The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: The Breightmet Centre for Autism

Overall: Inadequate read more about inspection ratings

Milnthorpe Road, Bolton, Lancashire, BL2 6PD (01204) 524552

Provided and run by:
ASC Healthcare Limited

Important: The provider of this service changed. See old profile

All Inspections

22 and 23 March 2023

During an inspection looking at part of the service

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Our rating of this service stayed the same. We rated it as inadequate because:

  • People’s care and support was not provided in a safe, clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
  • People were not protected from abuse and poor care. The service had sufficient staff to meet people’s needs but staff were not appropriately skilled or effectively deployed and so people were not always kept safe.
  • People were not being well supported to be independent and have control over their own lives. Their human rights were not consistently upheld.
  • People did not receive kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs.
  • People did not have their communication needs met and information was not shared in a way that could be understood.
  • People’s risks were not assessed regularly and managed safely. People were not given the freedom to manage their own risks whenever possible.
  • We observed disproportionate use of restrictive practices including physical intervention. The provider was not taking sufficient action to review the use of restrictive practices at the service to try to reduce these.
  • People and those important to them, including advocates, were not actively involved in planning their care. People were not supported to use their preferred methods of communication to express their views about their care. When people did raise concerns about their care these were not always listened to and addressed in a timely manner.

This service was placed in special measures following its inadequate rating in March 2022. Following the second inadequate rating, in December 2022, we commenced action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration within six months of the notice.

This urgent inspection was carried out to check the safety of people using the service and, as a result, we took action in line with our enforcement procedures to impose urgent conditions on the provider’s registration to ensure people’s safety including ensuring all people using the service were transferred to alternative placements by 14 April 2023 and to not make any further admissions. The provider complied with these conditions and the hospital has now closed.

12, 13,14 and 15 December 2022

During an inspection looking at part of the service

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

SUMMARY

Our rating of this service stayed the same. We rated it as inadequate because:

  • People’s care and support was not provided in a safe, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
  • People were not protected from abuse and poor care. The service did not have sufficient, appropriately skilled support staff to meet people’s needs and keep them safe.
  • People were not supported to be independent and have control over their own lives.
  • The service did not provide care, support and treatment from support staff who were trained and able to meet people’s needs.
  • People did not receive kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People did not have their communication needs met and information was not shared in a way that could be understood.
  • People’s risks were not assessed regularly and managed safely. People were not involved in managing their own risks whenever possible.
  • People’s care, treatment and support plans, did not reflect their sensory, cognitive and functioning needs.
  • Staff did not follow the requirements of the Mental Capacity Act 2005 in relation to assessing capacity and making decisions in people’s best interests.
  • People did not receive care, support and treatment that met their needs and aspirations. Care did not focus on people’s quality of life and did not follow best practice. Staff did not use clinical and quality audits to evaluate the quality of care.
  • Staff did not support people through recognised models of care and treatment for people with a learning disability or autistic people. Governance processes did not help the service to keep people safe, protect their human rights and provide good care, support and treatment.

However

  • There had been improvements in the management and investigation of complaints.
  • People were in hospital to receive active, goal oriented treatment. People had plans in place to support them to return home or move to a community setting.
  • If restrictive practices were used, there was a reporting system in place and there were comprehensive reviews to try and reduce the use of these practices.
  • People made choices and took part in activities which were part of their planned care and support.
  • Managers ensured that staff had regular supervision and appraisal.
  • People and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
  • Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983.
  • Staff worked well with services that provide aftercare to ensure people received the right care and support when they went home.

This service was placed in special measures in March 2022. Following a further inspection in December 2022 where we found insufficient improvements we took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. As a result of concerns found at the our inspection of the service on 12,13,14 and 15 December 2022 we served a Notice of Proposal, the provider submitted representations against this proposal and following review of these representations, a Notice of Decision to cancel the provider’s registration was served. This was not appealed by the provider. The service was deregistered on 9 May 2023.

8 March 2022, 9 March 2022, 22 March 2022

During an inspection looking at part of the service

Our rating of this service went down. We rated it as inadequate overall and decided to place it in special measures.

The Care Quality Commission took immediate enforcement action and issued the provider with five warning notices for Regulation 9, Regulation 12, Regulation 13, Regulation 17 and Regulation 18. Summaries of the warning notices are available in the enforcement section of the report.

When a warning notice is issued, this normally limits the key question rating to inadequate.

When an independent healthcare service is in special measures it is the provider’s responsibility to improve it. We expect the provider to seek out appropriate support to improve the service from its own resources, and from other relevant organisations or oversight bodies or both.

