We rated Billingham Grange Independent Hospital as good because:

• Individual risk assessments were carried out and regularly reviewed. Ligature risks had been assessed and steps had been taken to mitigate these risks.
• Mandatory training at the hospital was at 88%, which was above the providers’ requirement of 85%.
• Staff employed at the hospital had undergone checks to ensure they were suitable for the role.

Investigations were carried out following incidents and lessons learned were fed back to staff.

We decided to visit the home late evening and through the night to gain a wider view of the service provided. This was part of an out of normal hours pilot project being undertaken in the North East region.

We spoke with six people who used the service, 11 different grades of staff and the manager. We also observed the interaction between staff and people who used the service.

We found that where people were detained under the Mental Health Act, appropriate systems were in place which ensured that the service worked within the legal frameworks.

We spoke with six patients and observed the staff practice on the units. Patients told us that they were happy with the care they were receiving and thought highly of the staff. One patient said, “The staff are very, very good and nothing is a bother.” Most patients were unable to make extensive comments about their care due to their limited speech but non-verbally indicated that they were happy with the care. From observations we found staff understood patients care needs and consistently worked in a person-centred manner.

We found there were good systems in place for working with other health and care professionals.

We found there were good systems in place for monitoring the quality of the service and service delivery.

This inspection was conducted by three compliance inspectors and a Mental Health Act Commissioner. We used this approach, as some concerns had been received about care and welfare of the people who used the service. The issues centred around the staff ability to support people with complex needs. We spoke with a range of staff and at least two people on each unit. A large number of people living at the service were unable to verbally communicate with us. Throughout the inspection we observed people being treated kindly and with respect and being encouraged to make choices in regard to their daily lifestyles.

People said “It’s alright here”, “I like the staff”, “I would like a bit more freedom as I could get back without getting lost” and “I go out with staff all the time”. One person stated they, "Loved it" and "It the best place ever".

We found that since the previous inspection the care records had been improved and information was more accessible. We found that where people were detained under the Mental Health Act this had been done within the correct legal frameworks.

Improvements had been made to environment since the last inspection, this continued to be ongoing. Emergency equipment and procedures had been reviewed and appropriate training, checks and systems were seen to be in place. People's needs were being met by a staff team, with sufficient skill mix, knowledge and understanding.

We spoke with people about the care they were receiving. One person was extremely positive about this. They said, "Well supported by the staff. There is enough going on, I can go out, like to watch TV and DVD's."

One person said they were not happy, which was discussed fully with them and a senior member of staff, who agreed to have further discussion with the person. They were aware of their legal rights and the constraints this placed upon them.

People spoken with generally felt well supported by the staff team. One person said, "I have been here for five years and feel well supported by the staff."

We did not seek the views of people using the service on this occasion.

People we spoke to told us they had been fully involved in the process of assessing their needs and developing their care plans. They talked of an inclusive environment in which they were well able to express views about their care and daily life. One person said, "Named nurse discussed my assessment and care needs with me. Yes I have discussed my care plan with named nurse and have a copy of it as well as a copy of the Mental Health Act guide. I am aware of my mental health act status and my rights have been discussed".

People were positive about the care provided at The Billingham Grange. One person spoken to confirmed that they received the care they needed. They said, "I think I get the care and support needed at the moment, I am fully aware of my care management plan and medication regime. I can express my views and influence changes to care plan".

Another person said, "I get the care I need and am treated with respect".

People spoken to told us they felt safe living at The Billingham Grange.

They said, "I get the care I need and am treated with respect. I feel safe living here. I would talk to the staff if I was worried about something, but I haven’t had to do this. I don’t know how to make a complaint, but I would talk to staff if I wanted to make one".

They were also well aware of who to speak to should they have any worries or concerns.

They were fully aware of their legal rights under the Mental Health Act, confirmed they had been read their rights and had supporting documentation.

People were very positive about the staff who care and support them. They said, "I love the staff here, it is the way they support me". "All staff are lovely, it is calm, they talk to me and comfort me, they make me feel wanted, dead kind and dead nice".

We rated The Billingham Grange Independent Hospital as outstanding because;

• Staff displayed a caring and compassionate approach to patients. Staff knew patients they cared for well and ensured that the support they gave was in line with their personal preferences.
• There was a strong governance structure in place, which displayed joined up working from ward to board level. The service was very well-led at ward and regional level. Staff and patients told us the hospital director was approachable and supportive. The company had clear vision and values which were clearly embedded in the running of the service. Values were demonstrated by staff who cared for patients in a kind and compassionate manner.
• Staff went the extra mile to ensure that patients were involved in decisions about their care and treatment. Staff made multiple attempts to engage patients and used different methods to help patients make choices. Where appropriate there was evidence of families being involved in decisions about care.
• Patients, families and carers participated in the formulation of care plans. Where people were reluctant to participate, they were encouraged by staff. Patients were involved in planning for discharge. Discharge planning was embedded in care delivery and was discussed in multi-disciplinary meetings and ward rounds.

• Patients who lacked capacity were automatically referred to independent advocacy services. Contact details for advocacy services were displayed throughout the service. Patients were supported and encouraged to access services in line with the Mental Health Act Code of Practice

• Staff encouraged and supported patients to access health screening tests. There was a registered general nurse on each ward to monitor the physical health of patients. Staff used recognised screening tools to help them monitor various aspects of physical health.
• All patients had a named nurse and secondary nurse. Photographs of named nurses were in patient’s bedrooms to help them remember who the named nurse was. Patients had regular one to one time with their named nurse.
• There was minimal use of restraint and this was only used after verbal de-escalation had been attempted. Restraint was kept to low level holds and patients were given de-briefs following incidents.
• The provider kept staff, patients and visitors up to date with the running of the service and ratings from previous CQC inspections were posted in the hospital to ensure people could see them.
• Patients and carers were encouraged to give their feedback on the service and the care and treatment they received. The service had been proactive in capturing and responding to patients concerns and complaints.
• There was a good and varied activities programme which provided patients with activities seven days per week. There were a range of activities which helped with patients’ physical and mental health and fitness.
• Poor performance was identified and dealt with quickly and effectively. There was clear learning from incidents and lessons learned were shared both during clinical governance meetings and with staff from national Barchester Healthcare services. This helped to prevent recurrences of incidents.