We rated Cambian Community Services East Midlands as good because:

• Staff provided a safe and caring service for patients in a friendly supportive manner. All areas of the service were maintained and visibly clean and tidy. The service did not use blanket restrictions, restraint or seclusion. Staff used a least restrictive approach to manage challenging behaviours.
• The arrangement for managing medication was safe. Patients had the option of storing prescribed medication in a locked safe in their bedrooms or in a locked cupboard in the staff office. We observed staff following the provider’s self-medication policy as staff did not administer medication.
• Patients followed a therapeutic rehabilitation programme in the community. Staff encouraged patients to complete these activities independently or with support. Support provided by staff encouraged patients to integrate fully into local communities. Staff used a positive risk taking approach in encouraging patients to engage in activities.
• Patient records were up to date and comprehensive. Care plans we saw were holistic and reflected aims and goals set by patients. Risk assessments were current, detailed and clear. Patients attended multi disciplinary team meetings and were involved in discharge planning before and during admission to the houses.
• Staff were trained; knowledgeable and had many years’ experience working in step down services. There were no vacancies in this service as staff had remained in their posts for many years. Staff levels of sickness were low and the service reported no cases of bullying or harassment over the past 12 months.
• Patients said they raised issues with staff and managers without fear of victimisation. Patients raised their concerns at community meetings and received feedback about their concerns from staff. Interactions we saw between staff and patients were very positive.
• All staff received supervision every eight weeks and had an annual appraisal. Staff had access to mandatory and specialist training and had the opportunity to develop leadership and management skills. Staff we spoke to completed qualifications in leadership and management and the care certificate.
• The provider collected weekly data from the locations, which was part of the governance process. The provider used key performance indicators to gauge the team’s performance, which was feedback to the provider’s quality team.

However:

• The multi disciplinary team did not invite support workers to their team meetings. Support workers gave feedback to the multi disciplinary meeting by email and received multi disciplinary team feedback from house managers.
• Staff did not receive feedback of lessons learned that occurred in other hospitals and step down units owned by the provider.