We rated [Dartmouth House as good because:’

• Staff ensured the service was safe for patients by undertaking regular environmental risk assessments relating to potential ligature risks. They provided individual risk assessment for patients and ensured they used the part of the service which was most suitable for their needs. This could include a ligature free room or one with ligatures present for a patient due to be discharged into the community. The service was clean and furniture well maintained and the clinic rooms provided suitable equipment to meet the need of patients.
• Staff ensured care plans had been completed in a timely way. This included information which was holistic, person centred and recovery focussed. Staff reviewed care plans and risk assessments regularly in multidisciplinary team meetings. Staff attended handovers so that information about patients could be shared at the start of every shift.
• Patients stated that staff were caring and respectful. Staff knew patients well and used this as a basis for providing support that was supportive and responsive to patient need. Families and carers had been involved with permission of the patients.
• Patients had their own personalised bedrooms. The service provided quiet rooms and areas for visitors and patients had unrestricted access to the large outside space. The service provided rooms for patients who needed disabled facilities. Staff ensured the food met the dietary, religious and cultural needs of the patients and that they had a degree of choice in the food they had been offered.
• Dartmouth House had a good governance structure in place so that staff felt well supported and able to do their jobs to the best of their ability. Staff received mandatory training and could request specialist training elated to their roles. Staff knew the visions and values of the provider and demonstrated these in the support they offered to patients and each other.

However:

• Not all staff had received regular supervision as set out in the providers policy. The provider had identified the reasons for this and developed a plan for improving access to supervision for staff.

The chief inspector of hospitals has decided to take Dartmouth House out of special measures. We previously inspected the service in August 2015 where we rated the service as Inadequate in each domain; safe, effective, caring, responsive and well-led and as Inadequate overall. Following our most recent inspection however, CQC has found that significant improvements have been made to the quality and safety of care provided and as such, we have rated each domain; safe, effective, caring, responsive and well-led as good.

We rated Dartmouth House as good because:

• All areas including the clinic were clean, well maintained and fit for purpose. The service had ligature risks but these had been risk assessed to increase the level of independence for patients and were risk assessed for individuals. Staffing levels met the needs of patients and the service only used agency staff who knew the service and patients. Staff training was up to date and staff were knowledgeable about the type of service they provided.

• Patients had care plans, which were detailed, and recovery focussed. Staff used National Institute for Health and Care Excellence guidance when prescribing and dispensing medication and staff monitored patients physical health needs on a regular basis. Patients had access to a wide range of skilled staff including nurses, healthcare assistants, psychologists, occupational therapist and activities coordinators.

• Patients spoke positively about staff and the care and support they received. Staff showed good knowledge of the patients’ needs and used this to build relationships based on trust.

• Patients had access to a wide range of rooms including a clinic and therapy rooms. Staff offered a wide range of activities seven days a week and patients contributed to the discussions about what should take place. Patients could access outside space when they needed to during the day. Patients could lock bedrooms and they had their own secure lockers in the communal area allowing them to be responsible for their own belongings such as mobile phones.

• Staff knew senior managers and said there was a culture where open discussion was encouraged. This helped to ensure staff morale and job satisfaction was high.Access to administrative staff allowed staff to maximise the time spent with patients.

There were nine people using the service on the day of our inspection. Six people were detained there under the Mental Health Act. We spoke with six people who used the service, four members of staff and the registered manager.

We found that people were not always asked for their consent about their care and treatment.

Staff spoken with showed that they knew people who used the service well and how to support them. People had regular physical healthcare checks to ensure their wellbeing.

People told us that they went out with staff and did activities within the local community. One person said, “I go to a sewing class every week.” Another person told us that they went to a textile class. People told us that they would like more planned activities within the hospital. We observed that staff could not engage all people in meaningful activities.

The environment was regularly maintained so that it was safe for people who used the service and staff. We saw that systems were in place to ensure that staff knew how to safeguard people from harm.

People told us that the staff were good and knew how to support them. One person said, “There is a nice atmosphere. It's quite a nice place.”

We saw that staff received most of the training they needed to know how to support people who used the service.

