Our rating of Cygnet Heathers stayed the same. We rated it as good because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding. On our previous inspection we had told the service that they should ensure all clinic equipment is calibrated to manufacturers standard, out of date medicines are disposed of promptly and staff should ensure the monitoring of vital signs post intramuscular rapid tranquilisation is accurately documented. On this inspection we found that the provider had met all of the shoulds requested.

• 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 cared for in a mental health rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward 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, 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.

We rated Cambian Heathers as good because;

• The unit ensured that newly admitted patients and those with high dependency needs were based on the ground floor close to the nursing station. The unit was very clean with appropriate furnishings and patients could personalise their bedrooms.

• The unit had a large pool of bank staff to cover shifts if required. The multidisciplinary team routinely assessed, monitored and supported patients with their physical and mental health care needs and enabled a comprehensive range of primary healthcare services.

• Of the seven care records we reviewed, all contained up to date risk assessments with holistic, patient centred care plans that were adapted to the communication needs of the patient. The care plans had clear goals and were recovery focused. Patients had access to a variety of  therapeutic interventions and had access to psychological therapies recommended by the National Institute for Health and Care Excellence.

• Staff had access to training and reported receiving regular supervision, 92% of staff had received regular supervision and all non-medical staff had received an appraisal. Staff were aware of what incidents to report and we saw evidence that they had  acted in accordance with their duty of candour.

• We observed staff treating patients with kindness, consideration and respect and all of the patients we spoke with had a positive comment about the service. Staff were praised by patients and carers for being caring, supportive and patient.

• Patients had access to advocacy and there was information available for patients on how to access advocacy or how to make a complaint. Patients had regular meetings where they could share their concerns and comment on the running of the service.

• Patients had access to a wide variety of meals that met their dietary requirements and staff regularly facilitated access to spiritual support.

• Staff at the unit told us they aware of the organisations vision and values. We found that there were appropriate governance systems in place to ensure that best practice and lessons learned could be shared and that the majority of shifts were covered. We found that staff had the chance to feed back to the service and suggest improvements and that staff morale was high and staff we spoke with spoke highly of the organisation and their colleagues and the way in which everyone worked effectively together and supportively as a team.

However;

• We found that none of the equipment had been calibrated in the clinic in line with manufacturers recommendations and one item of stock was out of date.

• We found that the monitoring of patients vital signs post rapid tranquilisation was not always documented and we saw that these incidents were not always reported using the incident reporting system.