We rated Woodbourne Priory as good because:

• Staff worked well together to assess and plan for the needs of patients. There were a range of professionals available to meet patients’ needs. Staff provided patients with care and support to offer them the best chance of recovery. There were a range of therapies available to patients and patients told us they enjoyed the therapies on offer.
• The service routinely sought patients’ ideas and feedback and consistently made changes to the way they ran the service because of this. The service delivered effective programmes of therapy and specialist rehabilitation for the different patient groups.
• Staff completed patient-centred risk assessments and care plans on most wards. Patient records were comprehensive and in good order. Staff considered mental capacity and assessed those they believed to lack capacity. They advised patients of their rights under the Mental Health Act. Staff addressed physical healthcare needs of patients and supported them to manage their physical health.
• The ward provided patients with a comfortable and homely environment. Wards were visibly clean and furnishings in good order. Patients were provided with high quality meals and had access to food and drink 24 hours a day. Patients were able to personalise their own space. The ward areas reflected the presence and personalisation of patients in recovery.
• The service had recruited new managers and they demonstrated the skill and experience needed to drive forward further improvements. There were systems in place to allow managers to audit the quality of care. Supervision and annual performance reviews were routinely held between staff and managers and were most were up-to-date

However, we also found:

• The service did not follow its own policy in privacy, dignity and mixed sex accommodation by not allocating male and female areas of Maple ward at different ends of the ward. Guidance on same-sex accommodation requires providers with patients on mixed wards to be grouped to achieve as much gender separation as possible (for example, women towards one end of the corridor, men towards the other).
• Care plans and staff handovers on one ward were not written in a way which reflected patient views and used clinical terminology.
• Dual signatures were missing on two controlled drugs records on two wards. This was not in accordance with the providers drug administration guidance and policy.

We inspected one ward that provided care and treatment to young people. We spoke with four young people aged twelve to seventeen years including people whose rights were restricted under the Mental Health Act.

Young people were supported to understand the care choices available to them. Where their rights were restricted under the Mental Health Act the appropriate forms were in place to authorise their treatment. People who were using the service on an 'informal' basis said they were involved with their treatment plans. One young person told us, "It's lovely here. Everyone is treated with the same respect."

Young people's capacity to consent to treatment was assessed when they were admitted. Where they did not have the capacity to consent, the provider acted in accordance with legal requirements. People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Each risk presented by the person's needs or condition was identified a care plan put in place to manage and treat it.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines. The service worked closely with an external pharmacy supplier and a pharmacist visited regularly to provide advice and support.

The provider formally notified us of significant incidents concerning young people throughout the year and had made referrals to other authorities as appropriate.

During our inspection of this hospital we focused on and spoke with five young people on one ward at the service. Some had their rights restricted under the Mental Health Act. Each person knew about their care plans and was well informed about the aim of their care including their medication.

Young people told us that the ward provided a good, caring and supportive service. We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety. Risks presented by the person's complex conditions were identified, assessed and managed through an agreed plan.

People's treatment and progress was monitored by regular meetings of the professionals involved with their care. Parents said they had 'excellent involvement' with their child's principal practitioner and community services and they understood the strategy for managing their child's safe return home and into community provision.

Young people were protected against the risk of unlawful or excessive control or restraint by arrangements such as including them in agreeing safe ways for staff to intervene in order to prevent self harm.

Young people told us that there were enough staff to look after them during the day and at night. We found there were sufficient numbers of staff on duty with the right skills and experience to meet people's needs and further training was made available to them. People were made aware of and used the provider company's complaint system.

The purpose of this review was to ensure that medicines were prescribed and given to people safely. The review was completed by a pharmacist inspector. This visit was to follow up on previous concerns.

We found that improvements had been made which should ensure people using the hospital services received their medicines, as prescribed, safely. We found that the medicine management systems in place were well organised and under constant review to ensure a high level service was maintained.

We could only speak with two people using the service on the day of our visit; this was due to people being involved in their treatment programmes throughout the day. The people we did speak with told us that they enjoyed staying at the hospital. They told us that they were able to use computers, that staff were friendly and that they had plenty of activities to keep them occupied.

We did not rate The Manor at this inspection. We inspected Woodbourne Priory Hospital on 20-22 June 2017 and gave an overall rating for the hospital. The Manor was not opened until August 2017, therefore we will inspect and rate the ward at our next comprehensive inspection of Woodbourne Priory Hospital.  

On this inspection, we found that:

• There were sufficient numbers of skilled staff available on the ward for patients to access. There was good access to medical cover 24/7. Staff showed good knowledge of safeguarding and had a clear line of governance for reporting concerns. 
• Staff carried out environmental risk assessments of the ward area daily. Patients had individual risk assessments and detailed contingency plans in place in the case of emergencies. 
• Patients had detailed care plans in place and were aware of and in agreement with their therapy programme. The service offered a comprehensive therapy programme that offered therapies recommended by The National Institute for Health and Care Excellence. 
• Staff learned from incidents and the provider ensured learning from other areas of the service was shared. 
• All patients we spoke with were positive about their treatment and their experiences on the ward. 
• Staff knew who their senior managers were and told us they could raise concerns if needed and would be supported to do so. There were opportunities for staff to develop. Staff morale on the ward was good. 

However:

• The ward did not have a designated room for patients to see visitors with children. This was not in line with Priory policy and a potential safeguarding risk.
• Nursing staff were not given guidance on what order they should administer as needed (PRN) medication. This meant that they may not have issued PRN medication in the order intended by the prescribing consultant. 
• There was no documented admission criteria and no standard operating procedure available at the time of inspection.
• Not all staff were specially trained or showed good knowledge of identifying risks in treatment and detoxification for substance misuse. Less than half of the ward staff had been trained in this area at the time of inspection. Recent changes in leadership of the hospital had led to a delay in organising specialist training.