We rated Lea court as good because

:

• effective systems and processes were in place to monitor and manage environmental risks
• there were adequate staffing levels, with staff on duty that were knowledgeable, and experienced. Staff had all attended their mandatory training and had additional training to support their role
• patients’ care plans and risk assessments were in place and up to date. They all reflected the patients’ needs and were recovery focused
• safeguarding procedures were in place and staff were able to tell us how they would identify and report any issues
• we observed staff being kind and respectful to patients. Staff were also very knowledgeable about the patients they cared for
• patients were able to personalise their bedrooms, and had access to a pay phone in a private area of the ward. Blanket restrictions were limited and individualised based on risk
• there were no restraints or complaints over the 12 months period prior to inspection
• physical health care was prioritised and monitored. This included those patients on high dose antipsychotics
• multi-disciplinary team meetings and care programme approach meetings took place that were patient centred and focused on the person’s recover journey
• the visions and values of the organisation were embedded, and there was evidence of positive leadership
• staff and team morale was good, staff had access to regular team meetings, supervision and work performance appraisals.

However,

• there were not enough panic alarms available for all staff, which put the staff at risk of harm
• the service did not log informal complaints therefore there were no records of how these were managed.

We saw that care plans had been signed by people who live at the service and their named nurse.

Most of the people spoken with said they were asked to consent to treatment and felt they were given sufficient information to enable them to make informed choices. One person said “the Dr explained all the side effects about my medication to me it was the way he told me that made the difference, he told me the good and the bad and I thought, I trust you, your right up front”.

All of the people we spoke with told us they received the care and support they needed and they said staff responded well to their needs. One person said, "I get really good support. I am doing so well."

Another said they were asked to put their own ideas and suggestions into their care plan and explained how their key worker encouraged him.

The staff we spoke with had a good understanding of people’s individual support needs and the majority of staff were good at identifying behaviours which may present risks to the person or to others.

People were encouraged to cook meals for themselves as part of rehabilitation and they were supported by the occupational therapist and key worker to budget, shop and cook meals sometimes for their peers.

The people who lived in Lea Court we spoke with told us they thought there was enough staff to support them in the way that they needed. One person commented “There always seems to be enough staff.”

The purpose of this visit was to follow up on what actions the provider had taken to improve the service since our last visit in July 2012 in which several areas of the service were judged as non compliant. At this visit we met with the provider and they sent us regular updates on the action they had taken to meet the compliance actions we had issued in July 2012.

During our visit on 21 December 2012 we saw that improvements had been made in the areas of safeguarding; care and welfare of people who use the service; supporting staff; assessing the quality of the service and records.

People who use the service told us that they were consulted and supported to make decisions about their treatment and care. They told us that they have regular opportunities to discuss their plan of care with the staff and their doctor. People told us that the staff team always respected their privacy and dignity. One person told us “staff have been very good and help me.”

People told us during our visit that they regularly had the opportunity to get involved in the planning of their care. People told us that they had regular access to mental healthcare professionals and their GP. They told us they felt safe living at Lea Court and that they knew who to speak to if they were not happy or had a concern.

People told us positive things about the staff who supported them. Comments included “they are great”; “they are very supportive and listen to me.”

We rated Lea Court as good because:

• The hospital complied with the Department of Health guidance on same sex accommodation.
• There was enough staff to provide recovery-based care and treatment to patients.
• Patients’ risk assessments were well completed and reviewed.
• There were minimal significant incidents but when incidents did occur, staff learnt lessons.
• Staff carried out regular physical health checks with patients.
• Patient recovery plans were well completed and personalised.
• There was good multidisciplinary working with thorough occupational therapy assessment and input.
• Staff were receiving specialist clinical skills training to provide more effective care and treatment to patients with a personality disorder.
• Staff were trained in, and adhering to, the Mental Health Act and Mental Capacity Act.
• Comments from patients on the standards of care and treatment were positive.
• Patients were involved in identifying their own goals to aid meaningful recovery and developing their care plans.
• There were regular weekly patient community meetings occurring for patients to discuss day to day issues.
• Staff had regular contact with community mental health team professionals and the hospital had links with the wider community.
• There were no patient complaints and managers had put in systems so that if informal complaints were made they were managed well.
• Staff morale was good and there was good local leadership.
• Governance arrangement and checks in place were good.

However:

• There was a domestic sink in the clinic room with plug and overflow which did not meet good infection control measures. The provider was taking action to address this.
• Following a recent incident, managers at Lea Court had not been able to fully clarify the pathways into acute mental health inpatient and psychiatric intensive care for deteriorating patients with local partners.
• There was no designated on-site psychologist but patients had access to psychological services.

• Managers were working to improve formal supervision uptake rates.

• Although staff were regularly informing detained patients of their rights, we found a small number of patients’ files where staff had not revisited patients’ rights at particular intervals such as, in one case, when a patient’s detention was renewed.
• While overall adherence to the Mental Capacity Act was good; we did see in one case, nursing staff had applied for a standard Deprivation of Liberty Safeguards application and were still awaiting a decision but had not applied for an urgent authorisation alongside this. This was rectified at the earliest opportunity.
• Written minutes of community meetings did not always clearly record what action was needed or what action had been taken to show that patients’ concerns had been fully addressed.