We rated The Willows as requires improvement because:

• There were issues with the reliability and safety of clinic room equipment and supplies including portable appliance testing, calibration of equipment and some supplies being out of date. The provider did not detect these issues through their own monitoring processes.
• There was a restrictive practice relating to patients having section 17 leave suspended if they did not request their medication on time.
• Patient records did not show carer involvement. We previously raised this issue during a Mental Health Act review of the hospital in August 2017. It remained an issue during our inspection.
• There were recording errors on patient capacity forms. The provider did not detect this issue through their own monitoring processes. Staff corrected the error when we raised it with them.
• Staff we spoke to were not confident in the rights and management of informal patients. This did not affect patient care since the hospital had never admitted an informal patient. However, the hospital could accept informal patients. The provider had a protocol for the management of informal patients.
• Not all patients had clear discharge plans.

However,

• The hospital provided safe care. The ward environment was safe and clean. The ward had enough staff. Staff assessed and managed risk well and managed medicines safely.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients in a mental health rehabilitation ward and in line with national best practice guidance.
• The ward team included or had access to a range of specialists required to meet the needs of patients on the ward. Managers ensured staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients.  They actively involved patients in care decisions.

We rated The Willows as good because:

• We observed friendly and positive interactions between patients and staff.
• There were no blanket restrictions in the service.
• The arrangements for managing medicines were safe.
• Staff understood the individual needs of the patients.
• Staff used psychological interventions when patients were experiencing distress.
• All the care plans we saw were comprehensive and focussed on the patient’s goals and individual needs.
• Some patients were ambassadors and attended the East Midlands Recovery and Outcomes Meetings.
• Patient information was stored securely, patient notes were computerised and password protected.
• Staff said supervision was effective, covering all aspects of their role.
• Staff attended No Force First and Positive /Proactive Groups ran by the Department of Health.

A range of training was provided for staff to enable them to safely meet the needs of patients.

We spoke with four of the five patients living at the service to help us assess compliance. We also spoke with five staff including the acting manager and the deputy to help us form a judgement about the service.

Most of the patients we spoke with told us they received the care and support they needed. Comments included, "I really like it here, this is the best locked rehabilitation service I have been in," and "The staff are approachable and I can talk to my keyworker." We found risks were identified and action was taken to mitigate against this where possible to protect patients from the risk of receiving inappropriate or unsafe care or treatment.

We found staff at the service liaised with other agencies to ensure people's holistic needs were met in a co-ordinated way. One patient told us, "I can see my pathway through care and in 4 months I want to be in supported living."

Complaints were recorded and responded to in line with the provider's policy and staff took action to learn from complaints with a view to improving the service. One patient told us, "I feel I can complain and they listen to us."

We were joined on this inspection visit by a Mental Health Act commissioner (MHAC) who remained with us throughout the visit. This report focuses primarily on compliance under the Health and Social Care Act 2008 regulations but does refer to other issues which were discussed with the MHAC.

We spoke with all five patients. Four of these were subject to detention under the Mental Health Act 1983 (MHA).The fifth had recently been discharged from their section and remained as an informal patient while accommodation was being arranged for them. One of the patients showed us around the newly refurbished building.

We spoke with three healthcare staff, the acting senior nurse and the deputy charge nurse. A newly appointed manager was away on a peer quality network review on the day of our visit.

Patients told us they were happy with the care and support they received; they felt well looked after by staff who treated them with respect, but that some staff were better than others. They were involved in decisions about their care and liked their en-suite shower rooms which had been installed as part of a recent refurbishment programme.

Staff told us they enjoyed their work, felt well supported and that the provider was good in terms of providing training and development opportunities. One staff member told us, “I really enjoy working here, we have a good team.” Another told us, “I love it here, but I think we could do more in terms of the activities provided for patients.”