We rated Oak Lodge as outstanding because:

• The service had a person-centred approach to recovery. Patients were involved throughout their care and recovery plans. Individual goals and objectives were identified with each patient to help them achieve their preferred outcome. Staff respected and valued patients as equals. This was complemented by clear governance structure with a comprehensive range of audits which were fully completed to continuously drive improvement.
• Patients and staff worked in true partnership as equals in a range of ways and at all levels from involvement in their own individual care goals through to involvement in the management of the ward. This was exemplified by the manager who encouraged patient representatives to be not only fully involved in the preparation of a presentation to the Care Quality Commission inspection team but also actively presenting it.
• Discharge planning from the point of admission promoted links with the local community either by accessing services or volunteering at local community groups. 

• Staff at all levels displaying an understanding of the individual needs of patients and acting upon those needs. Patients and relatives were universally positive about the staff and how they would make time to assist patients.
• The morale of staff was high and they reported strong working relationships with their colleagues. Staff felt supported by management and that they were encouraged to raise concerns with them. Staff spoke highly of the culture. Staff felt that senior management listened to them and included them in the development of the service.

• The hospital was recovery focused with care and support plans developed from the mental health recovery star tool. Patients received multidisciplinary input from a range of staff. Staff provided enthusiastic and individualised support to patients over daily tasks. There were good systems in place to support adherence to the Mental Health Act (MHA).

We visited Oak Lodge on 4 November 2013 and found the hospital to be warm, clean and bright. There were four self-contained flats and eight en-suite rooms, a service user’s kitchen, an activity room and communal areas. There was a private enclosed garden with seating and fire pit tables.

We discussed with the manager what people living at the hospital wished to be known as. The manager told us that following discussions with them they preferred to be known as service users.

We arrived as the mornings meeting was due to start. With the consent of service users we were invited into their meeting. The meeting takes place daily Monday to Friday and where possible all service users were expected to attend. The meeting provided service users with the opportunity to discuss any issues and how they were to spend their day, for example going shopping, attending courses or appointments. Each service user was allocated a member of staff who they would be working with that day. We observed staff interaction with service users was friendly and polite.

We were shown around the hospital by a service user who invited us into their flat and told us about their plans for the future. Another service user also showed us their room. Rooms were comfortable and had been personalised with service users own belongings.

We spoke with four service users, one told us, “The staff are very good”. Another told us, “They help to sort things out for me”.

We saw staff had access to relevant policies and procedures including safeguarding procedures and contact details. Staff we spoke with demonstrated an understanding of safeguarding and whistleblowing.

The hospital works with services users on engaging with them, consent and treatment and recovery. Their aim is to assist service users where possible to live in the community with continued staff support if required.

We observed a relaxed atmosphere in the hospital environment, with people interacting with staff easily. People spoke openly with inspectors, about their experience of living in the hospital.

One person told us: “Takes a lot of beating, this place.”

We saw seven records for people who were detained in the hospital under The Mental Health Act 1983. We looked in detail at three records, in which we saw that capacity assessments had been completed and were in date.

All three records provided evidence – that people had their rights explained; speaking to one nurse they told us "Everybody has a named nurse and it is their responsibility to ascertain that people know their rights and also to answer any questions people that they have. We also ensure that people have information about advocacy support."

The hospital was purpose-built with an outdoor court yard in the centre of the building, which is a well maintained area with a summer house, plant beds and BBQ. There were eight en-suite rooms and four self-contained flats.

Oak Lodge had twenty five staff, including two managers, four domiciliary staff, six registered nurses and twelve support workers, qualified up to NVQ level 2 (National Vocational Qualifications) several have also completed level 3.

One member of staff told us: "This is the best place I have worked, seeing how staff work as a team, there are no weak links here since the new manager took over."

We spoke with two people. One person said, “This is the best place I have stayed at. The staff listen to you and they understand if you have any worries.”

We were told that staff offered encouragement and support in helping people who were attending educational courses and other community programmes.

Another said, “This place it’s great, I am very happy. The staff know when things are not right and they sort it out”.

We rated Oak Lodge as good because:

• There were enough staff working at Oak Lodge to ensure the safety of patients. Nurses carried out weekly medication audits, which the senior nurse practitioner verified on a monthly basis. The environment of Oak Lodge reflected good practice for a rehabilitation ward as it provided a safe and homely space which helped make patients feel stable and secure. Staff carried out thorough risk assessments. Staff demonstrated that they understood safeguarding procedures and had established links with the local authority safeguarding leads.

• Patient records were holistic and personalised. Staff had a clear recovery focus to support patients to recover from mental health problems. Staff also understood and followed the requirements of the Mental Health Act and Mental Capacity Act. Training opportunities in addition to mandatory training were offered to staff. Staff followed the National Institute for Health and Care Excellence (NICE) guidelines in the prescribing of anti-psychotic medication.

• Patients and carers gave us positive feedback about the service. Staff and patients worked together as equal partners with joint meetings and shared decision making as part of patients’ recovery. There was a stable and committed staff team who knew the patients well. Patients were treated with dignity and respect and were involved in their own care. Patients were involved in meaningful activities and there was an impressive gardening project.

• Patients were given information on treatments to support them to make informed choices about their physical healthcare. Oak Lodge staff worked collaboratively with other agencies to make sure patients were treated close to home. Oak Lodge had developed a patient group that supported patients preparing for discharge.

• Patients enjoyed the food and said it was nice. Menus could be adapted in line with patients’ religious and cultural needs.

• The provider had a range of quality assurance and governance meetings set up across their organisation and were introducing new performance management processes and service audits. Staff had changed the medicine management audits that were continuing to improve quality by addressing minor concerns. Staff were positive about working at Oak Lodge. Senior managers were working well with other health and social care agencies to improve quality.

However, while local governance was largely effective, there were minor gaps within the audit system. The provider was aware of these gaps and had started the work necessary, to improve their systems.