We rated Pendlebury House as outstanding because:

• There was universally positive feedback from patients, carers and outside agencies such as advocacy. All felt that staff went that extra mile to provide recovery focused, person centred care. Staff were continually respectful and positive in their approach to patients and there was evidence of strong caring and supportive relationships between staff and patients. Patients were seen as true partners in their care and were involved in decisions about the service. Patients were involved in interviewing all new staff and attended meetings regarding changes about the service at every level. Staff valued patients emotional and social needs and they worked with patients to identify these needs. Feedback from advocacy services about Pendlebury House was positive reporting that they receive appropriate referrals and patients give positive feedback to them about the hospital and its staff. All patients we spoke with were clear that they knew how to complain should they feel they wanted to.
• Staff at all levels took a proactive approach to understanding the individual needs of each patient. We saw evidence of this during our inspection where kosher food had been ordered for one of the patients. Staff had given careful thought into the ordering and storage of this food. They ensured that it was clearly labelled, kept separately in the fridge and cooked separately. The chef was up to date on the need for kosher food to be kept separate from other foods and the foods that cannot be eaten together in the Jewish religion such as milk and meat. All patients made positive comments about the food. The chef had an excellent knowledge of the patients and was able to talk us through each patient and their nutritional needs on the day of our inspection.
• Pendlebury House was providing holistic and person centred care to every patient. Staff had a clear vision of recovery and used outcome measures to monitor and assess recovery, whilst engaging patients in the process. The in-depth staged admission and assessment process enabled patients and staff to get to know each other in order to ensure the placement was the correct place for everyone involved. Staff encouraged daily living skills to be developed in fun and innovative ways. Patients had access to psychological therapies as recommended by the national institute of health and care excellence (CG178). Every patient’s physical health was checked on admission and throughout their time at Pendlebury House.
• The hospital was clean, tidy and well maintained. Staff managed blind spots , such as corridors that were not in sight of the nursing office, by use of observations, individualised risk assessments and the good knowledge of the patients by the staff. The clinic room was fully equipped and there were weekly medication audits. The hospital was staffed sufficiently in order to ensure the safety of patients. There was no evidence of restrictive practice and patient risks were managed on an individual basis using a recognised risk assessment tool. Staff had a good understanding of safeguarding procedures at all levels and the hospital had good links with the local safeguarding team. All staff were aware of how and when to report incidents and the process for learning from incidents.
• There were good links with the local GP practice. Staff were encouraged and supported to undertake specialist training for their role. Staff received supervision every six weeks and 100% of staff had an appraisal in the 12 months leading up to our inspection. There was a good working relationship between the local mental health trust and Pendlebury House which included the use of their on call doctor facilities and psychiatric intensive care unit.
• There was a good understanding at all levels of the Mental Health Act and its code of practice. Likewise the staff had a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Staff assessed mental capacity when there were concerns and best interest meetings were held for patients that this affected.
• The staff at Pendlebury House incorporated the vision and values of the provider in everything that they did. Staff had adapted medication audits in order to respond to minor concerns. The morale in the team was high and staff had a sense of pride in their work. The staff were committed to providing good quality, recovery focused care to all patients. The provider had a range of quality assurance and governance meetings set up across their organisation in order to monitor and improve performance and look for trends across similar services. The hospital was engaging in a project with Manchester Art Gallery. This was a service user led visual art and sound project, for patients to explore aspects of mental health and recovery through a series of art workshops. This will culminate in a final exhibition open to the public. This was a good example of innovation and maintaining links with the local community for groups that struggle to engage in society. The project hoped to challenge misconceptions and stereotypes surrounding Schizophrenia and mental illness. There were plans for the project to feature on BBC Radio 4 show “All in the Mind”. Following completion of the project there were plans to use it to research the benefits and outcomes.

However:

• Several policies  in electronic form on the Turning Point intranet were past their review date. This included the medication policy, the customer feedback policy and the visiting policy. The operations manager was aware of this and had raised it with head office on several occasions. They were now to take part in a policy review group to ensure that policies due to be reviewed were done in a timely manner. This group was currently reviewing three policies per month in order to get all policies up to date.

On the day of our inspection we spoke with people who used the service, staff and relatives. We also undertook a tour of the premises, looked at policies and procedures and read peoples support plans.

Overall, people told us they were happy at Turning Point and felt well supported. Comments from people who used the service included; “There is room for me to write my own view on my support plan and I sign it.This allows me to be more involved in my care plan reviews” and “The support here is very good” and “You are allowed your freedom here but get the support at the same time” and “There is nothing to complain about here”.

We undertook a tour of the premises to ensure they were safe and fit for purpose. People who used the service accessed the building using a key fob which allowed them to leave the premises when they chose. We observed the building to be clean and tidy with a homely atmosphere.

We looked at how staff were recruited to ensure this was done safely. We found Criminal Records Bureau (CRB) references from previous employers had been sought.

We spoke with staff during our inspection to ensure they received adequate support to undertake their work. There was a staff induction programme in place and a variety of staff training available.

We found there were appropriate systems in place to monitor the quality of service provision and respond the complaints appropriately.

Turning Point was registered with the Care Quality Commission to provide support for up to ten people and there were eight people living there on the day of our visit. We spoke with three people in order to find out how they had been supported during their time at Turning Point.

Comments from people who used the service included;

“I’ve have lived here for a while now. I’m happy here”.

“I like the staff. They help me to develop my daily living skills such as cooking and budgeting”.

“I can come and go as I please. I like getting the bus into Manchester”.

“I feel safe living here. I trust the staff”.

During our inspection we found that people had received adequate support during their time at Turning Point and were treated with dignity and respect by the staff. People who used the service told us that they ‘felt safe’ and would speak with the staff if this ever changed.

We found that staff had received adequate support which helped them to undertake their job role effectively. One staff member told us “There is alot of training on offer. Most of it is done formally but we also do e-learning aswell”.

We found that Turning Point had robust quality monitoring systems in place and that people who used the service had contributed towards this process in order do develop a person centred service.