We carried out an unannounced focussed inspection and found that:

• The hospital was using blanket restrictions. We found staff searched all patients on return from unescorted leave and staff supervised patients opening their parcels. In addition, patients had set bedtimes during the week and at weekends where staff asked them to return to their bedrooms. Access to outdoor space was at set times when it was permitted for patients to smoke. These were set times outside of the therapeutic and activity sessions and mealtimes. The telephone box was kept locked. We found that these restrictions had not been individually risk assessed. Care and treatment records that we reviewed did not contain information in relation to these restrictions and the rationale why this was proportionate for each individual patient.
• Items that patients’ were not permitted to hold in their possession were stored in contraband storage. Individual care and treatment records contained a log of items which detailed if patients could access these with or without staff supervision. We could not identify how patients’ needs and risks directly related to risk items in contraband in the records.
• We found that some staff had prevented patients from accessing the kitchen during the night for hot drinks by overriding key access. We raised this with the hospital manager who told us that this was not an agreed practice and would address this immediately.
• Not all staff had received training in the Mental Health Act code of practice since the last update in March 2015. Thirty three percent of staff still required this training. This equated to 15 members of staff.
• The hospital did not have a central record of informal complaints or issues raised.

However;

• Staff told us about the restrictive practice including the blanket restrictions identified and these were recorded on the hospital risk register.
• Four patients told us that they felt safe and happy at Aspen House and observations showed that staff knew patients well and treated them with kindness.
• The hospital had facilities to promote activities for therapy and recovery including a sensory room, gymnasium, hair salon and internet café.
•  Staff involved patients in the development of their care plans. Care plans contained personalised information and patients’ views and aspirations for the future. 

We rated Cygnet Aspen House as good because:

• The hospital had undergone significant organisational changes and there was limited impact on patient care and on frontline staff. Patients and staff reported clear and stable leadership from managers who were visible, supportive and approachable.
• Staff morale was high and staff demonstrated the provider’s values. There were low sickness rates at 3% and no shifts had been left unfilled. The hospital did not use agency staff.
• The service managed risk appropriately through comprehensive individual patient risk assessments completed and reviewed by the multi-disciplinary team. Incidents of restraint were low and there was no use of prone restraint.
• Staff had developed and ran a physical health clinic that fed into patients’ care and treatment well. Staff had developed documentation to record physical health monitoring which had been shared across the provider’s services.
• Patients had access to a range of care and treatment interventions and activities to promote their recovery and rehabilitation needs. The hospital had full multi-disciplinary team.

However:

• Out of hours an on-call doctor was available but would not be able to attend the hospital promptly following incidents of restraint.

• The provider trained staff in basic life support, automated external defibrillation and registered nurses received oxygen training. The provider did not provide staff with training in immediate life support.

• Team meetings did not take place regularly so it was unclear how all information was cascaded fully to all staff.
• The appraisal rate had improved significantly but at the time of our inspection was 71%.
• Even though staff planned and discussed patient discharge regularly, care plans did not contain clear discharge planning information.