The hospital were going through a number of transitional changes, which included new management structure and a refurbishment.  There were improvements since the last inspection which included a focus on improving the environment through reallocation of the multi-disciplinary team (MDT) and placing the MDT on the wards to support better joint working with ward staff and improve access to the MDT for patients on the wards. 

The hospital was clean, the newly refurbished wards were much improved, promoted recovery and there was a good security system in place to ensure the safety of patients.

Each ward had at least one nurse on a shift.  The hospital still had vacancies and were taking steps to rectify this through targeted recruitment programme.  

The hospital staff treated patients with kindness, dignity, respect and support.  We saw that the patients were engaged in a range of activities, including the option to go offsite regularly. 

Mr Simon Yates is jointly named as the registered manager of Ashley House in this report. Mr Yates has left the company; his details appear as he has yet to formally notify us of us that he has left. We carried out this unannounced inspection in order to follow up on concerns which had been identified to us and to monitor the areas for improvement noted during our previous inspection which we conducted in February 2014.

During our inspection visit, we spoke with four members of staff, three people who used the service and two relatives. We also spoke with the Hospital Manager and Senior Charge Nurse.

We saw that people were treated with dignity and respect by staff. Care and treatment was provided in a caring and compassionate manner. Improvements had been made in areas previously considered of concern, in regard to environment and restrictive practices.

We saw that care plans were comprehensive and people's needs were individually assessed. Care plans contained a good level of information about how they should be supported to ensure their needs were met.

We found people had received their rights under the Mental Health Act and received a copy in an easy to read format. People told us that advocacy workers attended the ward reviews and gave support at tribunal hearings.

People and relatives we spoke with said they felt safe and able to speak with staff if they were unhappy or worried. We found that people who used the service were protected from the risk of abuse.

Records showed that provision of supervision and annual appraisals were irregular. Staff we met with confirmed that they were not receiving regular planned supervision or appraisal. This meant that the provider was failing to provide a support structure for staff in line with good practice and their own policy.

There was an effective system in place to deal with complaints. Information about how to make a complaint was available in a variety of formats for people, their relatives and visitors to refer to.

Mr Simon Yates is named as the registered manager of Ashley House in this report. Mr Yates has left the company, his details appear as he has yet to formally notify us of us that he has left. A new manager is in the process of registering with us. References in this report to the hospital manager are references to the new manager.

We carried out this inspection in order to follow up on concerns which had been identified during our previous inspection which we conducted in July 2013, and to monitor areas of concern from other earlier inspections. Concerns regarding the services compliance with the requirements of the Mental Health Act 1983, had also been identified by CQC’s mental health act commissioners (MHAC’s), during a records review conducted in November 2013. A follow up visit by MHAC’s on 4 February 2014 revealed that whilst the concerns had been partly addressed some minor issues still remained.

Since the last compliance inspection the provider has employed additional senior nursing staff and the service has a new hospital manager. Changes in senior clinical staff have also occurred. In addition to clinical and nursing staff a dedicated Mental Health Act administrator has been appointed.

We saw that care was provided in a safe environment and the staffing numbers reflected the needs of the patients on the ward. The staff understood the procedures in place to report safety concerns. This meant that patients were cared for in a safe environment by an appropriate number of staff.

Patient risk was assessed on admission. Plans to manage people’s risks relating to behaviours that challenged were completed and updated at regular intervals.

Staff told us and staff records confirmed that adequate pre-employment checks were completed prior to people being employed.

We saw that the care and treatment provided was based upon national guidance. Treatment was based on evidence based practice.

We saw that patients were treated with dignity and respect by staff. Care and treatment was provided in a caring and compassionate manner. However, the general appearance of the hospital and the state of it’s décor made the environment very clinical and oppressive.

We found that effective systems were in place to ensure that all the staff consistently understood the individual needs of the patients. This meant that patients were treated in a caring and compassionate manner.

Improvements had been made in all areas previously considered at risk. Evidence showed that one area of minor concern remains. Regulation 17 of the Health and Social Care Act 2008 identified a number of institutional restrictions and lack of community mobility which was judged to have a minor impact on the quality of patient’s lives. Improvements in other regulations continue to progress as the provider is anxious to demonstrate their willingness and ability to do better than simply meet the minimum standard.

At our inspection in November 2012, we found that the delivery of care did not always ensure that patients were safe and had their care needs met. The use of seclusion at the hospital was also not compliant with the Mental Health Act 1983. The purpose of this inspection was to check on compliance with the warning notice issued.

We spoke with 13 patients, who all felt that their care was good and was meeting their needs. We found a caring and attentive team of staff, who went out of their way to encourage people to be involved with conversations and things happening on the units. We looked at the care records for seven patients in detail and a brief overview of a further three to check how well the planning of patients’ care and treatment now focused on their individual needs. There was evidence that progress had started to be made.

