We rated Monet Lodge as good because:

• The ward was clean, tidy and well maintained. The clinic room was fully equipped and emergency equipment was checked regularly. Staff were aware of how to report incidents and all staff had access to the online reporting system. There were single sex ensuite bedrooms and a separate female lounge in accordance with same sex guidance. There were good systems in place for ordering, dispensing and storage of medications. Staff were aware of their responsibilities under duty of candour.
• There was good evidence that National Institute for Health and Care Excellence guidance was being followed in relation to prescribing and monitoring of medication and non-pharmacological treatments for dementia. Staff completed a physical health check on admission and these were regularly reviewed throughout the patients stay at Monet Lodge. Mandatory training was at 86% and staff took part in clinical audits including medications, care records and mental health act documentation. Staff had a good understanding of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. The service adhered to the Mental Health Act and the revised Mental Health Act Code of Practice. Mental Health Act documentation was complete and correct.
• Staff engaged positively with patients and their carers. All interactions we observed were respectful, kind and maintained the dignity of the patient. Carers and relatives told us that the staff were friendly and approachable and always took the time to speak to them and involve them in their loved ones care.
• There was a full range of rooms to support the care and treatment of patients with complex needs. There was a good variety of activities available to patients seven days a week. Information was available in easy read format and in other languages if required. There was access to spiritual support and the chef was able to provide food for any specialist needs such as vegetarian, vegan, halal and kosher. Patients had access to an independent mental health advocate who visited the hospital and attended care programme approach meetings if patients wanted them to.
• Staff were aware of the organisations vision and values and these underpinned all the work they did. These were incorporated into staff meetings, supervision and the key performance indicators for staff. The staff felt supported by the manager and the clinical lead and felt that their suggestions about the service were listened to.

However,

• On the day of our inspection, the clinic room floor and worktops were dirty and the plastic suction tip on the suction machine was uncovered. On our return to the hospital this had been rectified and the room was added to the cleaners schedule for a daily clean.
• The ligature knife was locked in a drawer that not all staff had a key to.

• The clinic room temperatures were found to be over 25 degrees Celsius on a regular basis.

• Due to the amount of care plans some patients had (up to twenty) we found that some care plans were generic and not person centred. We found one example where the patient was referred to as “he” when the patient was a “she” and one with another patients name in.

We rated Monet Lodge as good because:

• the design and layout of the environment reflected best practice in dementia care, all areas were clean and clutter free, and ligature and falls risks were adequately mitigated
• the service had a stable staff team and an appropriate skill mix, which helped ensure continuity of care for patients’ physical and mental health needs
• staff did not use prone (face-down) restraint or rapid tranquillisation techniques but did occasionally use the ‘holding’ technique (a low level of restraint), and only after de-escalation (calming down) techniques had failed
• medicines management practice, including storage, dispensation and administration was mostly in line with the relevant guidelines
• patients’ care records were thorough, up-to-date and personalised, and contained a range of assessments and care plans associated with their physical and mental health needs
• patients received co-ordinated and all-round care and treatment from the multidisciplinary team, with each specialism contributing their specific skills and expertise
• staff received timely and meaningful supervision and appraisal, and managers encouraged their personal and professional development
• staff had a good understanding of the Mental Health Act (MHA), the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS), the service adhered to the MHA and the revised MHA Code of Practice, and MHA documentation was in place and up-to-date
• there was a strong person-centred culture within the service and staff knew the patients and their relatives well
• we observed caring and respectful interactions between staff, patients and relatives
• relatives gave very positive feedback about Monet Lodge and were particularly impressed by the highly-motivated and caring staff, and the excellent care they provided
• the unit contained a full range of facilities and equipment to support treatment and care, and patients had access to a wide range of dementia-friendly activities tailored to their needs
• staff, including specialists, assessed patients’ dietary needs and informed the unit’s cook of any specific requirements
• the service had a clear governance structure, with effective systems and processes for overseeing all aspects of care including regular management meetings, a programme of audits and access to a service improvement team
• there was good morale among staff: they experienced job satisfaction, they felt valued and supported by colleagues and managers, and they shared the provider’s vision and values for their service.

However:

• staff were not up-to-date with all their mandatory training
• medicines were not always ordered promptly, medicine errors were not always reported appropriately, and when nurses retrospectively corrected gaps found in medicine charts, this increased the risk of errors
• new ‘capacity to consent to treatment’ assessments were required for all patients because Monet Lodge had a new responsible clinician, but these had not yet started
• in one patient’s care records, handwritten medical notes indicated that relatives had given consent for vaccinations on two occasions, with no reference to the MCA and the best interests framework (legislation that describes what to do when a person lacks the capacity to make a specific decision)
• although records contained information about patients’ health-related dietary needs, we did not see any recorded information about their food preferences.