We rated Cambian The Willows as good because:

• Staff were up to date with mandatory training, Mental Health Act compliance was 87%, Safeguarding was 94% and Mental Capacity Act including Gillick competence was 87%.
• Staffing numbers were calculated using the Quality Network for Inpatient Child and Adolescent mental health service guidelines (QNIC). A review of the rotas completed during the inspection indicated most shifts had above the recommended staffing levels each day.
• From the five care and treatment records reviewed, all contained thorough assessments of patient needs, detailed risk assessments with evidence that these were reviewed and updated regularly and after any incidents.
• Patients had access to psychological therapies as recommended in the National Institute for Health and Care Excellence (NICE) guidelines for treatment of child and adolescent patients with mental health problems.
• Health of the Nation Outcome Scales for use in child and adolescent mental health, child global assessment scales, and other measures were used to monitor the physical and mental health needs of patients. Patients received education sessions and one to one input on areas such as healthy eating, exercise and smoking cessation.
• Staff interacted with patients respectfully, and handled challenging situations with professionalism. When patients were distressed, staff were responsive to their needs and used verbal de-escalation and distraction techniques to good effect.
• Patients said they were involved in their care planning, through one-to-one sessions with their named nurse or key worker. Patients reported to have a copy of their care plan paperwork.

However:

• Patients did not have access to their bedrooms during school hours (9am to 4pm), to encourage participation in education and activities. Where patients were unable to attend school for the whole day, or during break times patients only had access to the seats in the dining room. As a result, patients were observed to sit on the floor outside the nurse’s station and in ward corridors.
• Staff were seen to be sitting with patients on the floor which impacted on patients being able to have private conversations. This arrangement was for patients on one to one observation, and those wishing to access support from staff members during school hours.
• One floor-mounted chair in the dining room had a seat missing. This resulted in a large square of exposed metal being accessible to patient. The seat had been damaged since December 2016, assurances were sought that maintenance had ordered a replacement, but no temporary measures had been implemented to prevent patients accessing the exposed metal to harm themselves.
• It was noted that items such as DVDs and craft equipment stored in the lounge were not kept securely, and the room was cluttered. Staff were unable to account for all items in the room, and know if any patients had removed items to use for the purposes of self-harm.
• Family members or carers for patients we contacted raised concerns regarding poor communication by ward staff, and that they were not kept updated on progress or deterioration of patients. Family and carers reported this made them anxious, and worried about the care of their loved ones.
• Patients expressed frustration that staff did not keep them updated or communicate information for example in response to complaints or questions about their treatment

We rated Cambian- the Willows as good because

• The registered manager had established staffing levels that met the needs of the patients and had autonomy to increase staffing levels if required. Staff received up to date training, regular supervision and annual appraisal in line with the provider’s policy. We saw the provider had completed a ligature assessment of the environment and took steps to reduce the risk where possible.

• Patients received comprehensive assessments upon admission. The multidisciplinary team used this information to formulate a treatment plan. The hospital offered a range of therapy interventions recommended by the National Institute for Health and Care Excellence, such as cognitive behavioural therapy.
• Patient’s care files were thorough, person centred and outcome focused. Patients were involved in planning of their care and took part in weekly care reviews. The hospital provided family and carers weekly updates on the patient’s progress.
• Patients knew the complaints process and had regular access to an independent mental health advocate. Staff knew the whistle blowing process and told us they felt confident raising concerns without being victimised.
• The clinical team completed regular quality audits and analysed incident data. Where patterns were identified the hospital manager implemented control measures.

However:

• We found a prescription pad in the controlled drugs cabinet that did not have a record for used pages. This did not meet the National Health Service guidance and best practice guidelines set out in the safe management of prescription pads.
• The emergency bag contents did not reflect the checklist although it was signed to say it was checked regularly.
• There was a lack of pharmacy input; it was the nurse’s responsibility to reconcile and audit medication.