We rated Gateway Recovery Centre as good because:

• Concave mirrors situated in the ceiling allowed full view of the corridors, thereby allowing staff to observe all parts of the wards. Ligature points were noted during the inspection, and the environmental risk and assessment plan showed that these points were considered and action was in place to address issues. Staff had personal alarms and all rooms had wall-mounted call buttons. The key security system used biometric readings to issue and accept keys. Outside areas were well maintained, and had exercise equipment in good repair for all four wards. Staff, including bank and agency staff, completed induction training.
• Staff completed comprehensive risk assessments and these were updated regularly. Advance statements and crisis plans were in place for patients.
• Patient care plans were comprehensive, personalised, holistic and recovery orientated. Each patient had signed to show they agreed with their care plan and had received a copy. There was evidence of patient involvement in all aspects of their care.
• Patients had good access to physical health interventions. Staff completed physical health monitoring including the use of a tracker system by a practice nurse to ensure all relevant tests were undertaken. There was a service level agreement with a local GP, and evidence of their involvement in patient care. Multi-disciplinary meetings were attended by relevant staff including the consultant psychiatrist, a qualified nurse, an occupational therapist, and other staff as required ensuring patient needs were met. Work on diabetes monitoring with patients with a history of self-harming was really good practice. There were a range of mental health disciplines employed at the service, including consultant psychiatrists, qualified nurses and support workers, occupational therapists and psychologists.
• Staff were regularly supervised and appraised, with plans for monitoring and continual improvement. Mandatory training was being completed and monitored. Staff received training in the Mental Health Act as part of their mandatory training, as well as training in the Mental Capacity Act.
• Discharge planning was evident in care records and case files, as well as being actively monitored on the hospital electronic dashboard system.

• We observed kind, caring and positive interactions between staff and patients. Patients said that staff were respectful, approachable and were clearly interested in patient well-being. Staff were knowledgeable about their patients, and this was reflected in their interaction and notes on case files. Minutes of community meetings that involved the patients were reviewed and shown to reflect the feelings and demands of patients. Patients commented favourably on the available activities. Multi-disciplinary team reviews showed participation and consideration over all aspects of care. Carers said that they had been involved in meetings with their relatives and the multi-disciplinary team, and felt that their opinions had been taken into consideration.
• Patients who were on leave did not have their beds filled in their absence, ensuring the bed was available on return. Patients had access to a range of rooms and equipment to support treatment and care.
• There was access to telephone rooms, as well as patients having their own mobile telephones. Patients had access to a range of meaningful activities for patients, available seven days per week.
• The service could make adjustments to meet the needs of patients with physical disabilities as well as mental health problems. Patients had been involved in menu choice developments and smoking cessation initiatives.
• Complaints were fully investigated, and there were a low number of complaints in the 12-months prior to inspection.
• Staff knew senior managers; both qualified staff and support workers said that senior managers and executives visited the hospital. Staff used performance indicators to gauge and improve performance by ‘ward to board assurance’, and these were available live on the service electronic dashboard.
• Clinical audit was being carried out with full staff involvement; the audit and assurance framework showing comprehensive auditing across the service, with indications of positive impact on the service.
• Staff felt they could raise concerns without fear of victimisation, and morale was high among staff.

However, some of the care plans reviewed did contain jargon or language that might be confusing to patients.