We rated Lombard House as good because:

• Ward areas were clean and well maintained. Patients completed cleaning and laundry tasks as part of their rehabilitation programme to develop life skills. Staff supported patients with kitchen tasks and ensured items such as cleaning products were accounted for after use.
• All ward and treatment areas contained blind spots due to their layout, but this was mitigated by use of convex mirrors to aid lines of sight for staff.
• The provider had completed a ligature risk audit for the main house. Staff were observed to monitor patient whereabouts within the main house and the ‘flats’ in line with their procedures.
• Staff collected risk information before admission and reviewed this regularly at multi-disciplinary meetings and during shift handovers. Staff updated risk assessments following incidents. Information on historic risks including those linked to index offences, self-harming behaviours and episodes of being absent without leave from previous settings was assessed before admission.
• The provider had a policy in place for patients requiring increased levels of observation and monitoring during the day and overnight. There were procedures in place for searching property, patients and their bedrooms during their stay.
• Patients received ongoing health monitoring, with onward referrals to the local GP surgery for medical input. Arrangements were in place for patients to receive a learning disability specific annual health care check with the local GP.
• Patients had access to psychological therapies as recommended in the national institute for health and care excellence guidelines.
• As part of the rehabilitation programme, patients were encouraged to develop independent medication management skills.
• Staff morale was good, they spoke passionately about their jobs whilst acknowledging the challenges they faced. Staff cited cohesive, strong team working and peer support as the means of sustaining their role, along with regular supervision and managerial oversight.
• Staff completed mandatory Mental Capacity Act (MCA) training. Training completion compliance was 100%.
• Staff discussed admission and discharge arrangements in the daily handover meetings and as part of regular formulation, care programme approach and risk management meetings.
• Patient areas contained artwork and pictures, and patients could personalise their own bedrooms.
• Patients discussed weekend activities during weekly community meetings. Staff ensured activities linked to rehabilitation goals and development of life skills, along with increasing community integration. Staff worked collaboratively with the patients to ensure activities were meaningful to maximise engagement.
• Staff were up to date with mandatory training, with completion rates between 91%, and 100%.
• Completion of annual appraisal rates were 98%. There was one appraisal to be signed off by the management team.
• Staff received regular supervision, with completion compliance at 93%. The provider key performance indicator was for 85% completion rate.

We spoke with people who lived at the home who told us that staff consulted them and respected and acted on the decisions they made about the care and support they agreed to.

Our observations showed us that people were given the support and attention they needed and had a positive experience of being included in conversations, decision making and activities.

We found that plans of care contained the information staff members needed to ensure that the health and safety of people was promoted.

People told us that they received the care and support they needed and that staff were very kind.

Improvements had been made to the environment which was clean and adequately maintained in most areas.

Staffing levels were adequate when all staff absence was covered. However, people told us that they sometimes had to wait to receive the one to one support they required for them to go on outings.

People told us their complaints were listened to and resolved. We found that there was a complaints system in place that met the needs of people living in and visiting the home.

We spoke with five of the seven people who were living in the home. People told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that they always treated them with respect and that their privacy was respected. They told us that the activities they chose were arranged and that they were provided with something to do on most days. They also told us that the environment was comfortable and clean and that they were provided with good quality meals.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who did not comment. We observed that people living in the home were given the support and attention they needed, were appropriately supported to manage their behaviour and had a positive experience of being included in conversations and decision making.

Members of the team made the following observations of the environment whilst on site: -

“The service was very calm and welcoming when we arrived”, “It doesn’t seem like a rehabilitation unit”, “The house felt quite homely, had pictures on the walls and was decorated nicely”, “Everyone seemed to get on well with each other”, “The payphone for people to call their families was in the hall”, “Staff seemed to talk to people in a calm and respectful manner”, “There was nowhere private to meet with visitors”

The registered manager provided us with a list of contact details for people’s relatives and we chose a sample from this list. A member of the team contacted two of them by telephone, having first ensured that the person using the service was happy for us to speak to them. A third person they had arranged to speak with was not available when they called. They were asked a range of questions about their relative’s care and some of the comments included.

When asked about attending clinical meetings; one person that we spoke to told us that they were “asked to a meeting every six months or so” but couldn’t go as it was too far (about 70 miles) they told us they were “sent notes about the meetings but there was no explanation”. They also told us they would like to have “more say in their relative’s life”. All said they were in regular contact with their family in Lombard House, mainly by telephone.

The five people living at Lombard House that we spoke with all agreed that it was a comfortable place to live. One person said “I knew I was moving here and was told it was the next step and for rehabilitation, but it’s no different to the hospital’; another said they had been “living at Lombard house for 17 years”. Other people that they spoke to had been there for more than three years. They all said that they had been involved in creating their care plans, one person said “if I have an idea my nurse will put it in my care plan”, and when asked whether they had a copy, we were told by two of the people that they had a simplified care plan that they were able to keep, and showed us a copy.

Other comments included,

“We have a member of staff who is a brilliant cook and we want to learn more from them”, “Staff help me as much as they can”, “I can tell staff what I want”, “I would like to be involved in choosing new staff “ and “Sometimes there aren’t enough staff on duty to do the things I want to do”

We rated Lombard House as good because:

• Patients were encouraged to be fully involved in their own care and treatment. They were active partners in their care and treatment and supported where needed.
• Staff made comprehensive assessments of risk and patient needs, including physical health, and devised care plans that addressed these. They assessed risk before during and after admission, reviewed, and updated these assessments regularly. Staff monitored physical health regularly.
• There was good multi-disciplinary input into planning patient discharge, transfer or transition to other services. This was reviewed regular to facilitate discharge at the earliest possible stage.
• Patients were appropriately safeguarded and managers had systems for tracking and monitoring safeguarding referrals. They take steps to prevent abuse occurring and work effectively with others to implement any protection plans in place. The provider has a service wide approach to learning from incidents, allowing lessons to be learnt across the organisation
• There were good audits in place and managers were well sighted on any issues within the hospital and were working to address these

However:

• The provider should continue to implement and review their patients’ search strategy for locked rehabilitation units to reduce any blanket restrictions in place.