We used a number of different methods to help us understand the experiences of patients residing at the the hospital. We looked at records. We utilised the service user satisfaction survey for 2013 and also spoke with one patient. We also spoke with the registered manager and three support staff.

We found that patients enjoyed the meals provided at the hospital. They were also offered a choice of food and drinks and received advice on nutrition and diet as required.

We found that the premises were maintained to a high standard and records showed that one hundred per cent of patient’s felt safe and comfortable living at the hospital.

We found that support staff received a comprehensive induction programme when they commenced employment at the hospital. They were also provided with on-going training opportunities pertinent to their roles and responsibilities. A patient also told us that in their opinion the support staff were suitably qualified and felt they were effective in performing their duties.

We found that a complaints procedure was on display throughout the hospital and documentation showed that one hundred per cent of patients were aware of how to make a complaint.

Patients told us they were satisfied with the quality of service provision and did not express any concerns whatsoever. They told us that the staff employed at the hospital would always respect their wishes and felt their views and opinions were valued. They also told us that they were satisfied with the social activities provided within the hospital and within the broader community.

A relative of a patient told us that they were extremely satisfied with the quality of service provision. “I just cannot believe the change in my son. It’s an excellent service that’s tailored to his needs,” and,” The staff are all excellent, I cannot fault the service in any way.”

We found that systems were in place to provide the support staff with comprehensive details about patients needs and preferences in relation to the support they received. We also found that the support plans examined on the day of our inspection were very well organised.

We found that the organisation had adhered to an effective recruitment process to ensure suitable staff were employed at the hospital. We also found that the support staff had received a thorough training package to ensure they were competent and confident in performing their duties.

We found that effective quality auditing procedures were undertaken to monitor the quality of service provision and patients and their relatives were encouraged to contribute to the auditing process.

We rated Cambian Lodge as good because:

• The provider assessed the risks presented by the environment such as blind spots and ligature points, and took appropriate action to reduce them.
• The unit had adequate staffing levels. Staff were up-to-date with most of their mandatory training and they received annual appraisals and regular supervision.
• Staff were committed to the least restrictive approaches to managing challenging behaviour such as de-escalation (calming down).
• Care records were comprehensive and contained up-to-date risk assessments, and robust care plans that covered patients’ physical and mental health needs. Staff fully involved patients and their relatives in assessment and care planning. Records and discussions showed that staff assessed capacity on a decision-specific basis.
• The provider complied with the relevant national institute of health and care excellence (NICE) guidelines, and offered a range of therapies in line with the acquired brain injury pathway. The provider’s model of care focused on recovery and rehabilitation, and incorporated a positive risk-taking approach.
• Most family members gave positive feedback about Cambian Lodge and mentioned improvements they saw in their relatives since their admission.
• All patients received a welcome pack of useful items on admission and had access to a fund to purchase items for their room.
• The chef cooked food each day taking into account the patients’ specific needs and preferences, and patients could also cook for themselves.
• Staff actively sought opportunities for patients to participate in community-based activities of their choice.
• The provider had a robust incident reporting process that led to actions and lessons learned for the whole organisation.
• There was good morale among staff and they felt valued and supported by all the managers.

However:

• The compliance rate for Mental Health Act, Mental Capacity Act and Deprivation of Liberty Safeguards training was low (44%).
• The unit had not fully complied with their complaints procedure in the past.
• Not all care plans had dates on them. This meant it was difficult to see when staff wrote them and when they were due for review.
• Patient involvement was not always evident in care records.