This was a joint inspection visit with a Mental Health Act commissioner and two specialist advisors. We spent time talking with people that used the service, managers and staff. People who used words told us they were safe, though one person reported staff member had sworn at them. We were told this was an agency staff who had not been allowed back to work at the service. People told us staff were, "A good laugh" and "There's more staff around to do things with, like activities". Where people did not use words we saw that staff understood their individual communication gestures and language..

People told us they were not involved in contributing toward their care and support plans and some decisions made without being consulted. For example menu planning.

We found there had been changes to the management team, who recognised the monitoring of the quality of the service provided needed to improve so people received safe, effective care and treatment which responded to their individual needs.

Following an investigation by the local authority safeguarding team the provider put an action plan in place to address the concerns highlighted as part of the investigation. The action plan has been monitored by the safeguarding team, commissioners and the care Quality Commission, including this responsive inspection and Improvements had been noted.

We found the action plan put in place had not been risk assessed to ensure the most important priorities were being addressed.

We visited the hospital on 30 January 2014. We found the hospital to be safe, secure, warm and clean.

We were told six patients were currently being accommodated. Throughout the course of the day we spoke with all the patients. For some patients communication was limited, however one person told us they were going out shopping and what breakfast they had helped staff to make for them. Another told us about how they spent their day and they had a nice bedroom.

One visitor told us communication between staff could be improved. They explained they should receive a telephone call from staff twice a week for an update on their relative’s wellbeing was often overlooked and messages left were unanswered.

We saw patient’s views and opinions were taken into account in the way the service was provided and delivered in relation to care.

Care and treatment was planned and delivered in a way that was intended to ensure patients safety and welfare.

Patient’s staff and visitors were protected against the risks of unsafe or unsuitable premises.

Patients were cared for by staff that were supported and trained to deliver care and treatment safely.

We saw patients records were ‘person centred’, with updated risk assessments in place.

We carried out a responsive inspection at the service due to receiving information of concern regarding the care and welfare of the patients. Information was also received about the skills and ability of the staff to care for patients. We found adequate person centred care plans, with up to date risk assessments available for the patients.

We found staff had policies and procedures to support the safe management and care of the patient’s within the hospital.

Staff had been recruited following a robust recruitment policy with all relevant checks having been carried out prior to patients being admitted to the hospital.

As this was a new service staff had recently undergone induction training but we highlighted some training needs to be addressed, to ensure the safety and security of both patients and staff within the service.

Staff told us they felt supported and valued in their roles. They acknowledged there had been some problems since patients had been admitted to the service, but felt the management had supported them fully to carry out their roles.

We saw incidents had been fully documented and care plans and risk assessments had been updated as required.

We spoke with patients who were receiving care but they were unable to provide any comments due to their medical condition.

We rated Breightmet Centre for Autism as good because:

• Patients received comprehensive care assessments which involved input from a multidisciplinary team which including psychiatry, nursing, clinical psychology, occupational therapy. Care plans showed evidence of patient involvement in care planning, risk assessment and management and activity planning. There were sufficient nursing and support staff available to ensure patients were cared for in accordance to their care plans.

• Patients had access to physical healthcare and the service ensured their physical health needs were assessed and monitored on a regular basis. Patients with underlying physical health conditions had appropriate health action plans to monitor and manage these.

• We observed kind and respectful interactions between staff and patients. Both patients and carers gave positive feedback about how staff treated them. Staff knew the patients well and their needs.

• Patients could access telephone facilities within each apartment by either using their own mobile phone if this had been risk assessed or the cordless office telephone which could be used in their own bedrooms or in the quiet rooms.

• Patients had access to drinks and snacks throughout the day, with drink facilities kept on each apartment and snacks stored in the main kitchen.

• Patients had personalised activity planners, which were person-centred and designed to support their individual rehabilitation needs. Activities were available seven days a week both on and off site.

• There was an effective governance structure in place, which included systems and processes to ensure monitoring of the service. The provider was committed to service improvement. As well as having a comprehensive internal audit programme in place, the provider had commissioned a number of service specific reviews to ensure approaches and strategies were most appropriate for the patients within their care.

However:

• Although staff were aware of the processes in place for raising safeguarding concerns, the service manager did not immediately demonstrate that the threshold for these were understood when a concern was raised during the inspection.

•         Though the service had psychiatry provision provided by a part time locum psychiatrist with the support from an assistant psychiatrist, there was no assurance to ensure all patients had received regular psychiatry assessments and reviews.