We rated Meadow Park as good because:

• Concave mirrors situated in the ceiling allowed full view of the corridors, thereby allowing staff to observe all parts of the ward. Ligature points were noted during the inspection, and the environmental risk and assessment plan showed that these points were considered and action was in place to address issues. The hospital furniture was well maintained, the hospital itself was very clean. Staffing levels were good, and followed policy. Care plans showed evidence of positive risk taking on the part of the staff at Meadow Park.
• Patient care plans were comprehensive, personalised, holistic, and recovery orientated. Each patient had signed that they agreed with their care plans. Positive behavioural support plans were in place. There was evidence of patient involvement in all aspects of their care. There was evidence that staff participated actively in clinical audit. Staff were regularly supervised and appraised. Discharge planning was evident in care records and case files. There was active physical health monitoring at Meadow Park, with a registered general nurse employed to take the physical health lead. Mental Health Act documentation was in order and audited. There was training in the Mental Capacity Act.
• We saw staff interacting with patients at Meadow Park, and it was clear that there were good relationships. Patients stated that staff were respectful, approachable, and interested in patient well-being. Staff were clearly knowledgeable about their patients, and this was reflected in their interaction and notes on case files. Patients commented favourably on the available activities, their named nurses and their plans for the future.
• Patients who were on leave did not have their beds filled in their absence, ensuring the bed was available on return. Patients had access to their bedrooms, and could securely lock the room. There was access to a telephone with a privacy hood, as well as patients having their own mobile telephones. On admission to Meadow Park, patients completed a questionnaire relating to dietary requirements. Likes and dislikes, allergies, and religion were considered.
• Staff knew senior managers; both qualified staff and support workers said that senior managers visited the hospital. Staff used key performance indicators to gauge and improve performance. Clinical audit was being carried out with full staff involvement. Staff felt they could raise concerns without fear of victimisation, and morale was reported as being high among staff. We saw evidence of good team working, and there was a high level of support from the hospital manager and senior staff.
• However
• Although patients had signed to agree with their care plans, there was no evidence to show that patients had received a copy of the care plan. Some patients told us they did not have copies, but that they were involved in the production, so they knew what the care plan entailed.
• Psychologist input was initiated through a service level agreement, but we could not fully determine the levels of input by the psychologist; guidance suggests 0.4 whole time equivalent for a psychologist in a 14-bedded unit, and Meadow Park is a 20-bedded unit.
• There was one full-time Occupational therapist at Meadow Park, a 20-bedded unit. This is the accepted guidance for a 14-bedded unit, and it was felt that an occupational therapy assistant could be utilised to ensure therapies were fully utilised.

We rated Meadow Park Independent Hospital as good because

:

• Concave mirrors situated in the ceiling allowed full view of the corridors, thereby allowing staff to observe all parts of the ward. Ligature points were noted during the inspection, and the environmental risk and assessment plan showed that these points were considered and action was in place to address issues. The hospital furniture was well maintained, the hospital itself was very clean. Staffing levels were good, and followed policy. Care plans showed evidence of positive risk taking on the part of the staff at Meadow Park.
• The care plans were comprehensive, personalised, holistic, and recovery orientated. Each patient had signed for and received a copy of their care plan. There was evidence of patient involvement in all aspects of their care. There was evidence that staff participated actively in clinical audit. Staff were regularly supervised and appraised. Discharge planning was evident in care records and case files. There was active physical health monitoring at Meadow Park. Mental Health Act documentation was in order and audited.
• We saw staff interacting with patients at Meadow Park, and it was clear that there were good relationships. Patients stated that staff were respectful, approachable, and interested in patient well-being. Staff were clearly knowledgeable about their patients, and this was reflected in their interaction and notes on case files. Patients commented favourably on the available activities, their named nurses and their plans for the future.
• Patients who were on leave did not have their beds filled in their absence, ensuring the bed was available on return. Patients had keys to their bedrooms, and could securely lock the room. There was access to a telephone with a privacy hood, as well as patients having their own mobile telephones. On admission to Meadow Park, patients completed a questionnaire relating to dietary requirements. Likes and dislikes, allergies, and religion were considered.
• Staff knew senior managers; both qualified staff and support workers said that senior managers visited the hospital. Key performance indicators (KPIs) were used by Meadow Park staff to gauge and improve performance. Clinical audit was being carried out with full staff involvement: the quality assurance framework showed that 14 clinical audits were undertaken by trained staff. Staff felt they could raise concerns without fear of victimisation, and morale was reported as being high among staff. We saw evidence of good team working at Meadow Park, and there was a high level of support from the hospital manager and senior staff.

However

Mental Capacity Act training was only considered as part of safeguarding training, not as a separate training topic, and although it was an agenda item in meeting minutes, it was not audited.

We spoke with three patients who told us that they felt well supported by staff and involved in their own recovery. Comments included, "Support is getting better, staff are helping me move on with my life" and "I have regular meetings where we discuss my care, I help draw up my care plan."

We observed care and support being delivered by staff. We noted that staff were warm in their manner, spoke at a relaxed pace and worked collaboratively with patients. Staff had a good understanding of the patients they supported and could adapt their approach according to the individual needs of the patient. One patient we spoke with said "I don't always treat staff with respect but they are always professional regardless of my mood."

We looked at records held by the provider and found these were accurate, fit for purpose and stored securely. We reviewed care files belonging to seven patients. Appropriate care plans and risk assessments were in place and these had been reviewed regularly. Care files contained clear and up to date information. In general, all appropriate documentation was signed by patients. Where a patient had not signed a document the reason was clearly recorded by staff.

We spoke to four patients who told us they felt safe at the service and well supported. They told us they felt involved in the care and treatment they received. Some comments made were:-

“The staff are very nice. They are helping me to get better.”

“I see the nurse regularly. If I have any issues they sort them out.”

We looked at three care and treatment records. Care plans and risk assessments were in place with information about patients care needs and risks identified.

Staff were aware of how to protect patients through the safeguarding vulnerable adults procedure.

There were systems in place to monitor the quality of the service and to obtain the views of patients about how the service operated.

We found that improvements were needed to record keeping to ensure that patients were fully protected against the risks of inappropriately maintained records.

We spoke to four people who used the service who said that they regularly had the opportunity to get involved in the planning of their care.

They said staff listened to them and that staff were approachable if they needed to discuss any concerns or wanted support.

They said that they were treated in a respectful manner by the staff team. They told us that they felt safe at the service and that they had a good relationship with the staff. Some comments made were:-

“The staff are friendly and helpful and give me the support I need.”

“The staff ask for our opinions and respect our views. They listen to us. It’s a nice place.”

“The service is very good. The staff are brilliant.”

Records showed that people had a care plan detailing the support they needed and how staff were to minimise risks to their well-being.

There were practices in place to ensure that the recruitment of staff and staff training appropriately supported the people who used the service.

The service was clean and there were procedures and training in place to promote good hygiene and prevent infection.

There were systems in place to obtain the views of the people who used the service and their relatives about how the service operated. The home operated an effective system for the management of complaints.

Cheshire West and Chester Social Services reported that no concerns had been received about the operation of the service within the last twelve months.

People told us positive things about the service they received. They told us that they were encouraged to participate in the planning of their care and treatment.

People told us that they liked the environment that they lived in. They told us that they felt safe and one person told us it is 'like a hotel.'

People told us they liked the food that was served at Meadow Park and that they had a choice of what they wanted to eat.

People told us that the staff listened to them and that they could approach the staff with any concerns they may have.

Overall people were very happy with the service they received. One person told us 'it’s the best place I've ever lived.’