We rated Elm Park as good because:

• The provider had safe staffing levels. We checked duty rotas and saw that the provider maintained appropriate numbers of staff on all shifts and always had one qualified nurse on shift as a minimum. Staff received regular annual appraisals. Staff compliance with appraisals was 99%. The provider had systems in place to monitor mandatory training and training compliance was 93%. Staff spent their time on direct care activities. We observed staff spent most of their time engaging, interacting and supporting patients to meet their needs. Staff treated patients with dignity, care and compassion. We spoke to two patients who told us staff were kind and caring.

• Staff undertook a risk assessment of patients upon admission. Staff reviewed these and updated them regularly during patient review meetings or following an incident.

• Staff completed comprehensive assessments of patients upon admission. Staff used the information gathered during the assessment is to create holistic and personalised care plans. Patients with speech and language therapy input had detailed dysphagia plans and dietician support. Patients were involved in and participated in the planning of their care. We reviewed five patient care records which showed that staff discussed care plans with patients and recorded their views. Staff completed physical health examinations of patients on admission. The provider also had ongoing GP input for patients.

• Staff stored medication in locked cupboards within the clinic room. We checked all medication records for patients, staff administered patient medication correctly and recorded this appropriately.

• Patients had access to a full activity programme. The occupational therapy team managed activities Monday to Friday and the nursing team provided activities at weekends. Patients told us the food was of good quality and they had choice. The provider offered a range of food choices to suit the needs of patients, including for religious or cultural needs. Carers also felt that the provider helped underweight patients reach a healthy weight goal.

• The service had a full range of rooms and equipment to support treatment and care. There were group rooms for activities, a log cabin with a gym and quiet rooms.
• The provider had good complaints procedures in place. Managers investigated complaints and they shared any lessons learned with staff. The provider used advocates to debrief patients after safeguarding incidents. The advocate led on patient forums to ensure the views of patients were heard.

However:

• Management had not identified all ligature points across the service. This meant staff could not mitigate these risks to patients. We found out-of-date emergency medication packs, including a needle and glucogel in the emergency grab bag. Staff did not keep medication cupboards clean.

• The décor in some areas was in a poor state of repair and there were stains on the floor. Windows in certain rooms did not open and there was a large crack in the quiet room window which the provider had not fixed. The provider did not know when plans to address environmental issues would be completed.

• Some carers had commented that there was a lack of communication by the provider on general updates and a lack of involvement in care planning and meetings involving their relatives’ care.
• Corridors were narrow particularly for wheelchair users. The occupational therapy kitchen was also unsuitable for wheelchair access. The provider had started to receive quotes for renovations but had no set date for the completion of work.

We rated Elm Park as good because:

• The provider had safe staffing levels. We checked the duty rotas and saw that the provider was maintaining appropriate numbers of staff on all shifts.
• Staff undertook a risk assessment of patients upon admission. Staff reviewed these and updated them regularly during patients review meetings or following an incident.
• The provider had good medication management procedures in place. All the medication was stored appropriately, in locked cupboards within the clinic room. We reviewed the medication administration records for all patients and found that staff completed these correctly.
• Staff completed comprehensive assessments of patients upon admission. Staff used the information gathered during the assessment is to formulate a care plan.
• Staff completed physical health examination of patients upon admission. The provider arranged admissions on the days when the GP and the physical health care nurse were in attendance.
• Staff received regular supervision and annual appraisals. Staffs compliance with supervision was 96% and compliance with appraisals was 93%.
• We observed staff to be kind and caring towards patients and they treated them with dignity and respect. Staff were responsive to patient's needs.
• Patients, their families, and carers were involved in and participated in the planning of their care. We reviewed five care records which showed that staff discussed care plans and they recorded patient’s views within these. Staff shared these with families and carers.
• The provider had a full activity programme. The occupational therapy team managed activities Monday to Friday and the nursing team provided some activities during the weekends.
• Patients told us the food was of good quality and there was choice. The provider was able to offer a range of food choices to suit patient’s different needs, such as dietary requirements of religious needs.
• The provider had good complaints procedures in place. Managers investigated complaints and they shared any lessons learnt with staff.
• Staff were able spend their time on direct care activities. We observed that staff spent the majority of their time engaging, interacting, and supporting patients to meet their needs.
• The provider had systems in place to monitor mandatory training and staff supervision and appraisals. The provider used a dashboard system on the computer that would highlight when staffs training, supervision and appraisals were due.

