Is the service safe?

Several areas of the building were dirty or in need of repair. The safeguarding policies and procedures were up to date and staff demonstrated a clear understanding about how to make a safeguarding referral.

Is the service effective?

There was a multi-disciplinary team of staff working within the service. Staff had received the necessary training and support to work effectively with people in the service. Audits had been carried out, but there was limited evidence to demonstrate that changes were implemented as a result.

Is the service caring?

We observed positive interactions between staff and people using the service. However, there was limited evidence of people's involvement in care planning and discharge planning. People's preferences, interests, aspirations and diverse needs were not always recorded.

Is the service responsive?

The provider sought the views of people using the service. All of the people had a care plan, however these were not always person centred. There was limited evidence of discharge planning, although most people had a care programme approach (CPA) meeting.

Is the service well led?

The service had up to date policies and these were accessible to all staff. There were processes in place for monitoring the service, however, there was limited evidence to demonstrate that changes had been implemented as a result.

Patients we spoke with told us that they were in a hospital that supported them in a way that suited them. One patient told us, "I am really happy, I have a part-time job, so I am really getting better." Others told us, "Good staff." Staff told us, "The staffing levels are better and we are doing well."

From reviewing care plans and talking to patients and staff, we found that patients views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. We saw that the staffing levels and skill mix were appropriate to support all the patients' needs.

Patients we spoke with told us that they were in a hospital that supported them in a way that suited them. One patient told us, "I have been here a long time now, they treat me well." Another patient said, "I don't like the food much, never enough to eat, but the staff are okay." Others told us, "Good place, but too many new faces."

Some of the staff we spoke with were new to the service and were still on their induction or had just finished their induction. They told us, "The senior staff have been very supportive and the training is good." Staff that had been working at the home for longer told us, "It is very busy and sometimes there are not enough experienced staff."

We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. However, we saw that the staffing levels and skill mix were not adequate or appropriate to support all the patients’ needs. There had been an increase in incidents on one ward, which some staff said was due to the introduction of new and inexperienced staff. We were also told that trips out had been cancelled and this affected patients’ behaviour.

We saw that there was a complaints procedure in place and a log was kept of all complaints. The home had quality assurance systems to assess their performance and ensure improving standards. This included canvassing the views of patients who were receiving treatment and support, their relatives and visiting professionals.

Patients we spoke with told us that they were in a hospital that supported them in a way that suited them. One patient told us, “The staff are here for us, they are pretty good.” Other patients said, ”There are more staff now to support us,” and “We get to go out more and so we are happier.” One patient suggested more staff were needed to help with preparing them to live independently.

The staff we spoke with were well qualified and knowledgeable about patients needs and familiar with the support patients needed. We saw the service ensured that staff were able to deliver care and treatment safely due to the training in place. The staffing levels were adequate to support all their needs, including trips out. Untoward incidents in the home had been managed effectively with the introduction of more staff.

Patients we spoke with told us that they were in a hospital that supported them in a way that suited them. One patient told us, "I like it here, the staff are pretty good and are helping me." Another patient said, "I've been off treatment a couple of times and they've got me through it." Others told us, "The food is okay and we get to play football", and "I have made friends and that helps".

The staff we spoke with were well qualified and knowledgeable about patient's needs and familiar with the support patients needed. We saw the service ensured that staff were able to deliver care and treatment safely due to the training and audits in place. However, we saw that the staffing levels were not adequate to support all their needs, trips out had been cancelled. Agency staff were employed to increase numbers following our inspection.

The home had quality assurance systems to assess their performance and ensure improving standards. This included canvassing the views of patients who were receiving treatment and support, their relatives and visiting professionals.

Patients told us “Its pretty good, we are here to get better and they do look after us” “We have to wait for staff to take us out”.

We were told “It’s a good place to get better”. “Don’t always like to have new staff here”.

Patients said that the food was “alright” but not very much choice. This was more specifically for vegetarian options.

We rated The Langford Centre as good because:

• Mandatory training completion for the wards was high.
• Staff completed and routinely reviewed comprehensive assessments of patients’ risks, physical and mental health.
• Patients had access to psychology and a range of occupational activities including personal training sessions, weekly health walks, gym sessions, swimming, roller skating, volunteering at a local animal sanctuary, furniture restoration, and gardening.
• All staff received regular supervision.

• Patients told us they felt safe and cared for in the hospital.

• Carers and family members were involved in patient care wherever patients authorised for this.

• Staff, including the psychology and occupational departments, worked with patients from point of admission to rehabilitate and support them towards a positive move on from the hospital as part of their recovery.

• In 2017 the hospital took part in a Nottingham University-led pilot to review the hospital’s policy and practice regarding the political participation of residents. The pilot was held in conjunction with local snap elections at that time. The study involved observing how patients were supported to vote using policy, discussion around political views and choices, and social worker and speech and language therapist (SALT) support.

However:

• On Cooden Lodge and Seaford Suite we found that a range of equipment was out of date. The hospital director informed us that all out of date equipment was removed after our inspection.
• Cooden Lodge was untidy, four out of nine patient bedrooms had unclean shower areas, dirty window sills and skylights. The hospital director informed us they arranged a ward deep clean the day after our inspection and implemented two cleaning audits for each wards’ toilets and bedrooms.
• One patient’s care record on Daffodil ward detailed an unjustified blanket restriction. Staff concluded they would arrange for removal of the restriction.
• Risks identified following a number of recent incidents were not listed on the hospital’s risk register.