We did not rate the service as this was a focused inspection of one hospital ward. We found that:

• Areas of the ward were not clean and we found potentially infectious material in an open bin. Staff used the seclusion room daily to nasogastric tube feed a patient but did not clean the area before or after use.
• Staff did not always complete person-centred care plans that took into account the particular needs and preferences of patients on the ward.
• Staff imposed blanket restrictions on all the patients on the ward without any clear reference to individual risk assessments to justify their use.
• There was a lack of suitably qualified staff to deliver psychological therapies to the patients on the ward. As a result the ward did not provide the full range of psychological therapies recommended by the National Institute for Health and Care Excellence, and embedded in their model of care for the unit.
• Staff did not always update risk assessments after incidents and clinical discussions.
• The hospital relied on block-booked agency nurses to fill the majority of qualified staff roles on the ward.

However:

• The provider had improved the ward environment and had removed environmental risks, found on our last visit, to benefit the safety and dignity of patients.
• Staff had a good knowledge of safeguarding and reported concerns appropriately and in a timely manner.
• The provider’s new local policy for rapid tranquillisation was in line with national guidance and specific to the treatment of patients.
• Staff followed the Mental Health Act Code of Practice guidance in their monitoring of practices such as restraint. They offered support to patients after an incident.
• Staff included patients in discussions about their care at regular multidisciplinary team meetings.
• Staff considered the principles of the Mental Capacity Act and Gillick competency when they assessed a patient’s capacity to give consent.
• The hospital had a permanent management team that gave a period of consistency and stability in leadership.

Managers and the clinical team listened to the concerns of patients on the ward and acted promptly to investigate any concerns or allegations of abuse.

The Care Quality Commission (CQC) carried out a responsive inspection of Huntercombe Hospital Stafford on the 08 July 2016 to ensure effective safeguarding processes were in place. This followed the CQC issuing a warning notice on 19 May 2016 to the hospital managers requiring them to introduce an effective system and provide staff with training around safeguarding.

We found:

• Significant improvement in staff training and knowledge about recognising and reporting potential abuse
• Managers had introduced systems to quickly identify and act on any concerns about abuse.
• Hospital managers were taking an active role in the daily review of incidents and the clinical management of risk across the site.

However:

• Only one third of ward staff were aware of systems for raising urgent safeguarding concerns out of hours.
• Ward meetings did not have systems embedded to ensure concerns were reported and actions were followed up consistently.

We visited all three wards at Huntercombe, concentrating on Wedgewood, the eating disorders unit, and Hartley, the psychiatric Intensive care Unit (PICU). We spoke with two ward managers, a consultant psychiatrist, seven staff, five patients and three visiting relatives. We also spoke with a commissioner from NHS England.

At our last inspection in July we had concerns about the environment. We saw that refurbishments had taken place, notably on Thorneycroft and Wedgewood, leading to much better environments there, but that work was still to be completed, particularly on Hartley ward. We had concerns about how promptly issues of cleanliness and maintenance were addressed, particularly on Hartley ward.

Patients spoke highly of support and help offered by staff. Patients on Hartley ward told us, “Staff are really good.” We had similarly positive feedback from patients we spoke with on Wedgewood.

We saw evidence of a variety of activities on Wedgewood and Thorneycroft ward. Two patients on Hartley ward told us there weren’t enough activities.

One parent told us they felt their child was “well cared for” but felt the service “could communicate better.”

We saw sufficient staff in place. Many patients on Hartley required one to one observations. We saw that these took place appropriately.

Some staff told us ‘debriefing’ sessions after incidents did not always take place as promptly as they wished.

During our inspection we spoke with nine people who used the service, five relatives and seven members of staff. We also spoke with the deputy manager and the registered manager.

At our last inspection December 2012 we had concerns about the care and welfare of the young people who used the service. The provider had sent us an action plan which told us how they would improve. At this inspection we found that the service had applied changes hospital wide and not just to the one ward we had previously had concerns about.

Care plans were person centred and individualised. Young people who used the service each had a timetable which mapped outtheir events and treatments for each week. One person told us: “I would like my own copy of my patient timetable”.

We found that the building was uncomfortably hot on two of the units. One person told us about a dining room: "It's not very welcoming the way it's decorated". This did not improve the therapeutic environment for the people who used the service.

We saw that staff had access to suitable training and that the service took steps to ensure that sufficient staff were on duty at all times.

We saw that the service took steps to monitor all of the care outcomes for the people who used the service. We also saw that quality measures had been put in place to gain people’s views and share learning from feedback.

We received a report raising concerns about the care and welfare of people who were staying at Huntercombe Hospital-Stafford. We completed an unannounced responsive review. This meant that the provider and the staff did not know we were coming.