However:

• The décor in some areas of the ward was in a poor state of repair. In the lobby area there was peeling paint on the walls. There was peeling paint, rotten skirting boards, and a hole in the vinyl flooring in the toilet by the dining room.
• The provider had not mitigated all blind spots with the use of mirrors. One patient's bedroom did not have clear lines of sight when staff used the observation window in the door.
• Staff knowledge of the Mental Health Act code of practice was limited, especially with regards to seclusion. Staff were restraining patients in the quiet room but were not documenting this as an incident of seclusion.
• Senior staff could not explain what key performance indicators they were using to monitor performance.

Summary of findings

We rated Elm Park as ‘good’ because:

• The wards were safe, clean and had designated rooms for therapies and activities. Staff had undertaken environmental risk assessments to identify potential ligature anchor points that might endanger people at risk of suicide. They had plans in place to manage them safely. There was a fully equipped clinic room with accessible resuscitation equipment. Staff regularly checked equipment.
• Beds were available to admit and treat patients when needed and the provider reported no delayed discharges.
• There was a weekly timetable of community and on-site occupational activities. The hospital had a ‘pets as therapy’ dog and patients could look after chickens. Patients were able to personalise their rooms and quiet areas were available on the ward where patients could meet visitors. Patients had private access to a telephone.
• The wards had an adequate number of staff to provide safe care. Where there were vacancies, they used suitably skilled bank and agency staff to cover any gaps.
• All staff carried personal alarms and we saw alarms in patient bedrooms for summoning assistance when needed. The provider had an induction programme for new staff and rehabilitation workers were offered training via the care certificate. Staff received annual appraisals.
• Staff were skilled in managing risks to patients and received training in managing challenging behaviour. Staff completed regular observations of patients and recorded these. They managed and administered medication correctly. Staff reported incidents and managers monitored these reports to identify and implement any lessons learnt. Managers ensured that the trust board was aware of this information.
• Patients detained under the Mental Health Act 1983 (MHA) were aware of their rights and paperwork was in order and stored appropriately. Staff used the Mental Capacity Act 2005 to assess capacity for individual decisions. Staff received training and support was available from a MHA administrator when needed.
• Staff from different disciplines worked well together to provide care. Staff undertook a multidisciplinary assessment following admission and used this to develop a care plan.
• There were appropriately trained staff to deliver care. Staff received annual appraisals.
• Staff included neuropsychology, psychology, occupational therapy, psychiatry, speech and language therapy, physiotherapy, social worker, nursing and rehabilitation workers. This included meeting the patient’s physical healthcare needs. A practice nurse was available and a GP visited the site weekly. Podiatry and dental care were available and referrals for specialist input were made when needed.
• Staff used nationally recognised outcome measures to gauge how patients were doing. Senior staff attended daily handover meetings, which reviewed actions and outcomes for patients and the hospital. Regular team meetings were held, to include senior management team meetings, referral, admission and discharge meetings, ward team meetings, community meetings and staff and patient link up meetings. Actions and outcomes from meetings were recorded.

We were not able to speak to some people using the service because they had complex needs, which meant they were not able to tell us about their experiences or they chose not to speak with us.

We spoke with two people during our visit. They both told us that they were very happy living at Elm Park. One person told us that they had settled well and that staff were very helpful and nice. Another person told us that they were well supported to maintain their hobbies and independent living skills. They told us that they were listened to and were able to freely express their views or concerns and these were acted upon.

We saw that Elm Park provided a safe, relaxed and homely environment for people that encouraged personal development. Staff were friendly and respectful in their approach and interacted with people using the service in a confident and considerate manner.

During the course of our visit we saw that people were supported to express their views and choices and that staff clearly understood each person's needs and behaviours. Staff looked after people's healthcare needs in a proactive way. People were provided with choices of food and drink that met their individual needs.

The provider had effective systems in place to monitor the quality and safety of the service that people received.

We spoke with three people using the service during our visit.

The people we spoke with all told us that they were happy at Elm Park. They told us that they had reasonable opportunities to go out and did not feel unnecessarily restrictive. One person told us about their woodwork and that they had access to a small workshop. Another person told us that they were being supported to access the community and develop their daily living skills with a view to living more independently in the near future.

They all confirmed that they had a care plan and that they understood and were involved in the planning of their care plans. They said that they were able to contribute to their care planning reviews and had the opportunity to express their views

All the people we spoke with felt generally supported and listened to. They all said that they had access to an advocate and would be comfortable speaking to their nurse or a member of the management team if they had any worries or concerns.