improving.
• There was evidence to show that issues had been identified and acted on.
• Patients were able to personalise their bedroom.
• There was daily access to activities.
• There was a choice of food to meet dietary requirements and religious needs.
• We observed staff interacting with patients in a warm and positive way.