We rated The Spinney good for safe because:

• Staffing levels were appropriate with low staff sickness and limited use of agency staff.
• Patients all had valid and up to date risk assessments.
• The environment was routinely reviewed to ensure it was safe and well maintained.
• All safety equipment was safely and securely held in areas where it was accessible by all those that may need it.
• The rehabilitation ward allowed patients who were well enough sufficient independence whilst ensuring they remained safe.
• Safety was an active consideration across the service and was routinely reviewed by ward staff and the senior management team.

However we also found some areas for improvement:

• Compliance training targets for some mandatory training courses was below the service target.
• Overall staff appraisal rates for one quarter were below the service target, with nursing and psychology staff in particular showing lowest percentage compliance with appraisals

Following an inspection we follow a set of principles when aggregating ratings using discretion and professional judgement in reviewing all the available evidence.

As the management team at The Spinney had made the improvements within six months from the date of publication of our last inspection report. We re-rated the safe key question from requires improvement to good. Using our aggregation principles, this also led to an overall rating of outstanding for The Spinney because the caring, responsive and well led key questions were previously rated as outstanding and the effective key question was rated as good.

We rated The Spinney as outstanding because:

• The service tried to minimise the difficulties friends and families could experience when a loved one is admitted into a secure service.
• The service had established a well-supported network for carers to exchange views and share their experiences.
• The service had forged excellent partnerships with other organisations to enable it to facilitate opportunities for patients outside the service.
• The service had good links with other healthcare which meant these providers would visit and offer services to patients on site without the need for them to leave the hospital grounds.
• Patients were actively involved in how the service was run, participating in community meetings, the patient council, panels and project committees.
• The service recognised the importance of physical health and wellbeing, with a range of initiatives encouraging a healthier lifestyle, including a 12 week fitness programme.
• Patients had access to a vast array of varied activities, utilising the various facilities including a gymnasium, swimming pool, sports hall, art rooms, social room, photography suite and music studio.
• Patient centred care focused on patient recovery and the individual’s potential after hospital.
• Staff and patients felt valued and that their opinions would be respected.
• Patients were not subject to restrictive practices which limited or infringed on their rights.
• The environment across the site was well maintained and situated within large peaceful grounds.

We rated The Spinney as good because:

• The service recognised the difficulties friends and families could have when a loved one is admitted into a secure service. The service had established and maintained a well-supported network for carers to exchange views and share their experiences, the carers’ forum, which held regular meetings and events.
• The service had forged excellent links and partnerships with other organisations to enable it to facilitate opportunities for patients outside the service.
• The service had good links with other healthcare providers including opticians, dentists and podiatrists, which meant these providers would visit and offer services to patients on site without the need for them to leave the hospital grounds.
• Patients were actively involved in how the service was run, from community meetings in each ward to an active patient council, which was also represented on the governance committee. Furthermore, patients participated in staff recruitment panels and project committees focusing on specific service improvement and development initiatives such as developing the new ward.
• Managers and staff had appropriate systems and measures in place to ensure the safety of patients and staff.
• The service recognised the importance of physical health and wellbeing, with a range of initiatives encouraging a healthier lifestyle, including a 12 week fitness programme.
• Patients had access to a vast array of activities and therapies including a sports hall, gym and swimming pool on-site.
• Staffing levels were safe and staff knew their patients well, even when covering other shifts.
• Patient centred care focused on patient recovery and the individual’s potential after hospital.
• Staff and patients felt valued and that their opinions would be listened to and respected.
• Staff ensured that patients’ risk assessments were regularly reviewed and documented.
• Patients were not subject to restrictive practices which limited or infringed on their rights.
• Staff ensured that physical health checks and monitoring were done routinely and reflected patient co-morbidities and the use of medication, which required additional monitoring.
• The environment across the site was well maintained and situated within large peaceful grounds.
• Individual wards were kept clean.
• The complaints procedure was understood by the patients and carers, with posters displayed in each ward outlining the process.
• Patients were allowed opportunities to take part in their own care.
• Staff ensured that the emergency equipment and drugs were routinely checked.

However:

• Some ligature risks had not been captured on the ligature risk assessment audit.
• On one ward, we saw ligature scissors were attached to the office noticeboard in an office, which was often unlocked when staff were present. This was rectified when this was raised.
• Not all references of new employees were fully verified.
• Information about section 61 reviews was not always documented on individual care records though reviews were taking place as evidenced in other documents.
• Paper case notes and records were not always dated, though in most instances we were told the information was also captured electronically.

The complaints policy and complaint outcome letter did not explain the role of the CQC regarding complaints relating to the Mental Health Act.