We rated Fir Trees as good because:

• Patients gave positive feedback about the service
• carers gave good feedback and told us their views were considered and that they felt involved in patients’ care
• we observed caring, respectful and professional interactions between the staff and patients
• safe staffing levels were maintained and it was unusual for the unit to be short-staffed
• patients were involved in the development of their care plans
• patients benefited from a varied activity programme in and away from the hospital
• patients had good access to multidisciplinary team working, in particular psychological and occupational therapies
• the environment was of a good quality and the service was continuing to improve on this
• patients had good access to independent mental health advocates
• nursing staff received regular managerial supervision, had an annual appraisal of their work performance, had access to ongoing training and development, and were up to date with mandatory training

However,

• domestic staff had not received break away training
• Patients on high-dose anti-psychotic medications did not always have this clearly recorded as part of their care plans
• Stand-alone medication care plans related to the medication prescribed rather than the underlying physical health condition.

On the day of our visit there were eight people living at the service and there were only two people who wanted to discuss their care with us. We heard comments such as “I like it here”; “The staff always ask us nicely if they want us do something.” and “It is very nice here. It is quite chilled.” We saw people were supported on an individual basis with aim of the service being for people to live as independently as possible within the community. We saw that people were involved in their plans of care and they were not forced to do anything that they did not want to.

We looked at the way that medicines were managed at the service and we found that there were effective systems in place for ordering, storing, administering and destroying medicines.

We saw there were effective recruitment procedures in place and that there were sufficient numbers of suitable qualified staff within the service. We spoke with five staff members and a student nurse who told us that they were well supported in their roles and that they did not have any concerns about the way that the service was managed. We also spoke with two visiting health professionals, one of whom told us “This service has an excellent reputation locally.”

There were appropriate systems in place for storing, archiving and destroying records. We found that records were well maintained and were reviewed and updated when it was required.

We spoke with nine patients who were living at Fir Trees Independent Hospital who were very positive about the care they received. One person said “I have enjoyed my time here, it’s flown by and all staff are lovely.” Another person said “The staff have helped me to cope with my situation. You can talk to any staff. I am happier here than I was in the other hospital.”

We found that people were well cared for and were encouraged to be as independent as possible. We looked in depth at the care records for two people and found that appropriate assessments and risk assessments had been completed. These were updated on a regular basis.

One person told us “I am involved in my care and this is explained to me. I am treated with respect and dignity.” We also heard “I know about the Service Users meetings at the company’s head office, but I have chosen not to go.”

People told us that they felt able to discuss any issues or complaints with staff or the manager. The people we spoke with told us that they had no complaints.

We rated Fir Trees Independent Hospital as good because:

• All staff had received the training required to ensure the safety of patients. The training included basic life support and first aid training.
• There was a system in place to monitor when training needed refreshing and staff could not work a shift unless their training was up to date. Domestic staff had received break away training since the last inspection.
• Staff engaged in a number of audits which included physical health care plan audits, patient review audits and the introduction of a high dose antipsychotic audit.
• Patient care plans had been developed to become more person centred. The care plans included individual risk assessments, discharge planning and evidence of reviews taking place regularly at multidisciplinary team meetings involving named nurses, senior nurse practitioner, consultant psychiatrist, care coordinator, social worker, service user, family and advocacy.
• The service adhered to the Mental Health Act and Mental Health Capacity Act. Patients were informed of their rights and had access to advocacy services.
• The service complies with the Department of Health’s guidance on the provision of same sex accommodation.
• The service was clean and tidy with maintained furnishings, fixtures and fittings including a fully equipped clinic room. Infection control procedures were being followed and cleaning chemicals were stored away correctly.
• Staff we spoke to felt supported. Staff appraisals and supervision had been carried out regularly.
• Patients felt able to give feedback about the service at regular community meetings.
• We observed positive interactions between staff and patients. There was a good governance structure in place and Alternative Futures Group had involved all staff from each service to provide feedback in order to establish new values.

However:

• There were no psychologists working into the service. We did not find any evidence of psychological interventions being provided to the patients as part of their rehabilitation and recovery care pathway.
• There was no evidence to show if patients had been given copies of their care plans or if they had refused a copy.
• Section 17 leave forms were not fully completed. The outcome of leave was not being recorded.