We found that this service sought consent from people who used it in relation to their care and treatment and that it met peoples' care and welfare needs.

One person who used this service told us they were very happy with the care and treatment they received. however another person told us that they were unhappy with the medication they had been prescribed.

A health professional who we spoke to told us that they were very satisfied with the service being provided.

We found that this service kept people safe from the risks of being abused and that safeguarding was a high priority for managers and staff. We also found that the service managed peoples' medicines well and took steps to help people to self-medicate wherever possible.

We found that this service undertook relevant checks before employing staff and that this ensured that people were supported by staff who were suitably qualified, skilled and experienced.

We found that the service did not always report safeguarding issues to the Care Quality Commission as stipulated in Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

At our inspection we spoke with four patients and with six members of staff. We also looked at three patient care folders and other patient and staff records.

People using the service were satisfied with the quality of the service and with the staff team. We observed good staff patient interactions throughout our visit.

People were involved in decisions about and planning their care. One person told us, “we discuss everything in the planning meetings.” Care plans and risk assessments were up-to-date and relevant to individual needs. Patients were asked to comment on their care plans as part of their recovery process; one patient had commented, “I’m stable at the moment…I’m managing alright”.

At this visit we spoke with four patients in private and others in open and group settings.

People using the service who we spoke to praised staff, as individuals and as a team. We observed good staff/patient group and individual interactions throughout the day. Informal patients told us that they could come and go as they pleased; detained patients were encouraged to request leave. People said that visitors were made welcome by staff, and that people in the hospital were like “a family”. One person said he would like to be able to have overnight visitors, as this would be more like the “real world”.

Only one person we talked to felt that he had been overtly involved in writing his care plan, although others told us about their scheduled one to one time with named nurses.

A range of activities and facilities were available, including access to psychology, occupational therapy, one to one time with nurses, group sessions, access to computers and trips. Although people felt that there was not much to do at weekends, many said they visited family and friends at weekends anyway.

We rated this service as Good because:

• Patients said that staff treated them with respect and dignity and supported their needs. Staff were caring and supportive and they listened and responded to patients’ wishes and concerns. Both patients and the independent advocate who worked at the service said that staff supported patients to be involved in their care and treatment, including during clinical meetings. As part of this involvement, staff met with patients to discuss their recovery goals and staff recorded these objectives in patients’ care and recovery plans. This ensured that staff were working as far as possible according to patients’ wishes.

• Staff maintained an environment that was safe for everyone at the service. Staff assessed the location for ligatures and took effective steps to reduce the risks from these ligatures. Staff also undertook detailed risk assessments of patients, updated these and transferred information relating to risks into patients’ care plans. Staff responded promptly and effectively to incidents and to any safeguarding concerns. There were effective systems in place to ensure that staff investigated all incidents and identified any lessons from those incidents. Staff managed medicines in a safe and secure way.

• A range of therapeutic activities were available to support patients’ rehabilitation and recovery. These included paid work at the service that staff supported patients to apply for, group activities, IT skills training and art and music therapy.

• The service provided a range of facilities to meet patients’ needs, including a therapy room, recreational spaces, meeting rooms, and laundry and kitchen that staff encouraged patients to use.

However:

• Many patients and staff members said that there were too few staff to supervise the activities and as a result many were often cancelled. This undermined the principal purpose of the service which was to support patients’ recovery and rehabilitation and to prepare them to return to life in the community.  The provider had recruited additional staff to address this problem, although they had not yet started work at the time of inspection.

• An alarm system used to tell staff where potential emergencies were taking place was not working. This put people at risk of harm.

• Some areas were not always sufficiently clean and tidy, including the clinic room and some communal toilets and washing facilities.