We undertook this unannounced focused inspection to review a requirement notice that was given at our last comprehensive inspection in April 2016. We published our inspection report in July 2016. The requirement notice related to the safe question breaches of regulation 17 – Good governance. The provider submitted an action plan and this told us what they intended to do in order to make improvements. We inspected Weaver Lodge on 7 October 2016 to see if these improvements had been made.

We found that the provider had implemented all areas of the action plan. Following implementation of the plan there had been no further medication errors.

The action taken included:

• A copy of the medicine management policy had been given to staff and local protocols had been amended and updated.

• All registered nurses had undertaken a medicine management competency assessment. This will be repeated annually.

• A competency assessment and training plan was devised for support worker staff. Some staff had completed this and others were booked to complete this training.

• The senior nurse practitioner reviewed the weekly medicine audits and took immediate remedial action or undertook further checks where issues had been identified.

• Specialist pharmacy undertook additional monthly audits.

• The daily shift handover proforma was amended to require a daily signature. This was to confirm medication administration records had been checked, and were in order, that day.

The provider had made the required improvements within six months from the date of the last report being published. This means we are able to re-rate the safe domain of the report from requires improvement to good.

This did not affect the overall rating as this was already good.

We spoke with nine patients who told us they felt safe and well supported by staff. Patients expressed being pleased with the recent refurbishment and that the unit looked and felt better as a result. Comments included, "Nicer place to be," and "Big improvement, they have painted it well."

Patients told us that staff listened to them and asked for their consent before providing any care and support. We found where patients did not have the capacity to consent, the provider acted in accordance with legal requirements. We looked at care files belonging to 10 patients. In general, all appropriate documentation was signed by patients. Where a patient had not signed a document an appropriate reason was clearly recorded by the staff.

Since our last inspection visit a program of refurbishment had been commenced and was ongoing. The provider was able to demonstrate having made improvements to the environment in order to ensure that patients were appropriately supported and protected from risks.

We spoke to three patients who told us they felt safe at the service and well supported. They told us they felt involved in the care and treatment they received. Some comments made were:-

“The staff are fantastic. I see my (named nurse) when I need to.”

“I’m very well, the facilities are really good, staff are supportive. If you’re struggling they’ll help you.”

“The staff are excellent. I get on well with them.”

We looked at three care records. Care plans and risk assessments were in place with information about patients care needs and risks identified.

Staff were aware of how to protect patients through the safeguarding vulnerable adults procedure.

There was a system in place to manage complaints.

We found that assessments of patients' ability to consent to care and treatment needed improvement. This was to ensure that there was a clear assessment on which to base treatment.

We also found improvements were needed to the environment to ensure that patients were appropriately supported and protected from risks.

We spoke to two people who used the service during our visit. Both said that they regularly had the opportunity to get involved in the planning of their care. They told us that they had regular access to mental healthcare professionals and their GP. They said staff listened to them and that staff were approachable if they needed to discuss any concerns or wanted support.

Both people spoken with said that they were treated in a respectful manner by the staff team. They told us that they liked the environment that they lived in. They told us that they felt safe. They said that had a good relationship with the staff. Some comments made were:-

“I get on with the staff great. They give me help when I need it.”

“This is one of the best services I’ve been to.”

A health care professional who made regular visits to the service told us that a good service was provided. They said that people’s needs were appropriately met and that from their observations people liked being at the service.

A social worker who supported a person who used the service told us that care and health needs were appropriately met. They said referrals were made for additional support as this was needed. They described the staff as welcoming and professional in their manner.

We requested information from Cheshire West and Chester Local Involvement Network (*LINks). They had no information to give us at the time of writing this report.

* LINKs are networks of individuals and organisations that have an interest in improving health and social care services. They are independent of the council, NHS and other service providers. LINks aim to involve local people in the planning and delivery of services.

We rated Weaver Lodge as good because:

• patients told us that staff were kind and respectful and that they felt supported

• activities were available seven days a week and patients were able to say what activities they wished to do

• we saw that patients were involved in developing their care plans and had a say in the types of treatments they could receive

• carers felt included in care and treatment and their views and opinions were considered

• the hospital was bright, clean and well maintained

• staffing numbers were adequate and it was rare for activities or one to one time with nursing staff to be cancelled

• as well as medical and nursing interventions patients had access to occupational therapy and psychological interventions

• physical health was being regularly reviewed and specialist healthcare staff regularly visited the hospital

• there were good links between the hospital and community mental health staff

• all staff had regular training, supervision and appraisals.

However:

• although regular medication audits were being undertaken, stock discrepancies were being reported and it was unclear what action the managers were taking.