We rated Cambian Fountains Hospital as good because:

• Systems were in place to monitor and manage patient risks. Assessments were carried out in a timely manner, regularly reviewed and reflected in care plans.
• There was a programme of ligature risk assessment in place along with policies to support the management of this risk
• Staff displayed a good understanding of their roles and responsibilities in relation to safeguarding. Safeguarding was embedded within practice
• Staff accessed mandatory and specialist training. Staff were appraised and supervised regularly
• There was an open and transparent culture within the hospital. Staff were aware of the provider’s incident report and complaints processes.
• Staff received debrief sessions after incidents and feedback when things had gone wrong
• Ward shift establishment were developed using a staffing analysis tool. Actual staffing levels matched the identified need. There was access to a regular cohort of bank staff
• There was a multi-disciplinary approach to care and treatment. Patients were able to access a range of psychological therapies and activities. Patients had released a charity CD and won awards for art projects
• Feedback from patients was positive. We observed staff treating patients in a respectful manner
• Patients were involved in their own care and attendance at multi-disciplinary ward rounds was facilitated
• Outcome measures were in place to assess the effectiveness of treatment.
• Senior management were a visible presence. Staff felt supported in their role and there was good staff morale. A whistleblowing policy was in place. Staff told us they were confident in raising concerns
• There were good governance structures in place to support the delivery of care. Key performance indicators were used to monitor performance

However

• We found two instances where physical health checks had not been carried out on patients receiving high doses of medication.

At our last inspection in May 2013 we had concerns there were not enough staff to meet people’s needs. This meant people were not able to take their planned leave at the agreed times. Following the inspection visit the provider sent us an action plan informing us of the changes they intended to make.

We revisited the service to ensure the necessary actions had been taken.

We spoke with three people who used the service. They told us there were sufficient staff on duty to meet their needs and they had not had any difficulties in accessing their leave at the agreed time. Comments included, “I always get my leave and there are enough staff to supervise it” and “I think there’s enough staff on. I get escorted leave to the shop and it always takes place”.

We spoke with three staff. They told us they felt staffing levels had improved over recent months. One person commented, “I think we are well staffed now. I can’t think of anyone not having their leave facilitated since the last inspection”.

We found improvements had been made to staffing levels in the service. This meant there were enough qualified, skilled and experienced staff to meet people’s needs.

We found peoples' care plans were personalised and addressed their mental health, physical health and social care needs. People told us they had opportunities to discuss their care and treatment with their responsible clinician (RC).

People spoken with told us their views were not always listened to and they felt disempowered. They said, “I feel my wishes and feelings are undervalued” and “The psychiatrist never listens”. Also “My section is up in July and nobody has told me what will happen next”.

We found some patients had been detained at the hospital for several years and were unlikely to progress to more independent living. This meant there was a risk that the ethos of the service might be compromised.

We saw there was guidance in place to support staff to deal with difficult behaviours which would help to keep themselves and others safe.

Patients and staff told us that staff shortages in the hospital meant that patients were not always able to take their planned leave at the agreed times.

Whilst we found staff received a range of appropriate training to look after the patients’ properly formal supervision was infrequent, this may make it difficult to identify any shortfalls in staff practice.

We spoke with six patients about their medicines and the care they received.

Comments from patients included:

‘’I take my medicines in private but I’m not bothered about it’’

‘’I can ask for painkillers when I need them’’

‘’I was given the wrong medicines once, they were over worked and understaffed but things are okay now’’

‘’I know what medicines I am taking’’

‘’I get my inhaler for breathing problems when I need it’’

’’I am aware of my medicines’’

‘’I can discuss my medicines with staff ’’

Overall we found improvements had been made in the way medicines were managed.

Patients we spoke with told us they felt safe living in the hospital and had no concerns about they way their medicines were handled.

"We were supported on this inspection by an Expert by Experience. This is a person who has personal experience of using or caring for someone who uses this type of care service". People told us they were happy with the care and support they received and were treated well by staff. They were able to express their views and opinions and could influence the way the service was run. They said they could raise any concerns with their key worker or with the management team and were confident they would be listened to. Staff spoken with told us they were given the training, development and support they needed to do their jobs properly. People told us they were able to share their views and opinions about the service by taking part in service satisfaction surveys.

We spoke with five patients at The Fountains about the care and support they receive and they told us:

“Staff here help me in every way they can”.

”There is always somewhere safe to talk to staff if we want”.

“Staff treat me with dignity and respect”.

“I have only got good comments about this hospital”.

“I get to see a dentist and my GP whenever I need”.

“Yes I feel safe here”.

“Abuse, no not here”.

“I’ve not seen any abuse here”.

“There’s no staff bullying here, staff are ok”.

They told us that they can express their views and are involved in making decisions about their care treatment and support at anytime of the day or night. They spoke positively about the hospital staff and felt they treated them properly and gave them support in a way that respected their privacy, dignity and independence.

They told us they felt their views were listened to and that they knew who to speak to if they were not happy with something.

When asked about their knowledge of the hospital complaints procedure the patients confirmed they knew how to complain and that they had been given a copy of the complaints procedure as part of the patients guide.

A patient told us, “No I’ve no complaints, its ok here and so are the staff”.

We rated the Fountains as good, however:

• The patient bedrooms we checked were not all clean and tidy. Eleven of the 32 bedrooms had a combination of issues including dirty bedding, missing bed linen, dirty mattresses, old pillows and one bedroom had a significant leak from the bathroom area into the bedroom.

• There was a blanket restriction in place that had not been individually risk assessed.
• We found that although the National Institute for Health and Care Excellence guidance was being implemented in monitoring of physical health care needs, monitoring the use of antipsychotic medication and Clozapine monitoring there were no audits in place to check the implementation of this with individual patients.

We found;

• Systems were in place to monitor and manage patient risks. Assessments were carried out in a timely manner, regularly reviewed and reflected in care plans.
• Staff delivered person-centred therapeutic interventions to patients to support them to achieve improved independence and wellbeing. Staff interactions with patients demonstrated personalised, collaborative, recovery oriented care planning and involvement.
• Staff ensured patients were engaged with assessments, care plans and discharge arrangements.
• The service was proactive in promoting equality and diversity and meeting the specific needs’ of vulnerable groups of patients.
• Staff had an understanding of the Mental Capacity Act 2005 and the Mental Health Act 1983. They assessed mental capacity and supported patients to make decisions where possible. Staff routinely referred patients for advocacy support if they lacked the capacity to do so themselves.
• Staff received mandatory training, specialised training, supervision and appraisals.
• Patients were protected and safeguarded from avoidable harm and incidents were appropriately reported to the local authority. Staff received specialised training, supervision and appraisals.
• Patients were positive about the care and treatment they received and staff behaviours were responsive, respectful and caring. Staff involved patients in the care and treatment they received.
• The service had physical health checks in place.
• There was a programme of ligature risk assessment in place along with policies to support the management of this risk.
• There was an open and transparent culture within the hospital. Staff were aware of the provider’s incident reporting and complaints processes.
• Staff received debrief sessions after incidents and feedback when things had gone wrong and there was a multi-disciplinary approach to care and treatment.
• Patients were able to access a range of psychological therapies and activities.
• Patients were positive about the care they received. We observed staff treating patients in a respectful manner. Patients were involved in their own care, and attendance at multi-disciplinary ward rounds was facilitated.
• Outcome measures were in place to assess the effectiveness of treatment.