We focused our inspection on Hartley ward where reported concerns had been identified. There were 10 people admitted to the ward at the time of our inspection with a maximum capacity for twelve people.

During our inspection we spent time talking with people about their experiences of staying at the hospital.

People we spoke with told us that staff were respectful to them. People we spoke with had knowledge about their mental health conditions and the medication they were taking.

We found the care records we looked at had information about people’s needs and how they should be met. However people’s records were not always detailed and did not provide clear objectives to enable people to work towards their goals to recovery.

People using the service told us that activity sessions were not providing sufficient stimulation and were often cancelled, with no explanation provided.

We found that Huntercombe Hospital-Stafford was non-compliant with Outcome 4, in relation to the care and welfare of people who use service.

We visited Huntercombe Hospital (Stafford) as part of our routine scheduled inspections process. The visit on 2 July 2012 was unannounced which meant the provider and the staff did not know we were coming

Huntercombe Hospital is divided in to three separate units; Hartley Unit, Thorneycroft Unit and Wedgewood Unit. We visited all three units and we spoke with people who had been admitted to the hospital, staff members, consultants, the manager and his deputy.

We were joined by an inspector from the mental health act commission for part of the visit. They reviewed the detained patients at the hospital and reported that the hospital was compliant.

We asked these young people about their care plans. One of the young people did not want to discuss their care with us. We welcomed the fact that the young person felt able to voice this view and decline to be interviewed. We could see that the young person had confidence that this choice would be respected.

We saw evidence of care pathways being followed which were supported by updated risk assessments. A care pathway is "anticipated care within an appropriate time frame, written and agreed by the hospital's staff and the multidisciplinary team. The pathway plans the care to be received and records the action taken whilst the treatment is given.

The staff we spoke to had good knowledge of care and they were aware of the importance of keeping the records up to date.

One person we spoke with told us “I feel safe here and I know I am being looked after well as a lot of time and effort is being put towards me getting better.”

We asked one young person on how safe they felt in the hospital. This young person told us they felt very safe. They said that all the staff ‘were there’ for them and that the other patients were friendly and helpful.

We saw that supervision was taking place regularly for staff and there were good examples of staff being supported through reflective practice and peer supervision sessions.

A staff member told us “I love working here its very rewarding most of the time. We have had a period of change but things are settling down now. We are very patient focussed on all the units ensuring that the children make a good recovery as soon as possible.”

We saw good quality monitoring processes in place with evidence of high patient satisfaction including former patients giving the staff positive feedback following their discharge.

People that use the service told us that they felt safe and secure in the unit, supported by caring staff. We were told that the staff are lovely and really good fun. People told us that if they felt low they can approach any member of staff to talk to and they are given time to express themselves. We were told by one individual that if anyone has any complaints they can raise them easily and they are confident that action will be taken.

We rated Huntercombe Hospital - Stafford as good because:

• The hospital had taken action and showed that improvements had been made in areas that the provider was required to improve on in January 2017 and September 2017 inspections. These improvements included, staff training, psychological therapies and leadership, blanket restrictions, adherence to the Mental Capacity Act and the recruitment strategy for permanent staff.
• Staff managed risk well. They made a comprehensive risk assessment for every patient, reviewed this regularly and updated it when required. They carried out regular environmental risk assessments to ensure the environment was safe.
• The wards had enough staff to meet the patients’ needs and allowed patients to have regular one-to-one time with their named nurse.
• Staff ensured that every patient had an up to date, personalised, holistic and recovery orientated care plan. They ensured that patients had good access to physical healthcare, including access to specialists when needed.
• Staff tailored one-to-one engagement, leisure activities, and support to develop social and independent living skills to address the individual needs of each patient. Patients had access to a wide range of therapeutic activities. Staff encouraged and worked in creative and flexible ways to promote educational activities
• Patients spoke highly of support they received from staff. They told us that staff understood their individual needs, were polite, compassionate and always willing to offer that emotional and practical support. Staff actively involved patients in decisions around their care and the service. The hospital had demonstrated high commitment to develop the service with the full participation of patients. Staff gave patients information on how to make complaints and patients knew how to complain or raise concerns.
• Managers provided staff with regular supervision and an annual appraisal. Staff overwhelmingly reported high levels of satisfaction including those on contract from agency. All staff told us that they felt greatly respected, supported and valued. The leaders showed the high levels of experience and ability needed to provide high quality care.
• There were effective systems in place to monitor and review progress against the strategy and plans. There were effective working systems and ways for governance structure and arrangements.
• Staff followed good practice in medicines management process, all medication was stored appropriately. Medication was audited regularly.

However:

• The service relied heavily on agency staff to cover high number of vacancies.
• Not all staff were up to date with prevent and manual handling practical training.