Some people living at Oaktree Manor had complex needs and were unable to discuss their care with us which meant they could not tell us their experiences. We saw from gestures and facial expressions that they were happy. From some general conversations it was evident people were satisfied with their life at Oaktree Manor. One person told us: “I do voluntary work tidying up a nature reserve.” People also made positive comments about the staff. One person said: “Staff treat me fine” and someone else told us: “All (staff) have been helpful, I’ve got no problems.”

Staff knew people well and they were able to tell us about their specific needs. We saw that there were respectful interactions between members of staff and people living in Oaktree Manor.

Staff listened to people and provided care and support in ways that met their needs and took into account their individual preferences.

People living at Oaktree Manor had the benefit of an environment that was comfortable and well maintained.

There were systems in place to support and supervise staff and to provide them with the training they needed. This ensured that they had the skills and knowledge to provide safe and effective care.

Oaktree Manor was well run by a competent manager and there were effective systems in place to record information related to the management of the service as well as people’s personal information.

During our inspection of the service on 6 March 2013, we were accompanied by a Mental Health Act Commissioner who had carried out previous Mental Health Act 1983 monitoring visits.

Staff showed a good understanding of people’s needs and preferences and we noted that staff treated them with respect.

We gathered evidence of people’s experiences of the service by talking with people, observing how they spent their time and noting how they interacted with other people living in the home and with staff. People told us that day-to-day life was “...all right.” One person said they liked to watch football and play cards. Someone told us: “I went out yesterday for a meal” and “I go out at weekends.”

We saw good interactions between staff and people in the Oaktree Centre where they attended activity sessions. People said they liked the staff and one person told us their named nurse was “... really nice.”

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the needs of the people using the service.

There had been improvements to the environment to make it more homely and we saw that further improvements were in progress. One ward, Gate House, was due to be redecorated in the near future but we noted that there were some areas that could be improved by cleaning.

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we spoke with a small group of patients and were able to hold a conversation with three people. Most of the information about people's experiences of Oaktree Manor was gathered through our observations.

We saw that people looked well cared for and that staff provided care in a safe way. People told us that their care was discussed with them.

We saw that people were supported to be involved in day to day life at Oaktree Manor.

We saw staff were respectful when speaking with people, taking time to explain what they were going to do.

We saw from the records that staff supported them to manage their health care needs.

People told us they had a choice of food and had been able to influence the meals that were provided and that the food was much improved.

People we spoke with told us that they were sometimes angry with others and at these times staff helped and supported them.

We saw that people benefited from a safe and pleasant environment. One person told us that they could have their own television and music system.

People told us that they liked living at the hospital. One person said “It’s much better than the last place.”

We rated Oaktree Manor as good because:

• Managers ensured effective systems were in place to measure the quality of the service. The provider had systems in place to help staff learn lessons from audits, complaints and incidents, through debriefs, team meetings, supervision and bulletins. Managers used these to ensure that sufficient staff were on duty and monitored mandatory training compliance and supervision. The provider operated a system to increase staffing on Fridays to facilitate staff training and administrative tasks without compromising patient care.
• Safe staffing levels had been maintained on all wards. The provider had recruited additional staff since the last inspection and had reduced the use of agency workers from 45% to 30% in the last 12 months. Morale was good and staff teams supported each other effectively.
• Staff compliance with mandatory training compliance was 90%. Staff had access to specialist training in autism and dialectical behavioural therapy. Staff had access to regular supervision.
• Patients were offered debriefs shortly after incidents and periods of seclusion. They were also offered additional debriefs, 48 hours after the event by the psychologist and speech and language therapist.
• Staff completed risk assessments for patients, which were thorough and linked to care plans. Staff completed good quality positive behavioural support plans for all patients, formulated with patient involvement.
• Patients had access to a range of psychological therapies and to a range of activities such as attending a football match, animal care and art therapy.
• Clinical staff completed audits and action was taken as a result. The provider held monthly safeguarding meetings with the local authority and police.
• We observed staff treating patients with kindness, understanding and compassion. Staff understood patients’ needs and were motivated to provide high quality care. Carers and patients told us staff were helpful and polite. Patients had access to advocacy, including independent mental health advocates and independent mental capacity advocates, when needed.

• The service had reviewed how they planned and supported patients towards their discharge from hospital. The service still experienced delayed discharges but had made consistent and considerable efforts to work with commissioners to reduce delays. Every patient had a discharge plan and staff supported patients to contact their community teams.

However:

• Managers had not ensured that staff recognised or recorded that prone restraint techniques were utilised on patients to facilitate safe exits for staff from seclusion rooms. The provider had not ensured all patients received four hourly medical reviews during prolonged periods of seclusion.
• The provider completed ligature risks assessments; however, these did not cover all ligature anchor points.

• Not all patients could access outside space at will, particularly when staff were busy.

• Staff’s use of physical interventions remained high across the service, although this was decreasing. Staff did not always update patient risk assessments after incidents.
• Staff had not ensured all emergency equipment was safe for use. The emergency oxygen mask on Pine ward was out of date and had deflated.
• Staff had not documented best interest decisions for two patients who lacked capacity.
• There was a lack of patient involvement documented in some risk assessments.
• The average length of stay for patients was 918 days across the service. This is higher than the national average of 554 days. The average length of stay on Yellowwood ward was 1150 days.
• Patients stated that food was sometimes ‘greasy’ and choices, including vegetarian options, were limited.
• Multi-faith rooms on the wards did not contain all the required literature or equipment.