We carried out this inspection as part of our scheduled inspections to check on the care and welfare of people using this service. The visit was unannounced, neither the provider nor staff knew that we would be visiting.

During the inspection we spoke with the registered manager, the clinical manager, the deputy clinical manager, three qualified nurses, two care staff, and two people who used the service. Following our inspection we spoke with three relatives.

People told us that staff explained their treatment plan. Due to the nature of the health needs of people who used the service, the environment and choices available to them had to be restrictive. The people we spoke to told us that they understood the reasons for these restrictions. One person told us: “I was very ill when I came here but I am in a different place now and hope I will be well enough to go home soon".

We saw that suitable arrangements were in place to gain people's consent to the treatment and support they required. We saw that improvements made since our previous inspection were in place to ensure that when people did not have the capacity to consent to their treatment their rights were explained to them.

People generally made positive comments about staff. One parent said; "The staff are great, they are professional and caring and I have more confidence about the future than I had before x(person's name) came here". Another parent said: "Staff are always pleasant and welcoming, they come and talk through problems and keep us in the picture".

Staff received training and supervision to provide people with the support and treatment they needed to ensure they had the knowledge and skills to support people at Newbridge House.

Systems were in place to review and monitor the quality of the service and the treatment people received and when needed make changes to the service were made.

During our inspection, we spoke with seven people who used the service, one relative and three members of staff.

Due to the nature of the health needs of the people who used the service, the environment and choices available to them had to be restrictive. One person told us: “Every one is respectful here". Another person told us: “I miss home”.

We found some improvement was needed within the consent processes. We found that people who did not have capacity to consent to treatment did not have their rights explained to them and documented as required.

We saw that all medicines were appropriately and safely managed. We saw that the service had planned for people's home leave when ordering medicines, which ensured people, had appropriate medicines during their home leave.

We saw that a suitable complaints system was in place for people to raise concerns and ensured that these received appropriate responses.

People told us about their treatment plan and how their treatment needs are explained to them. They told us how staff explained their treatment and the reasons why if there were any changes to their plan.They told us about restrictions they have and how these restrictions are incorporated into their treatment plan. The people we spoke to all told us that they understood the reasons for these restrictions.

People we spoke to all felt that both their physical and mental health had improved since they came to Newbridge House. People told us how they spent their days and how they are supported with their ongoing education, interests and religious beliefs. They told us:

" I go for walks everyday, play badminton, write letters and watch television". People told us about the contact that they have with their friends and family.

They told us about the staff they said:

"Staff are really friendly and do not judge you”.

“They never get angry”.

We rated Newbridge House as outstanding because:

• Newbridge House was committed to research and innovation within the eating disorders field. They took part in local, national and international research. Staff published papers, facilitated public health education and continuously evaluated current treatments and piloted new interventions with the aim of developing an evidence base for eating disorder treatment in young people and becoming a centre of research excellence.

• Staff provided high quality treatment and care. Different professionals worked well together to assess and plan for the needs of patients. Staff were skilled and experienced. The provider supported ongoing training to develop specialist skills.

• Staff undertook regular safety checks of the environment, ensuring ligature points and blind spots were kept to a minimum. The building was undergoing a programme of refurbishment and the furniture and fittings were well maintained, comfortable and clean.

• Patients had up to date risk assessments and management plans which covered by physical and mental health needs.

• Patients had up-to-date care plans. These focused-on treatment plans, recovery and rehabilitation. Staff involved patients and their families and or carers in developing care plans, risk assessments and within clinical review meetings. All patients had copies of their care plan.

• Staff had a good understanding of Gillick competence, the Mental Capacity Act and the Mental Health Act. They routinely advised detained patients of their rights under the Mental Health Act.

• Staff worked towards discharge with patients and parents/ carers. The pathway toward discharge was open and clear for patients and their families to understand. They ensured that the patients community teams were kept fully updated of care needs and completed home and school visits prior to discharge. Patients and parents told us this led to a smooth transition back to home life.

• Staff used a wide variety specialist tools to assess the severity of the patients’ eating disorder and measure the outcomes of treatment interventions. They carried out regular clinical audits to monitor the effectiveness of interventions and adapt where necessary.

• Staff provided interventions following national guidance such as Junior MARSIPAN, National Institute for Health and Care Excellence guidance for eating disorders and Autistic Spectrum disorders.

• Newbridge House staff offered second opinion assessments free of charge to ensure the patient could access the most appropriate treatment interventions.

However:

• Not all eligible staff had undertaken the appropriate level of children’s safeguarding training as recommended by the Royal College of Paediatrics and Child Health.
• Newbridge House had not notified the CQC of all safeguarding alerts. However, the manager had submitted safeguarding alerts to the local authority safeguarding team. We were satisfied that patients were safeguarded by staff raising alerts.
• Staff did not always follow the medicines policy when disposing of medicines.
• One patient told us that agency and bank staff sometimes used their personal mobiles whilst on the unit and they did not have such a good understanding of their support needs around mealtimes.
• Medication charts for three detained patients did not show the Mental Health Act status of patients.