We have changed the rating for Safe from requires improvement to good because;

• The environment was visibly clean and records showed it was cleaned regularly. Environmental risk assessments were up to date. All of the staff had personal alarms. There were enough staff for all of the residents to have one to one time. Activities and visits were never cancelled due to lack of staff.

• The medicines management was good; we looked at all of the medication cards and they had all been signed and completed correctly. We saw records showed staff recorded fridge temperatures daily and all of the medication was stored safely and securely.

• We saw records showed the staff had checked all of the safety equipment including the defibrillator regularly.

• Staff completed risk assessments when a resident was admitted and updated them regularly. All of the staff we spoke to could explain how and when they would make a safeguarding referral.
• All of the staff we spoke to knew what and how to report an incident. Staff had reflective meetings at the end of every shift to help support learning from incidents.
• This meant the service now met Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 Safe care and treatment. During the last inspection, the service was in breach of this regulation.

We spoke with four people who were using the service and asked if their consent had been sought prior to receiving any care or treatment. We were told, “Yes the staff ran through everything with me. I have given consent.” Another person told us, “Staff asked for my consent.”

The staff we spoke with displayed a good understanding of different people’s needs which matched what we read in people's care plans. The care plans were being reviewed on a regular basis and changes made where required.

People were cared for in an environment that was clean and hygienic. There was an appropriate system in place for reporting and dealing with maintenance requirements. We saw that action had been taken to address areas of concern from our previous inspection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We spoke with six patients during our inspection. One patient told us, “‘I am involved. I feel I do consent.” Another patient told us, “I am happy with reviews. I feel involved and do consent and understand the care plan.” Where people did not have the capacity to consent, the provider had not acted fully in accordance with legal requirements.

During our inspection we observed some positive interaction between patients and staff and staff were treating patients with respect. One patient told us, “There are no real activities here.” We did not see much meaningful activity taking place within the hospital.

We spoke with six patients during our inspection who told us that they felt safe. One patient said, “I feel safe here. It’s like a second home”. Another patient told us, “I feel safe”. A relative of a patient told us that their relative had not said they felt unsafe.

There had been no cleaning staff for about six months. We saw that the environment was not always cleaned to an appropriate standard. Periodic service checks had been carried out such as gas and electric systems checks. However we saw evidence of possible water damage to parts of the building. We did not see evidence that this had been addressed.

Staff were provided with a wide range of training appropriate to their role. Not all staff were accessing their supervision. Records relating to patients and to staff were securely stored and could be located promptly when required.

This report is based on a visit that was carried out as part of a co-ordinated responsive inspection.

Patients had a key to their own bedrooms if they wished to spend time alone. One patient showed us their bedroom which was brightly decorated and personalised to their taste. Patients were able to visit the unit and stay overnight before a decision was made about placing them.

The care plans we saw contained basic information about how staff could meet the needs of each person. The care plans varied in the quality of information provided. The staff we spoke with told us they felt the care plans were useful once they had got used to the format and how to use them.

The patients we spoke with gave mixed feedback when asked if there were suitable numbers of staff to meet their needs. We were told, “The staff numbers here are ok”. Another patient said, “There are sometimes not enough staff.” During our visit we observed staff escorting patients on Section 17 leave into the community.

The manager was completing a schedule of monthly audits which were based on the expected outcomes for patients using the service. This process had identified areas where improvements needed to be made and follow up action was recorded.

The manager told us that the service was in a state of transition and that paperwork was gradually being migrated to a new system. However it was acknowledged that paperwork was not of a good standard.

We spoke to four people using the service to get their views of the support they received at Mansfield House.

People confirmed that they had care plans and told us they were able to decide who was involved in their care plan reviews.

People told us that staff supported them to maintain and develop their skills and independence and were able to follow their interest and hobbies. One person said,” I’m going to Graceland, America because I love Elvis, a nurse and another member of staff is going with me.”

People told us that they felt safe at Mansfield House and one person told us that staff supported them to manage their money and said they were learning how to budget, so that they could work towards living in the community.

We rated The Huntercombe Centre Sherwood as good because:

• The service completed environmental and individual person risk assessments that helped to keep people who used services safe.
• The service identified and met individual people who used service’s needs. There was a clear recovery focus. People were involved in their care and could influence the delivery of the service.
• Staff treated people who used services with respect and dignity. People who used services and their relatives felt the service was safe.
• There were effective communication systems, which enabled the team to operate as a whole team. This meant that appropriate staff supported people who used services with elements of their care.
• The manager was a visible presence in the service and staff felt supported. Staff enjoyed their jobs and felt proud of the work they did.
• There were systems present between the service and company that allowed for the sharing of information.
• There were sufficient staff to meet people who used service’s needs. Staff knew how to safeguard people. Learning from incidents and complaints took place.

However,

• Staff had not signed all medication administration records, which could have led to medication errors.
• Records did not evidence that staff had checked the defibrillator as regularly as planned. The defibrillator should have been checked weekly but in the past two months there were gaps in the recording of this.
• Not all staff completed clinical supervision as regularly as planned. This was outside of the providers own standards of six to eight weekly supervision.
• Staff were unclear between the differences in the Mental Health Act 1983, Mental Capacity Act 2005, and Deprivation of Liberty Safeguards and how these supported people.