During our previous inspection in April 2016, all domains except for effective were rated as good. Following our inspection on 7 November 2016, we have changed the rating for effective from requires improvement to good because:

• Cambian had updated the corporate Mental Health Act policy in line with the Code of Practice.
• Staff reviewed patients’ risk before section 17 leave took place. Section 17 leave is any leave of absence that is authorised by the responsible clinician, which enables a detained patient to go outside the hospital grounds for any period of time. Section 17 leave paperwork was detailed, up to date and stored securely. Detention paperwork, including section papers and renewals, was up-to-date and stored correctly within the patients’ active file.
• Staff were experienced and qualified and there was a range of professionals within the multidisciplinary team. Staff attended a range of team meetings, including morning handovers for both nursing staff and the multidisciplinary team. We saw evidence that staff took part in clinical audits and monitored outcome measures using recognised tools. All staff had completed training in the Mental Health Act and Mental Capacity Act.
• The care plans we saw were up to date, personalised, holistic and recovery-oriented. Patients were actively involved in their care and treatment and were engaged in a range of therapeutic activities. Staff had a good understanding of individual patients’ risk and this was closely monitored to support patients towards rehabilitation. We saw evidence of good physical health monitoring, as well as good relationships with local GPs and acute hospitals.
• Staff followed the National Institute for Health and Care Excellence (NICE) and Maudsley guidelines, including guidelines for schizophrenia in adults when prescribing medication and for psychosis. Information was stored securely and key information was accessible to all staff.

However:

• There was no clear timeframe to the supervision schedule and this had resulted in some staff not receiving supervision within the recommended timeframe. However, we saw significant improvements to the supervision schedule and staff reported that the quality and frequency of supervision had improved since our last inspection.
• Capacity assessments lacked detail of the discussion between the assessor and the patient and therefore it was unclear how the decision about the patient’s capacity was reached.
• Consent to treatment forms were unclear as they contained patient signatures when the form indicated that the patient lacked capacity.
• We did not see any evidence of advance statements.
• Only five of the 30 therapeutic programmes and logs had been signed by the patient. Staff told us these therapeutic timetables were undergoing review and we saw evidence that patients were actively involved in therapeutic activity.

We rated Sherwood House as good because:

• the environment was visibly clean and well looked after and detailed records of the cleaning processes were complete.
• emergency equipment was checked regularly and all records relating to this were also complete
• we saw that equipment was well maintained and safety tested
• there was sufficient staff to meet patient need
• there were policies and procedures for use of observation and searching patients and staff were adhering to them
• there were good practices for the ordering, storage and dispensing of medications
• recognised risk assessments were completed and updated
• care plans showed evidence of physical health monitoring and there was good links with the local GP practice
• staff treated patients with dignity and respect and showed an understanding of the patients’ needs at all times during the inspection
• there was access to advocacy services in line with the Mental Health Act Code of Practice
• carers and patients told us they felt well cared for and their needs were met
• there was a choice of food to meet dietary and religious needs and there was access to hot drinks and snacks at all times
• there was access to spiritual support
• sickness, absence and staff turnover was low

However;

• the corporate Mental Health Act policy had not been updated in line with the new Code of Practice
• it was not recorded that risk assessments had been reviewed prior to section 17 leave
• it was not clear that patients had been involved in their care plan and care plans were not written in the first person.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five patients and asked them for their views. We also spoke with four support workers, a nurse, the manager responsible for training and the registered manager. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found patients understood the care and treatment choices available to them. A patient told us, “I have had the mental health act explained to me, I understand why I am here.” We found patients received care and treatment that met their needs. A patient told us, “There is always someone there to talk to you. They do listen.”

We found patients who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. A patient told us, “I think the staff know what they are doing, they keep us all safe.”

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. Staff told us they felt they had the training they needed. A patient told us, “I think they take into account my opinion, I am encouraged to give my opinion.”

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with nine patients and asked them for their views. We also spoke with various staff including four support workers, a nurse, head of care and the registered manager. We looked at some of the records held in the hospital including the care files for four patients. We observed the support patients received from staff and carried out a tour of the building.

We found patients gave consent to their care and treatment. A patient who used the service told us, “I feel I have a say.”

We found patients received care and support that met their needs. A patient told us, “If you are down they will help you. I’ve been down, they take it seriously.”

We found the premises were safe and suitable. One patient told us “I like the way it has been decorated, it is nice.”

We found there were sufficient and suitable staff available. One patient told us, “There is always a member of staff around. They make time for you. They are approachable.”

We found there were systems to deal with any comments or complaints. One patient told us, “I have not really had any complains here. I think they would listen to it fairly if I did have one.”

One patient told us they would, "Highly recommend the hospital." and part of the reason they liked it was that it was "Jammed packed with activities."

Other patients said, "I feel well respected, the staff feel like friends to me." And "I've been involved and given copies of my care plan. I can keep that it my room."

We were given examples by patients of how they were encouraged to become more independent and were supported to be involved in all aspects of life at the hospital. We were told, "I feel I have control over my life."

We were told that patients using the service could make use of formal opportunities to provide feedback about the hospital to the registered provider and were involved in decision making about their care, treatment and support in a variety of ways. One person said they could talk to the staff and they were confident they would be listened to.

We rated Sherwood House as outstanding because:

• There was a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity. Staff actively involved patients, families and carers in care decisions to make sure patients were active participants in their care and treatment.
• Feedback from patients, relatives and stakeholders was continually positive about the way staff treated patients. Patients told us that staff went the extra mile and their care and support exceeded their expectations.
• The service was tailored to meet the needs of individual people and was delivered in a way to ensure flexibility, choice and continuity of care.
• There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that meets these needs and promotes equality. This included patients with complex needs.
• The service provided safe care. The environment was safe and clean. There were 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.
• 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 high dependency rehabilitation ward and in line with national best practice guidance. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The hospital team included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The staff worked well together as a multidisciplinary team and with those outside the hospital 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 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 high dependency mental health rehabilitation. It was well led, and the governance processes ensured that hospital procedures ran smoothly.

However:

• There had been four consultant psychiatrists in the last two years and the current one was also leaving. Patients said this affected their wellbeing as they thought they had to explain how they felt repeatedly to a new doctor.
• One medication prescribed to a patient for the side effects of their mental health medication was not included on their consent to treatment form.