We rated Cambian – Victoria House Hospital as good in the effective domain. We did not give an overall rating for the service because this was a focused inspection. We rated the effective domain as good because:

• Mental Health Act training was mandatory for all staff working at the hospital.
• Ninety two percent of staff had received training in the Mental Health Act and the revised code of practice.
• Staff had been trained in managing actual and potential aggression as part of the hospital’s efforts to reduce the use of restraint and rapid tranquillisation.
• Policies and procedures had been reviewed and updated to take account of the revised Mental Health Act code of practice.
• Patients were able to access an advocacy service which provided independent mental health advocacy.

The hospital had a process in place for the ongoing review of restrictive practices and was involving patients in this process.

The patients appeared confident when approaching staff, and the patient/staff interactions we saw were positive and respectful. Talking with staff during the course of our visit, it was clear they had a good knowledge of the patients. Two patients we spoke with told us the hospital was, “marvellous” and “the staff can’t do enough for you,” they went further to say that “it’s the best place I’ve ever been.”

The multidisciplinary team developed care plans and we saw that patients were involved in all aspects of the assessment and planning of their care. This included patients completing a self assessment on admission and weekly meetings with their key worker and named nurse to discuss their progress and any issues.

The service had actively listened and positively responded to previous CQC recommendations from our last visit in 2012 and had made relevant changes. This had included unlocking the payphone area, giving risk assessed key access to patients for the therapeutic kitchen and enabling the gym to be open when supervised by Occupational Therapy staff. The other area of recommendation was to open the laundry room but we were told and saw records that stated patients had discussed this in a meeting and decided they wanted to keep the door secure in case any of their belongings were tampered with or removed. There was an on-going quality assurance programme in place by the hospital.

There was a catering team who worked closely with patients to provide a healthy and balanced diet and who also worked alongside patients teaching them cooking skills. 94% of patients in a survey in 2013 which 18 patients completed said they were offered a choice of food and drink and were able to make or access their own food and drinks.

The premises were in good order, clean and well maintained. It had recently benefited from redecoration in the first floor communal areas which had brightened the area from our last visit. There was also the addition of a therapeutic garden which included chickens, rabbits and guinea pigs which the patients cared for. This was really popular with many patients.

We had recently visited Cambian Victoria House in November 2012 where two inspectors, including a member of the Mental Health Act Commission, carried out a full inspection and we found the service compliant. We later received concerning information regarding the management of the service and allegations of bullying behaviour and harassment of both staff and patients. We carried out this responsive inspection visit to check those concerns.

On this visit we spoke with five staff and four patients regarding their experience of the service and in particular we discussed whether they had ever been bullied, had ever witnessed any poor practice and felt supported to raise any concerns. We also looked at records regarding incidents, complaints and restraint as well as meeting records for both patient and clinical governance meetings.

The nursing and support staff we spoke with did not raise any concerns about the management of the service. Staff told us they felt able to raise any concerns within the service or to external agencies. Staff told us; “I have never seen any bullying of anyone, the nursing and management staff are very supportive” and “if we need to talk we can talk anytime. They listen and support you”.

Patients we spoke with were also positive about their experience of the service and no-one said they had ever witnessed any untoward use of restraint. Patients said the staff were “Spot on” and commented, “It’s alright here, you can talk to anyone”.

We spoke with two patients living at the hospital. One patient was very negative about the food, staffing levels and activities whilst the other patient was very positive in their comments about the hospital and care. One patient said; "Its like a five star hotel" whilst another patient told us; "There is nothing mentall y stimulating to do".

We saw patients engaged in a variety of activities and staffing engaging with patients in a positive and friendly way. We saw from a recent patient survey in October 2012 that 95% of patients stated they enjoyed the activities at the hospital. All 22 patients who responded to the survey said they were given information in a way they understood from staff.

We looked at care plan records and staffing recruitment records, these were all up to date and showed that people were involved in their own care and the provider had a robust recruitment system in place.

We spoke to the hospital manager about addressing some areas of restrictive practice such as locked areas and internet access so that there was a clearer policy for both staff and patients.

The patients we spoke with were generally positive about the staff and the care they received from them.

One patient told us: “Its really good here” and “I get on great with the staff”.

The patients using the service appeared confident when approaching staff, and the patient/staff interactions we saw were positive and respectful. Talking with staff whilst we watched activities, it was clear they had a good knowledge of the patients and staff gave encouragement and praise.

We rated Victoria House as requires improvement overall because:

• There had been a negative impact on the rehabilitation ward since the opening of the acute ward. Managers and staff had raised concern about the timeframe in which the ward had been opened. Patients raised concerns about the restrictions placed on the environment after the opening of the acute ward. There had been a significant increase in the use of agency staff to cover the acute ward.
• Blanket restrictions were in place which did not meet the ethos of a rehabilitation environment.
• Care plans did not always reflect patient needs. Where significant risks had been identified there was not always a risk management plan or care plan in place to mitigate these.
• Although a timetable was in place there was little uptake of structured activity and many patients described being bored.
• Staff were not up to date with all mandatory training and were not trained in immediate life support. Supervision rates had decreased since the acute ward had opened.
• Discussions were taking place around discharge but these were not documented in an easily identified format.
• The hospital worked between paper and electronic records and it was not always clear which were the current documents.
• Medicine was not always authorised in line with the Mental Health Act.

However:

• There were enough staff on each shift to ensure the safe running of the hospital. The hospital was in the process of recruiting permanent staff and used regular bank staff where possible. Staff were supported by managers who were visible and approachable.
• Incidents were reported and investigated and lessons were learnt from and shared with staff. Staff were trained in safeguarding and protected patients from abuse.
• Patients had up to date risk assessments and care plans. There was good multidisciplinary working, daily handover meetings were effective and well-structured and attended by all staff.
• The hospital had a full range of disciplines to support patients care and treatment, which included adequate medical cover, psychology, nurses, support workers, occupational therapy and activities. A programme of activities was in place and offered to patients.
• The provider had appointed an experienced hospital manager.