We used a number of different methods to help us to understand the experiences of people using the services, because the people using the service had complex needs which meant that some people chose not to talk to us. The two people that spoke with us in private were very happy with their care and treatment. They said that the staff listened to them and cared about their welfare. They also told us that they felt safe in the hospital.

We saw that people were involved in their care and treatment, and they were positive about the gains that they had made in their recovery.

We heard staff speak with people in a way that was respectful and supportive.

People told us that they were generally well treated by staff and that staff treated them with respect.

People told us that the staff were “OK” but that there were not enough staff to allow them to have sufficient time away from their house.

A number of people who spoke to us complained about the lack of purposeful activities. One person told us that if they could change anything they would have more staff and more structured activities.

One person said that they were not able to choose their primary nurse and that if they did not get on with the nurse then there was nothing they could do about it. One person told us that they were required to be accompanied by a member of staff when they went to the theatre. On such occasions they were expected to pay for the member of staff

We rated Chadwick Lodge as good because:

• Patients had excellent access to psychological therapies. The psychology team operated a comprehensive, patient focused, individualised service (for example, by adapting therapy sessions to suit the needs of patients with autistic spectrum disorder or a learning disability). Their dialectical behaviour therapy program had been specially adapted for use in forensic services, and it linked with the cognitive behavioural therapy and trauma work. Psychology staff offered individual and group work to address offending behaviours and substance misuse. They also provided specialist treatment programs for male sex offenders and females with a history of fire setting. Members of the psychology team recently organised a national conference on the therapeutic treatment of sex offenders.

• Staff received necessary training, an appraisal and regular supervision, and medical staff completed revalidation. Most staff had a high level of morale and job satisfaction. They felt supported by their peers and by managers and felt able to raise concerns without fear of victimisation. In general, staff were highly positive about the organisational transition from the Priory Group to Elysium Healthcare.

• The hospital has been an accredited member of the Royal College of Psychiatry quality network for forensic mental health services, for both medium and low secure services, since 2011.

• Occupational therapy was available to patients on all wards. Therapists operated a model which focused on a holistic, person centred and recovery based approach. Staff helped patients to build and maintain independence by encouraging them to participate in activities of daily living. Patients had the opportunity to undertake voluntary work, either within the hospital or in the local community, appropriate to their ability and individually assessed level of risk. Patients had access to a hospital gym and to outside space, including a courtyard area with an enclosed sports pitch.

• Staff provided patients with extensive support to prepare them for admission to the hospital; moving to a different ward; or, being discharged from the hospital. Care plans we looked at were individualised, holistic, recovery focused and up to date. Occupational therapy staff were fully trained to use the model of human occupation screening tool, to help inform patient care plans. Patients had an initial physical health assessment and good access to ongoing physical healthcare.

• Patients were extensively involved in their own care and the running of the service. Staff sought patient input when devising risk assessments and care plans, and patients attended meetings about their own care. Some patients had helped to devise a handbook for newly admitted peers and a DVD to inform and promote the psychological therapy program to students and other patients. Patients attended ward daily meetings, community meetings and regular forums. They were involved in the recruitment of all staff at every level and had the ability to nominate elements of the service for upcoming audits.

• Staff treated patients in a caring, respectful and responsive manner. Staff displayed a high level of understanding of the individual needs and abilities of patients. Staff supported patients to maintain personal relationships during their time within the hospital. Patients had access to general and statutory advocacy services, and interpreters were available to patients as needed.

• Patients had a comprehensive risk assessment on admission, which was regularly reviewed and updated. Staff applied blanket restrictions only when justified and minimised their use where possible. Staff used good policies and procedures for observing and searching patients and the ward environment, in order to minimise identified risks. All wards had a detailed ligature risk assessment in place. Most wards had anti-ligature fittings throughout.

• Staff reported incidents appropriately and investigated them thoroughly. Staff met to discuss learning from incidents and received support following serious incidents. Staff used learning from incidents to inform future practice and they shared feedback on incidents with patients.

• Escorted leave and ward activities were rarely cancelled due to staff shortages. Staffing levels were managed to meet changing demands on each ward. The hospital had a low number of vacancies for substantive staff. All bank workers were required to complete the same induction program and ongoing training as substantive staff. Where possible, managers attempted to deploy bank workers to wards they were familiar with.

However:

• The closed-circuit television cameras in the seclusion suite on Berridale ward did not have a protective pane of Perspex, to prevent them potentially being removed by a patient. If a patient were to remove one or more of the cameras, staff would not be able to maintain an unbroken view of the patient.

• Social workers had a supervision rate below the hospital’s stated target of 85%, with a rate of 76%.

• Some patients told us they sometimes found the diction of some members of staff difficult to understand and this could impact on communication between staff and patients. They told us that this was more evident with members of bank staff who were not familiar with those patients.

• Some patients we spoke with were unhappy with the quality of food provided.

• Some patients we spoke with told us they would like there to be more activities on offer.

• Some nursing assistants we spoke with did not feel engaged with senior managers and the process of change within the hospital. They reported feeling undervalued by managers. Staff commented negatively about the introduction of a new arrangement for taking breaks.

• The rehabilitation ward had a blind spot in the garden area which had not been risk assessed, the laundry room was untidy and dirty and the kitchen fridge needed de-frosting