We rated Knightsbridge House as good overall because:

• The level of care and commitment from staff towards patients was outstanding. There was a real sense of community spirit at Knightsbridge House. Where possible, patients were actively supported to take ownership of their lives, care and treatment. A ‘this is me’ system was in place which held details specific to each individual patient’s needs. A recovery tool called life star was being introduced, that promoted independence, choice and wellbeing. Staff were also being trained in person centred care planning. There was a ‘my day’ system in place that offered patients the opportunity to make recreational plans outside of their usual routine. Staff who were new or unfamiliar with the patients held prompt cards on their person to guide them as to each patient’s needs. Some patients had assumed roles within the building, supporting staff in their daily activities. This helped build confidence and strengthen independence.

• The leadership within Knightsbridge House was visible and accessible. Governance procedures were in place to ensure a high standard of care delivery at all times. Medicine management arrangements were good as were all legal requirements surrounding the MHA and MCA. There was easy read information available, including information about the MHA and MCA. Where restrictions were in place, this was clinically justified and risk assessments completed, sometimes with the assistance of patients.

• The environment was clean and inviting. Cleaning schedules and environmental assessment were in place. All patients had their own bedroom and bathroom facilities where they were supported by staff to take care of their own personal space. All patients had a personal emergency evacuation plan in place.
• However:
• Although overall, statutory and mandatory training completion rates for staff were good, there were some subjects, including infection control and life support training, that many staff had not completed training in. This was due to the transition between one company to another as some training requirements had changed. However, staff were now booked onto training. Not all staff had received regular supervision but this was being addressed.

We rated Knightsbridge House as good because patients received care in a safe environment and there were enough staff of different disciplines to meet patient’s needs. The provider was recruiting to fill the vacant posts for qualified nurses.

Staff had received mandatory and specialist training and knew how and when to make safeguarding alerts. Staff managed medicines appropriately and safely in line with guidance and legislation.

Patients had detailed mental capacity act assessments. Staff we talked with had a good working knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff were kind and respectful to patients and recognised their individual needs. Staff spoke to patients in a respectful manner that suited each individuals preference. All the patients we spoke with told us they liked the staff and staff treated them with respect.

There were comprehensive assessments of patient’s needs. Patients had access to their own easy read care plans and the team made a good effort at adapting documents so they were accessible. There were no waiting times for treatment and discharge planning was thorough.

Good governance processes identified where the service needed to improve. This had led to improvement plans for the service. Staff expressed the vision and values of the service. Staff morale was good and team worked well together.

The manager told us, and records confirmed that, supervision took place every month and appraisals were completed annually. Staff told us they felt supported and they talked positively about their manager.

Staff, patients and families knew how to complain and comments books were easily available.

However, staff had not recognised that some medications in use at the hospital should be classed as rapid tranquilisation. While nursing staff were dispensing, administering and monitoring the medication correctly, they did not understand that this was called rapid tranquilisation. The consultant psychiatrist and registered manager acknowledged this and agreed that training was required. Rapid tranquilisation included the use of oral Lorazepam and Haloperidol which was being given to patients as and when required, this is known as (PRN) medication.

Some areas appeared in need of decoration and some had not been thoroughly cleaned. For example, we found a build up of dirt, dust and some cobwebs in higher areas including the tops of some door frames and window frames and in the laundry area of Carard Cottage (Carard Cottage is a four-bed step down property that forms part of Knightsbridge Hospital).

Some mental capacity assessments were identical in detail. For example, one patient had eight assessments of their understanding of each of their care plans. These assessments had been completed on the same day and were identical in detail with the exception of the care plan title. Mental capacity assessments should be decision specific and this was not reflected in the detail of these eight assessments.

For the mental capacity assessments we reviewed, it was not clear patients had been fully involved. For example, there were no quotes from patients or clear recording of patient responses to questions asked.

The hospital had no system in place to log concerns or complaints resolved at a local service level. This meant staff might not identify potential trends.