People told us that staff listened to their views and regular meetings were held where they were asked what they thought about the hospital.

We found that systems were not effective in assessing and monitoring the quality of the service provided.

There were seven people living at the hospital on the day of our inspection. We spoke with three people who lived there, five members of staff and the registered manager.

At our inspection in April 2013 we found that staff were unsure of how to safely support people to meet their needs and ensure their wellbeing. We found at this inspection that staff had the information they needed to know how to safely support people and people’s safety and wellbeing was promoted.

We also found at our last inspection that people were not offered regular opportunities to take part in meaningful activities. We saw at this inspection that people were offered regular opportunities to promote their independence, interest and their self-esteem. One person told us, “I’m happy here, staff help me to do the things I want to do.”

When we inspected the home in April 2013 we found that monitoring systems did not protect the people living there against the risks of unsafe care and treatment. At this inspection we looked at the improvements that had been made in relation to this. We saw that audits had been completed and action taken as a result of these to make improvements.

There were seven people living there on the day we inspected. Another two people were away staying with their family and one person had been admitted to another hospital. We spoke with four people living there and five members of staff. The manager was on holiday at the time of our inspection but they provided us with further information when they returned.

We saw that people were asked for their views about what they wanted to do and were supported to be independent. One person told us they did their own laundry and sometimes cooked their meals.

It was not clear how staff should support one person to meet their needs which could impact on their safety and well being.

People told us and we saw that there were not regular activities organised in the home. One person said, “There is nothing to do when I do not go out.”

We saw that people were supported to eat a balanced diet that reflected their individual tastes and cultural background.

People had their medicines as prescribed to ensure their health and well being.

Staff received training and support to ensure they knew how to support the people living there.

People were asked for their views about the hospital and these were listened to. Audits of the quality of care that people received were not completed so any improvements needed had not been identified.

We saw that record keeping had improved so it was clear what care and treatment each person had received to ensure their health and well being.

Our inspection was unannounced which meant that no one knew that we would be visiting. There were 12 people living at the home on the day of our inspection. We spoke with seven people living there, the manager and six members of staff to find out their views about the service provided.

We saw that people were encouraged to do things for themselves so promoting their independence skills. One person told us, "Staff here have helped me learn how to cook and do things for myself."

People consented to having their medication and to the treatment they received.

A team of health professionals working in the home supported people to meet their health needs.

Systems were in place to ensure that people were safeguarded from harm. One person said, “They never hurt me and look after me well.”

We saw that the systems to manage people’s medicines required improvement to ensure that people received their medicines as prescribed.

We saw the home was clean and tidy. Some rooms required redecoration and new furniture and we were told this was being done.

Sufficient staff who were appropriately recruited supported people to meet their needs. Staff told us they were well supported in their role.

People were asked for their views about the home and these were listened to. Audits were completed and action taken where needed to make improvements.

We saw that some records were inconsistent and did not accurately reflect the care provided.

The CQC is placing the service into special measures.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.’

We rated Harriet Tubman House as inadequate because:

• The manager and operations director were not aware of the regulations that they needed to meet to ensure a safe service for patients.

• The hospital did not have effective procedures to ensure the safety of patients and staff and to mitigate any risks to them.

• Staff did not identify risks to patients’ safety and take action to reduce them.

• Staff did not analyse incidents of harm or risk of harm so they could not identify trends and learn from them to prevent them happening again.

• Care plans and risk assessments did not show staff how to support patients.

• Staff did not demonstrate a good understanding of the Mental Health Act and Mental Capacity Act. This had resulted in inappropriate applications made to deprive patients of their liberty.

• Some staff did not engage with patients in a positive way to promote their wellbeing.

• The environment did not promote patients’ recovery and ensure they were comfortable.

• The hospital had no governance structures to assess risks and the quality of the service to promote improvements.

• Builders were renovating the hospital at the time of our inspection and the managers of the service were not taking proper action to prevent avoidable risks to patients and staff. As a result of our concerns and those expressed by a Health and Safety Executive inspector, the provider suspended the work until patients could be moved to alternative accommodation.