Two inspectors visited Cambian Churchill Hospital. The hospital had 57 people using the service when we visited, with a fourth unit, Elm, being newly opened. We spoke with people who used the service and staff across the hospital but focused our visit on Juniper ward. People told us they had mixed experiences of the services. However, most of the feedback we received was positive. Staff told us that they ensured people were involved in their care and we saw that most people were aware of their care plans.

We checked the records of people who used the service and found that most people had up to date risk assessments and care plans. Staff had a good understanding of safeguarding and most staff had completed training related to safeguarding adults. We spoke with catering staff, checked menus and spoke with people who used the service. They told us that the menu was varied and people had access to a variety of food.

We checked the staffing levels and found that while the establishment figures were usually met, there were some occasions when the full complement of staff had not been achieved for some shifts. Staff and people who used the service told us that sometimes there were not enough staff. We saw that analysis had been completed regarding the skill mix on site. The provider had access to bank and agency staff to cover shifts. Most staff had access to training, supervision and annual appraisals.

There were 40 people using the services at the time of our inspection. The third unit had recently been opened for people who were expected to be discharged in the near future.

People’s capacity to agree to treatment was regularly assessed. There were opportunities for people using the service to make suggestions about the service.

We observed staff responding to queries from people using the service and providing them with information. One of the people we spoke with said they had received a lot of support and good advice from their key nurse and key support worker. There were risk assessments and care plans in place, and these were regularly reviewed by the multi-disciplinary team. People had access to educational and other services in the community in addition to a variety of facilities at the hospital. People we spoke with said there were a lot of activities to choose from.

We found the service had reviewed staffing levels and had access to bank and agency staff when additional or cover staff were needed. The service was making improvements to the induction programme for new staff. However, we found that not all staff were receiving regular supervision.

There had been improvements to the monitoring of the requirements of the Mental Health Act 1983. There were regular meetings to discuss the results of audits and reviews of incidents. When there were incidents, appropriate action was taken to reduce the likelihood of these recurring.

There were 34 male patients at Cambian-Churchill Hospital at the time of our inspection. During our visit we spoke with 10 of these patients. We also spoke with senior staff, clinical and nursing staff, and support workers.

People told us the staff were kind, and that most of them would make time to talk to them. We observed staff interacting respectfully with patients and listening to their concerns. We found that people’s mental health needs were well understood, and other needs, such as alcohol misuse, were addressed.

However, we found there had been delays in giving a patient information about his rights and his treatment because an interpreter had not been accessed.

We found the service adjusted staffing levels when the number or needs of patients changed. However, there were no arrangements to access staff to fill in when there were unexpected staff shortages because of leave or sickness. We found there were some restrictions in the access people had to therapeutic activities.

Appropriate arrangements were in place in relation to the administration and recording of medicines. We found some examples of delays in accessing the second opinion appointed doctor (SOAD), when additional medication was prescribed.

There was evidence of systems to assess the quality of the service and to take action to make improvements. When there were incidents, appropriate action was taken to reduce the likelihood of these recurring.

The people we spoke to were generally positive about the service they received. People are encouraged to participate in the development of an individualised activity programme, and they gave us examples of where this was happening. People told us they were supported with their physical health care needs.

We rated Cambian - Churchill Hospital as good because:

• Following our last inspection of the service, in December 2015, we told the provider they must make improvements to ensure the safety of patients. At this inspection, we found that the management team had effectively implemented changes and all health and social care regulations were met.

• Mirrors had been installed to enable staff to better monitor patients and ensure their safety. Managers met each morning to ensure that there was a safe staffing level on each ward and any safeguarding issues were promptly followed up.

• Staff skills in managing actual or potential violence had improved. There was a reduction in the incidence of staff restraint of patients. When staff did use restraint, or administer rapid tranquilisation, they kept full and accurate records. There were notices in place to advise informal patients of their rights.

• Lessons had been learnt from adverse incidents. The management team had introduced a new way of training staff to respond to medical emergencies using simulations. Staff told us this had increased their skills and given them more confidence to deal with such situations.
• The experienced and well-staffed multidisciplinary team on each ward provided recovery-focused treatment and care. Staff supported patients to improve their mental health and move on from the service to a community setting.
• Patients told us staff treated them with dignity and respect. They said staff involved them in planning their treatment and care. They had opportunities for work experience and to follow their interests.
• Patients said staff took the time to talk to them about their medicines. They told us they received helpful support from an advocate who assisted them in discussions about their care and treatment.
• Staff morale at the service was positive. Staff said they had received training which had enhanced their skills in relation to meeting the complex needs of patients.

However:

• Some patients were at risk of an opiate overdose. The service did not stock Naloxone for use in an emergency. Naloxone is a medicine that can temporarily reverse the effects of an opiate overdose, providing more time for an ambulance to arrive.
• Staff may not have all the equipment needed to respond effectively to a medical emergency. The provider did not have a pulse oximeter in the emergency response bags, which meant staff may not have been able to easily check a patient’s pulse. Staff did not routinely check the contents of first aid kits to ensure that all of the appropriate items are in the kit and can be used when required.