Our rating of this service stayed the same. We rated it as good because:

• Patients received safe care from well-trained staff who understood their needs. 
• The hospital was clean and well maintained.
• Staff reported incidents and learned lessons when things went wrong.
• Staff assessed and managed risks to patients, protected them from abuse and achieved the right balance to maintain their safety in the least restrictive environment possible.
• The hospital team included or had access to a range of specialists required to meet the needs of patients on the ward.  A number of staff were undergoing training to deliver psychological interventions.
• Care and treatment was delivered by a multidisciplinary team that maintained good links with other agencies that formed part of the patient’s care pathway.
• Discharge was rarely delayed and meaningful activities were available for all patients.
• Patients and their families were treated with compassion and kindness and their dignity.
• Staff involved patients in decisions about their care and gave them opportunities to feed back on the service.
• The service worked to a recognised model of mental health rehabilitation. Governance processes ensured that ward procedures ran smoothly.

However:

• The provider did not offer the full range of psychological therapies for patients in line with national guidance on best practice.
• Discharge planning had not followed national guidance and had not started on admission or included clear goals for patients to follow.
• Records relating to patient care were not always up-to-date, easily accessible to all staff or accurate in reflecting how the service was supporting patients on a day to day basis.

• Governance and audit processes had not identified and corrected some issues we found at ward level.  

We rated Millbrook Independent Hospital as good because:

• The ward was clean, tidy and well maintained. The clinic room was fully equipped and emergency equipment was checked regularly. Staff were aware of how to report incidents and did so via the online incident reporting system. The ward complied with guidance on same sex accommodation by having single ensuite bedrooms and a designated female lounge area. There were good medicines management procedures for recording, dispensing and storing of medication. Staff were aware of the duty of candour and their responsibilities surrounding this.
• Care plans were holistic, recovery focused and included the views of the patient. All patients had a physical health check on admission and there was evidence of ongoing physical health monitoring. There was evidence that National Institute for Health and Care Excellence guidance was being followed in relation to prescribing of medication and there was a range of psychological therapies on offer to patients. Clinical staff participated in a wide range of clinical audit, including medications, mental health act and care records. All staff had received an appraisal in the last twelve months. The mandatory training rate was 86%. This was above the Alternative Futures Group target of 80%
• We saw positive interactions between staff and patient. All patients we spoke with told us they were treated in a dignified, respectful and caring manner. The staff we spoke with knew the patients well and this was reflected in the care plans of the patients. Patients all had a copy of their care plan if they wanted one and they were fully involved in developing them. There were weekly community meetings where patients were given the opportunity to give feedback on the ward. Patients told us they were encouraged to join in with activities that were available in the local community

• The service was a good example of social inclusion and there was a big emphasis on patients engaging in activities in the local community. This included a college course called “back on track”, which consisted of short six week courses on English and maths

• the service was discharge orientated, discharges were well planned and happened at an appopriate time for that person. There was a full range of rooms to support care and treatment of the patients. Patients had the facilities to make a phone call in private. There was a big emphasis on patients accessing local groups for activities. However, there was also a wide range of activities available on the ward seven days a week including evenings. Staff and patients were able to discuss any issues in community meetings and staff meetings. Information leaflets were available in a range of languages if required. Patients had access to an independent mental health advocate who visited the ward on a weekly basis. Staff were aware of the organisation’s vision and values and used them as a basis for their work with patients’. These were displayed in the communal areas.

However:

• not all staff had received quarterly supervision as per the managing performance policy
• there was no agreement in place with the advocacy service for the provision of a generic advocacy for informal patients
• the section 17 leave file contained duplicate copies of section 17 leave authorisation and old leave forms that had not been struck through. This made it difficult to establish exactly what leave had been granted for some patients
• in some of the files examined there was no evidence of the approved mental health professional report completed at the point of detention
• Sickness levels were at 9.5%

There were nine young adults present in Millbrook on the day of our inspection. They were all suffering from or recovering from long term mental health problems. We spoke to three patients and three members of staff, and the registered manager.

We felt that there was a calm and therapeutic atmosphere in Millbrook. There was plenty of space and relaxation areas. One patient said: "It's okay here. It is peaceful."

One person said: "They treat me with respect. They explained to me why I am here. For a hospital they treat me okay - they are polite about it."

There were also plenty of activities, both inside and outside Millbrook.

We found that patients were treated respectfully and their independence was encouraged, with a view to them returning to more independent living. However, we found that discharge planning had not always been recorded, as had been recommended in an earlier visit. We found that the staff were well trained in identifying and dealing with any instances of abuse.

We found that staff were well supported and there were good systems of supervision and appraisal.

We found one instance where the system of record-keeping had failed, but that the service was compliant with the standard around records.

On the day of our inspection 10 patients were living at Millbrook. We saw that patients had been assessed prior to being admitted to make sure the hospital was the most appropriate place to meet their needs. These needs and their treatment plans were reviewed usually monthly.

Patients had been assessed to see if they had the capacity to make their own decisions. If they had capacity consent was sought where appropriate for all aspects of their treatment. Where they did not have capacity they were involved in the decision making process. In all cases all appropriate documentation required under the Mental Health Act 1983 and the Mental Capacity Act 2005 had been completed.

Treatment was provided in a purpose built hospital that met patients’ needs. It was bright and well maintained. We saw there were enough experienced staff to provide treatment at all times.

Patients told us they were happy with the treatment and support they received. Comments from patients who recently completed a service user questionnaire included “Staff help me and support me in my wishes”, “Everyone is good here. I like living at Millbrook” and included “My nurse always gives me the information I need”.

We carried out this visit to check that the provider had made improvements in the areas we identified as non-compliant at the last review. The last time we visited people spoke very positively about the care they were receiving and did not raise any concerns. Therefore, we did not seek further feedback from people using the service during this review.

People using the service gave us very positive feedback about the care they received. Some people said the hospital was the best place they had been to receive mental health care. They were complimentary about the staff and one person said the staff were “wonderful”. People were aware of their current care plans and the medicines they were taking. They said they did not get bored and they were happy with the range of activities available. People said they felt safe. People told us that they liked the food and they had plenty of choice at mealtimes. We were given many good examples by people using the service of how staff were supporting them to become fully independent. People were aware of the plans for their future and spoke positively about the progress they had made at the hospital.