There were still some concerns in the planning of patient care that needed to be addressed. Care plans did not always adequately set out the risks to patients’ health and wellbeing and say how these should be managed. Staffing arrangements did not always ensure that patients’ needs would be met safely and appropriately.

The use of seclusion was still not fully compliant with the requirements of the Mental Health Act. The provider had plans in place to develop seclusion facilities that would be compliant with the Mental Health Act. There was no definite completion date for this work to be completed.

This inspection was completed to ensure that the hospital was safe for people living at the hospital. This followed concerns we received about the safety of people following changes to where in the hospital they lived and alterations to one of the units. The hospital did not know we were coming to complete our inspection. We visited two units and found that reasonable steps were being taken to ensure the hospital remained a safe place to live.

At the time of our inspection, the hospital was going through a programme of change, supported by investment in the premises and a review of where people lived in the hospital. The immediate changes were part of longer term developments at the hospital.

During our inspection visit, we spoke with two people about life at Ashley House. We asked them about how they felt about the recent changes and future changes to come. Both had recently moved to the second unit we visited and were very positive about the changes. They told us they were very happy and settled in their new unit. One person told us that they had enough privacy and that they had access to their own bathroom facilities. One person told us “I feel very safe and really enjoy living on this unit: I do not want to move again.” They both felt very involved in the changes and told us if they had any concerns they would not hesitate to discuss these with the manager.

We found that updated risk assessments and care plans had been completed and staffing arrangements had been revisited to reflect the changes. We understood from our discussions with the registered manager that the work on one of the units would continue for a further week. Following completion of the work, people currently living elsewhere at the hospital would be moving to live on this unit.

We visited Ashley House and carried out an inspection on 12-13 April 2012.

We talked with a number of patients in Fairoak, Lordsley and Drayton wards.

We heard staff talking to patients and explaining what they could do that day giving them a choice of activities that they were known to like.

We talked to five of the patients about their care plans. They told us that they had been asked about their likes, dislikes and hopes by the staff. Two told us that they had a copy of their care plan and the others told us that they could see them if they asked. All were happy with these arrangements. One person said “If I ask they always tell me what I want to know”.

We talked to the staff and they were all aware of the contents of patients care plans. One patient said “They always know what I’m supposed to be doing-they talk to me about what I want to do”. The relatives of one of the patients told us that they had been consulted about the care of their family member who had difficulty communicating for themselves.

The patients that we talked to told us that they had seen doctors, dentists and other healthcare professionals when they needed to.

We talked to a number of patients. They all told us that they felt able to raise issues with the staff should they need to. Patients told us how they felt able to talk freely with the staff about lots of issues. We saw many examples of short, relaxed and friendly chats between patients and staff. One patient said “They are not a bad lot really”.

We watched and listened to the staff as they worked with the patients who had difficulty in expressing themselves. We saw that they staff were sensitive to the ways that individuals expressed themselves.

Patients told us about the different ways that they could raise issues with the hospital’s senior managers. They told us about how they could access the ‘Noise Voice Choice’ meetings and the ‘User Involvement and Feedback Sub Group’ to do this. One also told us how they used the complaints procedure to resolve issues.

• Staff identified and mitigated environmental risks such as blind spots and ligature points on the wards. Wards had up-to-date environmental risk assessments, staff maintained daily environmental checks.
• The wards had access to emergency and medical equipment that was regularly checked and well maintained. Although nursing vacancies were a continuing challenge for the hospital, there were systems to ensure staffing levels were sufficient to provide safe patient care.
• Staff completed patients’ comprehensive assessments and risk assessments that they reviewed and updated as a multidisciplinary team. Staff regularly reviewed and updated care plans. Staff were involved in a wide range of clinical audits to monitor the quality of service provided.
• The wards worked well as a multidisciplinary team and with other external organisations to ensure that patients were discharged with the right support. Patients knew how to raise complaints and were involved in decisions about how the hospital was run.
• The hospital had a good approach to assessing, and responding to, patients’ physical health needs. Patients had access to a full time practice nurse who carried out ongoing monitoring of physical health checks.
• The hospital had robust governance processes to manage quality and safety. The hospital used key performance indicators and other measures to gauge the performance of the team.

However:

• Oakley West ward environment did not appropriately meet one patient’s care and treatment needs and the short term alternative plan of care was not appropriately designed to meet all the needs without impact on other patients using the ward. The ward did not have a clear long term plan in place to ensure that the needs of the patient would be appropriately met.
• Staff supervision was not consistently carried out in a structured way that captured areas of discussions; it varied in detail and quality.