People using the service told us the staff supported them and were helping them to manage their own health and finances. They felt their mental and physical health needs were being well looked after. People told us they enjoyed the social aspect of the service and being able to speak with other people in a similar situation to them.

Care and treatment was planned and delivered in line with their individual care plan. We saw that care plans addressed people’s physical and mental health needs, and identified social or financial support needs. An assessment of risks had been completed and management plans were in place to minimise those identified risks.

People were safeguarded against the risk of abuse. Staff were aware of potential signs of abuse and demonstrated knowledge in appropriate reporting procedures. There were processes in place to ensure people were protected from financial abuse.

There were enough qualified, skilled and experienced staff at the service. There was a multi-disciplinary team in place to support people using the service. We saw evidence that shifts were staffed appropriately and additional staff were available to support people using the community and those that had higher support needs.

Staff were supported to attend training courses and develop their skills and knowledge. A process of regular supervision and annual appraisal was in place to support staff and identify areas for development.

People using the service had an opportunity to comment on the service they received through community meetings and ‘service user representatives’. There were processes in place to manage and respond to complaints and incidents.

At our previous inspection we found that improvements were required regarding people’s care records. At this inspection we found that improvements had been made. The care records contained information on people's risks and the care and support they required.

During this inspection we spoke with six patients and seven members of staff, looked at three full sets of patient notes and some further patient and staff records.

Patients we spoke with said they were involved in decisions about their care and understood why they had been admitted to the hospital. No-one we spoke with raised any concerns about staff or the hospital with us. Patients were able to choose what activities they took part in and told us they valued the activities. There was a choice of suitable and nutritious food and drink, and patients were encouraged to eat healthily.

At a previous inspection on 29 February 2012 we had moderate concerns about how the provider was managing medicines, but at this inspection we saw the provider had appropriate arrangements in place to manage medicines.

However, there was a risk that patients might receive unsafe or inappropriate care and treatment which met their needs and protected their rights, because so many care records were incomplete or out-of-date and because nursing one-to-one sessions were so irregular.

This was a follow up inspection to check on improvements required by our previous inspection in October 2011.

At this follow-up inspection in February 2012 most patients we spoke to understood how they were being involved in their care and how and when their discharge might take place.

Everyone knew who their named nurse was, but some felt that they had no say in who their nurse was and one felt their named nurse was unsuitable for his needs.

Doctors had discussed peoples’ medicines with them, and they had given people both verbal and written information on any possible side effects of their medicines.

Most patients felt safe and secure in the hospital, or had spoken to staff and had strategies in place to minimise any potential or perceived risks.

People told us about issues, such as that the washing machine being out of order for several days, problems with a faulty shower, and that food was not appetising or sufficient for their needs. They said they had raised these issues with staff but that they were not aware of what was being done to address the problems.

People also said that staff used ‘jargon’, which they said was a barrier to their participation, and some said they would like more opportunities to take part in physical activities.

We rated Bromley Road Hospital as good because:

• The service had addressed the concerns raised following the last inspection in May 2017. For example, staff treated patients with dignity and respect. Staff no longer imposed inappropriate blanket restrictions on patients. The service provided adequate medical cover for patient care. The service had made improvements to ensure managers used effective systems to monitor the performance of the service.

• Staff developed personalised, recovery-oriented care plans and supported patients to give their views and develop recovery goals. Staff completed positive behaviour support plans. These plans contained strategies that focused on patients’ challenging behaviour. Staff provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national best practice guidance.

• The ward teams included, or had access to, the full range of specialists required to support patients with their rehabilitation. This included an occupational therapist, social inclusion worker and a clinical psychologist.

• Staff supported patients to live healthier lives. Staff assessed patients’ physical health needs on admission. Patients took part in the service’s programme to encourage patients to think about their physical health and take part in various exercises.

• Staff effectively planned for patients’ discharge and worked well with other agencies to do so. Staff created projected discharge dates on admission for each patient as a goal to work towards.

• Staff treated patients with kindness, dignity and respect. Patients said that they felt staff were kind, friendly and always supported them with their care and treatment. We observed positive interactions between patients and staff. The service held an annual talent contest for patients. Patients really enjoyed taking part and rehearsals were well attended.

• The service provided safe care. Staff completed risk management plans with input from patients and the multidisciplinary team. Staff minimised the use of restrictive practices, managed medicines safely and carried out regular physical health checks such as, blood tests and monitoring patients’ vital signs.

• The service was working towards a model of mental health rehabilitation. The provider had introduced a new rehabilitation model of care to be implemented at the service in January 2019. Improved governance processes ensured that ward procedures ran smoothly. Managers had accessible systems that provided oversight of the quality, safety and performance of the service.

However:

• Staff did not always actively promote the needs of all patients, including those with a protected characteristic. The service could do more to encourage an open and inclusive environment to support patients’ sexual, cultural and spiritual preferences.

• Although patients in the service were low risk in respect of self-harm and suicide; staff assessments of ligature risks in the service did not record all control measures for staff to reduce the risks to patients.

• Some parts of the building were run down and required some maintenance and refurbishment. The service had a schedule of works planned to improve the decoration and maintenance of the building.

• Although staff received regular supervision in the service; staff supervision records were brief and lacked detail. Records did not demonstrate that these sessions were effective in ensuring the learning and development of staff and delivery of high quality care.