We rated Old Leigh House as good because:

• Clinical areas were visibly clean and cleaning records were up to date. Staff prescribed and administered medication appropriately. Staff adhered to infection control principles. Resuscitation equipment was checked and accessible and staff carried personal alarms.
• Staff completed health and safety risk assessments of the environment, assessed the risks to patients thoroughly and reviewed plans to keep them safe regularly. They produced positive behaviour support plans that were holistic and based on the needs of each patient. Staff were aware of incident reporting and safeguarding processes, how to report and follow procedures.
• Patients had annual and ongoing physical health monitoring. Patients could see a General Practitioner (GP) at the hospital or at the local GP surgery. Patients could access other services such as dental, dietician or podiatry services when required. Nutrition, exercise and weight management were care planned if required.
• The hospital was appropriately staffed, regular bank staff were used who were familiar with the service, leave and activities were rarely cancelled due to staff shortages and there was adequate medical cover at day and night.
• All staff were trained in the Mental Health Act 1983 (MHA) and the Mental Capacity Act 2005 (MCA). Staff read patients their legal rights regularly and advocacy services were available. Staff assessed patients’ capacity to make individual decisions. Where patients were unable to make decisions for themselves, staff worked with local authorities to assess patients’ best interests and invited relatives to meetings to represent patients’ interests. The Responsible Clinician (RC) assessed detained patients’ capacity to consent to treatment on renewal of their detention.

• Patients had keys to their bedrooms, they had access to drinks and snacks when they wanted them and could personalise their bedrooms. Patients were involved in their Care Programme Approach (CPA) meetings, said they felt safe and listened to by staff, and knew how to complain. Relatives spoke positively about the manager, staff and the progress their relatives had made. Patients were happy with the access to and range of activities provided. They said they went out most days.
• All patients had Care Treatment Reviews to discuss discharge planning every three months. The hospital worked with case managers and care co-ordinators to find appropriate placements for patients.
• All staff involved in caring for patients, including nurses, doctors and therapy staff, worked well together and with external agencies.
• The provider reported, investigated, and learnt lessons from incidents and complaints. These were shared with staff and patients.
• Staff training, supervision and appraisals were up to date and staff had opportunities for professional development. Staff enjoyed their jobs, had good morale and job satisfaction.
• Senior managers visited the unit regularly and staff and patients knew who they were.

However:

• The provider had rated as low risk potentially harmful ligature points (anything that can be used to self-harm with) and the assessment was incomplete. Some staff were not aware of ligature points and the hospital’s ligature risk assessment. However, Staff did mitigate this risk by maintaining constant observations of high-risk patients.
• The provider escorted all patients on leave, including patients not detained under the Mental Health Act. Staff confirmed this was due to patient risks and vulnerabilities but they would be reviewing their leave policy to consider unescorted leave for appropriate patients.
• One patient consent to treatment capacity assessment did not include a record of the discussion between the consultant and the patient.
• Although patients signed care plans, evidence of patient and relative involvement were minimal.
• Room space was limited. Patients could not access the kitchen to cook and there was no separate clinic room for staff to treat patients. The provider told us they were commencing renovation work to create separate rooms for these purposes.
• Patients could not make a private telephone call or use the computer, as these were broken. The provider told us these were due to be repaired.
• Results of a staff survey conducted by the Danshell Group that owns the hospital were not broken down for individual services. Staff at Old Leigh House were not aware of the results for their service.
• There were no nurse call alarms for patients in their bedrooms, bathrooms or corridors. Staff mitigated this by regularly observing patients.
• The provider did not have patient discharge care plans or easy read versions for patients to work towards discharge.

We met with all six people that were using the service when we visited. People communicated with us verbally and non-verbally using gestures, pictures or assistive technology. People mostly gave positive feedback. People communicated to us that they felt able to approach staff if they had any issues and that staff gave them support. They indicated that their room was, “fine” and that they had activities to do in the day.

We found that the provider had systems in place for gaining people’s consent for the care and treatment and keeping people safe. Additionally there were arrangements to give staff support, for ensuring the premises were safe and suitable and for assessing and monitoring the quality of service provision.

We rated Old Leigh House as good because:

• The environment was clean and tidy and furnishings were in good condition. Cleaning records were up to date and demonstrated that staff regularly cleaned the environment.
• The provider had safe staffing levels. We reviewed the duty rotas for the past six weeks. All shifts were covered with sufficient staffing levels.
• Staff received and were up to date with mandatory training. Training records showed a 99% compliance.
• Staff completed a thorough and comprehensive risk assessment for each patient. Staff reviewed these regularly during care reviews or when there was a change in risk or following an incident. 
• There were safe medicines management procedures in place. Staff followed the National Institute for Health and Care Excellence guidelines and the Nursing and Midwifery Council guidance on medication management.
• Patients' received an assessment of their needs following admission. Staff used the information gathered during these assessments to formulate care plans and risk assessments.
• Patients' care plans were up to date and covered a range of needs. We checked four patients’ records and found that they reviewed these regularly during care reviews or when there was a change of need. Patients' were involved in the planning of their care and the care plans included the patient’s views.
• Patients had access to physical health care. The provider registered patients with a local GP service. Staff also monitored physical health need regularly and evidenced this in the patients care records.
• Patients told us that staff were kind and supported them to meet their needs.
• Patients told us that the food was of good quality and that there was a choice. Staff would ask patients on a daily basis for their choice of food from the menu. 
• Staff were aware of how to manage complaints. Staff we spoke with knew what action to take if a patient made a complaint to them. Staff told us they referred complaints to the manager who would then investigate them. 
• The provider had systems in place to monitor mandatory training, supervision, and appraisals. The manager kept records of staff compliance with training, supervision, and appraisals. We checked these and found that they were up to date.
• The provider had systems in place to share lessons learned from incidents and complaints. The provider discussed these during governance meetings and then shared with ward staff through team meetings. We reviewed the minutes of these meetings and found incidents and complaints were a standard agenda item.

However:

• Staff had not complied with the provider’s policy on supervision. All staff had received supervision within the past 3 months. The provider’s policy stated that staff should receive management supervision at least four times per year. The supervision matrix showed that 13 out of the 21 staff listed had not had this in the past 12 months. 
• Two carers felt they could be more involved in their loved one's care. They told us that they had not been consulted about care plans and had not been given a copy of their loved one's care plans.
• There was not a private room for patients to use to see visitors.