We rated CAS Grange as good because:’

• The environment was clean and well maintained. The provider carried out annual health and safety audits such as ligature and environmental risk assessments. The hospital had management plans and emergency equipment in place to ensure patient and staff safety.
• The provider had assessed appropriate staffing levels for each shift, which the hospital followed. All staff received regular supervision, an annual appraisal and completed mandatory training which gave them the skills to meet patient needs.
• Staff completed patients’ comprehensive risk assessments and regularly reviewed and updated them as a multidisciplinary team which ensured all identified risks were managed.
• Staff reported incidents, the registered manager provided staff with the opportunities to learn lessons to ensure that practice was improved.
• The multidisciplinary team routinely assessed, monitored and supported patients with their physical health care needs and access to a comprehensive range of primary healthcare services.
• Interactions we saw between staff and patients were caring, positive and friendly. Feedback we received from patients and carers said staff had a good understanding of the patients they cared for.
• The hospital maintained effective links with outside organisations to support patients with a programme of daily activities and rehabilitation process.
• The provider responded to and investigated complaints. Patients and relatives were provided with responses to complaints and staff were provided with lessons learnt from complaints
• The managers provided good leadership and support to staff. Staff felt supported by the registered manager and multi-disciplinary team and morale was good.
• The provider had developed key performance indicators for staff and outcome measures to monitor the quality of care provided to patients.

However:

• CAS Grange used a form to record capacity which did not include the diagnostic test; therefore the form was legally incorrect in accordance with the Mental Capacity Act 2005.

We rated Cambian The Grange as good because:

• The environment was clean and well maintained. The provider had carried out environmental risk assessments and had management plans and emergency equipment in place to ensure patient and staff safety.
• The provider had appropriate staffing levels on shifts with staff that received regular supervision, mandatory training and had the skills to meet the needs of the patients.
• Staff completed patients’ comprehensive risk assessments and regularly reviewed and updated them as a multidisciplinary team to ensure that all identified risks were well managed.
• Staff reported incidents and the managers provided staff with the opportunities to learn lessons to ensure that practice was improved.
• The multidisciplinary team routinely assessed, monitored and supported patients with their physical health care needs and access to a comprehensive range of primary healthcare services.
• Staff treated patients with respect and dignity and involved them in their care and treatment planning. Patients were able to give feedback about how the service was run.
• The unit maintained effective links with outside organisations to support patients with daily programme of activities and rehabilitation process.
• The managers provided good leadership and support to staff. Staff felt supported by team managers and morale was good.
• The provider had developed key performance indicators and outcome measures to monitor the quality of care provided to patients.

However;

• The provider did not review and updated the Mental Health Act (MHA) policies and procedures to reflect the revised MHA code of practice. Only 61% of staff had received training in MHA.
• The care plans did not have specific goals, patients’ views on what mattered to them and detailed interventions on how staff should support patients.
• Staff did not participate in a wide range of clinical audits to monitor the effectiveness of the service provided.

We found that systems were in place to involve patients in their care, treatment and support programmes.

We found that patients received input and treatment from health care professionals when required.

Patients who used the service told us that they were encouraged to undertake a comprehensive range of social activities within the home environment and within the broader community.

Patients told us that they felt safe and felt the staff had the right qualifications, skills and knowledge to perform their duties in a safe manner.

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements and promoted the safety of patients.