We did not rate Jeesal Cawston Park because this was a focused inspection:

• Both lodges had blind spots where staff could not observe all areas. Staff mitigated risks to patients by updating patient risk assessments, carrying out one to one observations and escorting patients at all times. Managers reviewed these risks during monthly multidisciplinary meetings.
• A pharmacist attended the lodges once a week to carry out medication audits, staff kept patient consent to treatment with patient medical records and created an individual patient passport detailing both physical and mental health care needs.
• Staff knew how to report incidents, there was a clear system in place which alerted managers straight away to any incidents. Managers shared incident outcomes and lessons learnt in team meetings.
• Staff developed easy read care plans and paperwork for patients. Staff involved patients with decisions and input in their care plan. There was a range of activities and treatments available for patients.
• Multidisciplinary meetings took place every four weeks. These meetings were attended by doctors, psychology staff, nursing staff, patients and family members.
• We observed staff interacting with patients in a positive respectful manner. We saw staff offering practical support to ensure individual patient needs were met. Staff knew each patient’s preferences and needs.
• Managers invited family members to patient review meetings and collected feedback from patients and families about the care and treatment provided.

However:

• One staff member carrying out one to one observations reported that they were not confident in carrying these out. They reported that the hospital was not following their own policy.
• Care and treatment records did not include detailed descriptions of how staff were helping patients to address individual skills on a daily basis. For example, one patient had a goal of building relationships, but the actions required to do this were not specific.
• One member of staff could not find care plans on the provider’s electronic records.
• Staff did not record all outcomes and the length of each episode of patient’s individual section 17 leave, clearly on patient records.

The service provided was safe. People told us they felt safe in the hospital. Staff engaged with people in a positive way and adopted a consistent and therapeutic approach.

Safeguarding issues were being appropriately reported. Staff were receiving their mandatory safeguarding training. The relevant records seen showed us that clinical risks were being managed safely by the provider.

The service was effective. Each person had an individual care record which included assessments of specific needs. Individualised care plans were in place. We found that individuals were having their rights protected under the 1983 Mental Health Act.

The service was caring. Most people told us that they felt involved in their own care and treatment. Staff interacted with people in a way which was positive and caring.

The service was responsive. Systems were in place to assess and manage any assessed risks for the people who used the service. People told us that they felt able to share any concerns with front line staff. We saw that there were a number of noticeboards on each unit to facilitate the provision of information to people.

The service was well led. Records were in place that demonstrated that the provider assessed and monitored the quality of their services.

You can see our judgements on the front page of this report.

The service provided was safe. People told us they felt safe in the hospital. Staff engaged with people in a positive way and adopted a consistent and therapeutic approach. Safeguarding issues were being appropriately reported. Staff were receiving their mandatory safeguarding training. The relevant records seen showed us that clinical risks were being managed safely by the provider.

The service was effective. Each person had an individual care record which included assessments of specific needs. Individualised care plans were in place. We saw monthly health of the nation outcome scale (HONOS) reviews documented in individual care records.

The service was caring. We found that individuals were having their rights protected under the 1983 Mental Health Act. Most people told us that they felt involved in their own care and treatment.

The service was responsive. Systems were in place to assess and manage any assessed risks for the people who used the service. People told us that they felt able to share any concerns with front line staff. We saw that there were a number of noticeboards on each unit to facilitate the provision of information to people.

The service was well led. Records were in place that demonstrated that the provider assessed and monitored the quality of their services. We noted that any required actions had been identified and subsequently addressed.

We spoke with five out of the nine patients receiving treatment and support at The Grange. They said they were treated with dignity and respect in their daily contact with staff. Staff talked with them about their needs and how they wanted to be supported. Patients had access to an independent advocate to help them to make decisions and put their views forward.

We found that patients did not always understand restrictions placed upon them or their rights with regard to some of the practices in the hospital.

Three patients told us that they thought the treatment and support they received met their needs. However, we had concerns that staff were not always clear about risks to patients’ health and safety.

Three patients said that the activities on offer did not really interest them. A new programme had been developed with the intention of giving patients more variety.

The parts of the hospital we saw were clean and hygienic. Staff had infection control training which was put into practice.

Patients said they thought there were enough staff on duty to support them. Staff absences were covered to ensure that staffing levels did not fall below the minimum set by the provider. Extra staff could be brought in if needed.

There were no formal complaints made about The Grange. However, we found a lack of clarity about the process for dealing with minor negative comments.

We rated Jeesal Cawston Park as requires improvement because:

Staff did not ensure that patients in seclusion were having the required medical and nursing reviews to meet the standards outlined in the Mental Health Act (1993) Code of Practice (2008).

Staff did not ensure that the recording of seclusion was complete and accurate. Managers did not have sufficient oversight of seclusion and restraint recording, despite seclusion recording being identified at a previous focused inspection and in the hospital’s own internal audit.

The seclusion room did not meet all the required standards of the Mental Health Act (1993) Code of Practice (2008).

Staff did not consistently and accurately fully record incidents involving restraint and the management of violence and aggression.Staff did not ensure that all patients in long term segregation were reviewed by an approved clinician every 24 hours and that all paperwork relating to long term seclusion was in place.

Staff did not ensure consistent recording of Section 17 leave for patients including risk assessment, clothing notes and details of patient engagement and behaviour whilst on leave.

However:

Staff knew the patients well and we observed good interactions across the hospital, with staff supporting and engaging with patients in a positive manner. Patients we spoke with told us they were happy at the hospital and the staff cared for them well.

There was a wide range of activities available for patients. Activity staff were enthusiastic about their role and told us that activities were person-centred and planned for patients on an individual basis, considering their preferences and interests.

Patients had comprehensive care plans that were holistic, patient focused and included a pen picture, observation and engagement plans, and goals for improving quality of life.

We observed a positive culture and good staff morale during the inspection. Staff we spoke with told us there was good teamwork and they felt respected and supported by managers and colleagues.