We carried out this inspection to check on the care and welfare of people. Sedgley House had 20 people and Sedgley Lodge had 13 people living there on the day of the inspection.

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We found that people were asked for their consent before care was delivered. One person told us, “They do ask us questions.”

We found that people’s support and therapy plans were reviewed and updated on a regular basis. The majority of people we spoke with were happy with the support they received. One person said, “The nurses are good, staff are friendly, and the food is good.”

Systems were in place to ensure that people received their medicines as prescribed.

We found that staff were supported through clinical supervision, appraisals, and training. One staff member said, “I can approach managers at any time.”

Systems were in place to ensure that people could complain, and these were taken seriously.

We spoke with the majority of people who used the service and were on the premises at the time of our visit. We spoke with the manager and staff of all grades and experience.

We spent the morning sitting with people in the communal areas of the Lodge, chatting with them and observed the interactions between people and staff. During the afternoon we spent time in the House, talking with people and observed the activity.

We looked at a selection of care records including support plans, risk assessments and daily reports. The manager supplied us with copies of audit checks and schedules, client survey reports, minutes of various meetings and staff training information.

People told us that generally the staff were good and that they felt at ease and comfortable talking with the staff. They told us the accommodation was ‘okay’ and the food was good. People told us they had regular meetings and discussions with staff about the care and support they need. They told us they had their own copy of their support plan. Staff told us of the support they offered to people each day. The information we saw recorded in the support plans was consistent with what staff and people had told us.

Some people required extra support from staff to help reduce the risk of harm to themselves and others. We saw staff provided this level of support in a calm and effective way. We did not see anyone waiting for help and support when it was needed.

Staff told us they had received training in managing violence and aggression and described the actions they took when situations arose.

The manager and staff told us they felt that the current staffing levels were sufficient to meet the needs of people. The manager told us of the contingency plans for other staff to be available when there were any changes to the level of support people needed.

Staff told us of the available training that was arranged for them. All staff we spoke with told us they felt the training was sufficient for them to do their job.

A visitor told us of their satisfaction with the support and treatment their relative received, “We have seen a great improvement since X has been here. We are very pleased with this home”.

We saw the way the service monitored the service to make sure that it operated in the way that it states it does. All records and documents that we requested were available, in good order and up to date.

The service was visited by two Mental Health Act commissioners in December 2011. They found that overall improvements had been made to the service. Observations for further improving the service were made by the commissioners. The provider has responded, detailing the actions they had taken to the issues raised.

We rated the Sedgleys Hospital as good because:

• A range of environmental risk assessments had been completed to ensure the safety of patients and staff. Emergency life saving and physical health monitoring equipment had been checked and calibrated in line with manufacturers recommendations and annual inspections of the services fire safety system were complete and in date.
• All care and treatment records contained detailed and up to date assessments of patients risk, and a plan of the care being provided by the hospital. We found that care and treatment records were routinely reviewed by the multi disciplinary staff team and reflected recent changes in patient risk or wellbeing.
• Morale amongst staff at the service was excellent. The registered manager and leadership team were described as leading by example and the service culture was one where patients and staff felt valued and listened to. Staff sickness rates were low and there had been no allegations of bullying or harassment in the 12 months prior to our inspection.
• Patients were offered a range of interventions to promote independence and social inclusion. Discharge planning was evident in all care and treatment records we reviewed and all patients discharged from the service in the 12 months prior to our inspection had moved to a less intensive community based service.
• Medicines for the use of patients were prescribed, reconciled and dispensed in line with the services policies and procedures and national guidance from the National Institute for Health and Care Excellence.
• Patients were able to access a range of specialist interventions, provided by staff that were suitably skilled and qualified. Attendance at mandatory training was high and all eligible staff had received an annual appraisal of their performance in the year prior to our inspection.
• A range of audits were routinely completed to measure the services performance and we found that actions plans had been implemented to improve the quality of service being delivered where required. Local and regional governance meetings enabled the service to measure their outcomes against similar services offered by the provider and to learn lessons from adverse events.
• Staff were able to describe their responsibilities for reporting incidents, ensuring patients were safeguarded against potential abuse and the actions they would take if they had concerns about patient wellbeing. All patients that we spoke with told us that they felt safe at the hospital and that staff treated them with kindness, dignity and respect.

However:

• We did not always find that care planning documentation was written in the patients voice or using accessible terminology.
• Staff were not always clear about the actions required if the fridges for the storage of medication exceeded the safe temperature range.