This inspection took place on the 18 June 2015 and was unannounced.

The Manor is a secure hospital that provides a rehabilitation service for up to 20 men with learning disabilities and/or mental health needs. Some people at the hospital are detained under the Mental Health Act 1983. The hospital is based in the Derbyshire town of Shirebrook close to a range of community services and facilities. The hospital was purpose built and is on two floors with a lift and stairs for access. The hospital has secluded gardens and recreational facilities including a gym and an all-weather pitch for basketball and football.

At the time of this inspection there were 20 people using the service.

The unit has a registered manager. This is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All the people using service we spoke with said they felt safe at the unit. Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they were concerned about the welfare of any of the people who used the service. An independent advocate spent one day a week at the unit which gave people the opportunity to speak with someone independent of the unit if they needed to.

There were enough staff on duty to keep people safe and meet their needs. We observed that staff had the time to support people safely and work with them on a one-to-one basis if this was required. If people needed assistance this was provided promptly and at no time were people left unsupported in the unit.

People using the service were encouraged to become responsible for their own medicines with staff support. Medicines was safely managed in the unit and administered by qualified nurses. They understood what the medicines were for and were able to explain this to the people using the service.

People told us the staff know how to support them and understood their needs. Staff had a good rapport with people and worked with them in an empowering and effective way. Staff were trained to carry out their roles and responsibilities effectively.

If people using the service were detained under the Mental Health Act (MHA) 1983 this was done lawfully and their rights were upheld. For example people had the right to see an advocate and this was facilitated at the unit.

Records showed that people had access to a range of health care professionals some of whom were employed by the service and others who were community-based. This meant that people using the service had access to intensive specialist support at all times.

People said the staff were caring, friendly, and helpful. We observed staff were warm in their approaches to people while maintaining their professionalism at all times. They had a genuine interest in the people they supported and were keen to tell us of the progress they’d made towards increasing their independence.

People received personalised care that met their needs. The care plans we looked at were individual to the people using the service and focused on their strengths and preferences. People using the service, relatives, and health and social care professionals were involved in care plan reviews.

The unit supported people to take part in a range of group and one-to-one activities both in the unit and in the wider community. On the day of our inspection people attended a walking group, a music group, an English literature group, played board games, and were planning a social event at a local community centre for the evening.

People told us that if they weren’t happy about something they know how to make a complaint. The provider’s complaints procedure gave clear information on how to do this with support provided where necessary.

People told us the unit was well-led and they got on well with the registered manager. Staff said the registered manager was a team player who was supportive of both the people using the service and the staff. The unit had links with the local community which gave the people using the service the opportunity to take part in local events.

People using the service and relatives had the opportunity to comment on the care provided and make suggestions. They could see the registered manager or the provider’s operations manager in private if they wanted to discuss the service. The registered manager and provider took prompt action if improvements were needed to the unit.

There were 18 people using the service at the time of this inspection. We spoke with five people, six staff and the manager.

We found that people were offered a choice of suitable food and drink. People we spoke with told us they had a “Good choice”, and, “I find it quite alright.”

There were appropriate arrangements in place to ensure that medicines were given correctly and safely to people using the service. Where possible, people were supported to manage their own medicines.

We found that the provider’s recruitment procedures included appropriate checks to ensure staff were suitable for the job. We found that there were enough staff with the right qualifications, skills and experience to ensure that people’s needs could be met. Staff we spoke with told us, “We’ve got a good staff team and good communication between us.”, and, “We’ve got a good mix of staff. Teamwork is good.”

There were effective systems to assess and monitor the quality of the service provided. People and staff had opportunities to comment on the service and their views were acted on.

We spoke with two patients currently staying at The Manor and three others more informally during our visit.

Patients were supported in promoting their independence. Patients we spoke with told us about the activities they took part in, including swimming, going to the local disco and going to the gym. One person told us, “I went shopping yesterday, I went to Mansfield and I got new t-shirts and joggers. I like it here.”

We saw that the patient's needs were assessed and that they were encouraged to take part in their care planning. We were told, “I had my ward round last week, everyone was really impressed.” Patients told us that they felt safe at The Manor.

Information was provided in a format which met patient's needs and we saw that the patients had regular contact with members of the multi-disciplinary team working at The Manor who provided them with support.

We met most of the patients at The Manor and spoke with three of them in more depth to gain their views of the service. Patients were generally positive about The Manor.

One patient said “this is the best place I have ever lived”, and, “the staff are quite nice”. Another patient told us they wanted to be nearer to their family and said “a positive thing I have been doing is working hard on my behaviour”.

Patients told us about activities they enjoyed, such as shopping, going to the cinema and ten pin bowling.

Patients told us they felt safe at The Manor. One patient said “if someone was hurting me, I would tell staff, or if it was staff, I would go to the manager”.

We rated Cygnet Manor overall as good because:

• Managers were qualified for their roles and had a good understanding of all aspects of the hospital. Staff told us managers supported, respected valued them. Managers encouraged staff to be involved in changes and quality improvement.

• There was a good two-way communication between senior managers and staff so that information was shared effectively. There was a robust audit cycle and staff took actions where required.

• Managers managed staffing well and there were enough staff to run the hospital safely and effectively. Managers ensured staff were suitably trained and supervised; 90% of staff were up to date with their supervision and training.

• Staff managed patients’ risk effectively. Patients had thorough up to date risk assessments. Staff discussed patients’ risk daily and patients had positive behaviour support plans that followed best practice. Staff understood how to safeguard patients and worked with professionals external to the service to do so.

• Care plans were holistic, person centred and focused on achievable recovery goals, they were individualised and focused on skill building required for discharge. Patients were genuinely involved care planning.

• Staff offered a range of treatment interventions recommended by the National Institute for Health and Care Excellence. They followed best practice in medicines management and patients engaged in individually tailored activity programmes. Staff ensured that patients had good access to physical health care. Patients had heath action plans and staff promoted healthy life styles.

• Patients were happy with the way staff treated them. Patients were positive about staff attitudes and patients and staff demonstrated mutual respect. Staff showed in depth understanding of patients’ individual needs and preferences. Staff ensured that patients had access to appropriate spiritual support.

• Staff communicated with patients in the way that suited patients’ needs best. The speech and language therapist worked to ensure all information was accessible to all patients. Patients were involved in decisions about the service and staff consulted them and asked for feedback at meetings.

• The service worked to deliver on strategy set out in NHS England’s ‘Transforming Care programme.’ Staff and patients started to plan discharge soon after admission and patients were at the centre of discharge planning

However:

• Staff completed observations in line with care plans and policy and recorded when they had completed these. However; staff recorded their observations on pre-populated forms. They did not record the actual time they had completed the observation. This was not in line with organisational policy.

• Not all staff had received an appraisal; 74% of staff were up to date with their appraisal. The hospital manager was aware of this and had booked outstanding appraisals to take place.

• Staff did not record all aspects of handover meetings. Staff did not record conversations when information about learning from complaints and incidents and daily business was discussed. This meant that there was not a record of these conversations.