We rated other specialist services as requires improvement because:

• The hospital was trying to meet the needs of patients who had a wide range of clinical diagnosis. Whilst their broad aim was to offer rehabilitation the hospital did not have clarity about the therapeutic model and pathways to meet the needs of all the patients. Discharge plans were not in place for all patients in the hospital and the hospital’s step down unit was not functioning effectively. There was also a risk that patients individual needs would not be met in line with best practice guidance.

• Staff did not always carry out patient’s health monitoring in line with their care plan, or take prompt action to address abnormal clinical readings. Staff were not recording the monitoring of patients’ vital signs after rapid tranquilisation to ensure that they were safe.

• Staff did not have sufficient training in supporting patients who required physical restraint. A member of the team who saw patients individually had not undertaken breakaway training to ensure their safety. This member of staff had not received management supervision within the hospital.

• The provider had not ensured that all staff had the specialist training necessary to ensure the safety of the patients. None of the nursing or care staff members had undertaken food hygiene training despite serving food to patients and supporting them with eating. None of the nursing staff had undertaken intermediate life support training. Staff had not undertaken training in positive behavioural support and learning disability training to ensure that they could meet all patients’ needs effectively.

• The hospital’s ligature risk assessment did not include risks within the communal areas and garden area.

• Staff and patients sometimes walked through the clinical room as a way through to the adjoining office/consulting room, which presented an infection control issue.

• Staff had not calibrated the weighing scales, and blood pressure apparatus to ensure that the readings were accurate.

• Some areas within bedrooms were not kept clean, and two identified bathrooms required redecoration.

• Staff were not always clear about the legal rights that were relevant to each detained patient.

• Management were not sufficiently monitoring staff engagement with patients, and patients did not always feel confident to raise any concerns over staff conduct.

• Discharge plans were not in place for all patients in the hospital and the hospital’s step down unit was not functioning appropriately.

However:

• Since taking over the service, the new management team had brought about some significant improvements to the hospital environment and staffing. The management team were open about improvements needed, and had plans in place to address many of the areas identified at the inspection.

• Staff had undertaken a comprehensive risk assessment and care plan for each patient and reviewed these regularly. Care plans were comprehensive, holistic and person centred and included patients’ views. The service provided information in an easy read and pictorial formats for patients with communication difficulties.

• The hospital had weekly patient community meetings, chaired by a patient who also recorded the minutes. The acting manager monitored and carried out actions from these meetings.

• Patients described a pleasant and positive atmosphere in the hospital, and support provided for them to pursue their own interests. Communal areas were spacious and inviting with table tennis, snooker tables provided and an outside space.

• Patients spoke positively about the choice and quality of food, which met their dietary requirements. Patients who were on individualised diets had diet plans in the kitchen in view of staff. Patients were involved in choosing the hospital’s menus.