We will inspect the service again within six months of the report being published. If insufficient improvements have been made to justify a higher rating than inadequate overall or for any key question or core service, we will consider whether it is appropriate to extend special measures for a further six months, or whether to begin the process of preventing the provider from operating the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Our rating of this service went down. We rated the service as inadequate overall because:

  • People were not protected from abuse and poor care. The service did not have enough, appropriately skilled staff to meet people’s needs and keep them safe. Staff did not meet infection control precautions that were required to minimise and control the spread of seasonal respiratory infections or follow systems and processes to safely administer, record and store medicines.
  • People were not supported to be independent and have control over their own lives.
  • People did not always receive kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs.
  • People’s risks were not assessed and reviewed regularly. People were not involved in managing their own risks whenever possible.
  • Comprehensive reviews were not completed to identify and reduce all restrictive practices in the service.
  • People did not make choices and take part in activities which were part of their planned care and support. Staff did not support them to achieve their goals.
  • People’s care, treatment and support plans, did not reflect their sensory, cognitive and functioning needs.
  • People did not receive care, support and treatment that met their needs and aspirations. Care did not focus on people’s quality of life and follow best practice. Staff did not produce effective clinical and quality audits to evaluate the quality of care.
  • The service did not provide care, support and treatment from trained staff and specialists able to meet people’s needs. The mandatory training and induction programmes were basic, and the service had not identified all training courses needed to meet the needs of autistic people and staff. Many staff had no prior experience of working with autistic people.
  • Autistic people and those important to them were not actively involved in planning their care. The multidisciplinary team lacked consistent input from occupational therapy, psychology and speech and language therapy roles.
  • Autistic people did not have all their communication needs met.
  • People in hospital were not receiving active, goal-oriented treatment. Staff did not always work well with services that provided aftercare.
  • Staff did not support people through recognised models of care and treatment for people with a learning disability or autistic people. Leadership and governance processes did not help the service to keep people safe, protect their human rights and provide good care, support and treatment.
  • Autistic people, and those important to them, did not work with leaders to develop and improve the service.

However:

  • Autistic people’s care and support was provided in a clean, well equipped, well-furnished and well-maintained environment which met people's sensory and physical needs.
  • Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Managers had ensured that staff, including regular agency and bank, had regular supervision and appraisal.
  • Advocates were actively involved in reviewing autistic people’s care.

04 November 05 November 06November 2020

During a routine inspection

Our overall rating of this service improved, it has gone from requires improvement to good. We have also removed the service from special measures because they had made significant improvements in a number of areas and we saw that all the regulatory breaches identified in the last inspection had been addressed:

  • The hospital had appointed a clinically experienced director who was also the registered manager. They had implemented a number of effective governance systems and made changes to the way staff were trained and supported. These changes were evident in our observations of care and in the reviewing of documentation.
  • Staff were now all trained in the same enhanced prevention and management of violence and aggression techniques which would reduce the risk of confusion and error.
  • The numbers of restraints that took place over a comparable period had reduced significantly and the hospital was working on their own restraint reduction programme.
  • Staff were now being offered a bespoke package of training that enabled them to improve their skills and knowledge for working with people with learning disabilities, autism and personality disorders.
  • Staff were now receiving supervision and appraisals on a regular basis and the hospital had a detailed induction process in place. Staff said they felt more supported and felt more confident in carrying out their roles as a result.
  • The hospital had improved the way they managed incidents, they were now reviewed on a regular basis and where necessary actions were taken to learn lessons and change the way that patients were cared for and risk assessments were updated as a result.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. We saw particular improvements to the way in which patients with communication difficulties were being cared for.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.

However:

  • The hospital was not following government guidance in the way in which it was managing infection prevention and control.
  • It was not always clear from staff duty records that the service had enough support staff to ensure that patient observations could be carried out to the prescribed levels.

02 June 2020

During an inspection looking at part of the service

This was a focussed inspection on elements of the safe key question only. Therefore, we did not rate the service in relation to this inspection.

We found the following:

  • Care plans and risk assessments did not always reflect patients current care and treatment needs. Staff were not always providing care and specific interventions in line with patients care plans.
  • Staff did not effectively assess and manage risks to patients.
  • Staff were not always managing and administering medicines safely.
  • There were not enough staff to ensure that patients could be cared for safely.
  • Managers had not always ensured that staff were clear who would carry out essential duties such as checking environmental risks and identifying designated responders.
  • Governance systems were not effective and were not picking up when policies needed updating or when staff were not adhering to them.

As a result of the concerns we found during this inspection, we took urgent enforcement action to impose conditions on the provider’s registration requiring the hospital to temporarily restrict admissions and provide assurances in relation to the safe care of patients. As a result of positive steps taken by the provider to improve the safety of patients the conditions have been removed.

19 to 26 February 2020

During a routine inspection

During an inspection in June 2019 a number of serious concerns were raised, and we used our power to take enforcement action against the provider.

In November 2019 ASC healthcare successfully appealed against our enforcement action at tribunal. In November 2019 the hospital was placed into special measures and a Quality Surveillance Board was convened to oversee the necessary improvements until such time that it was no longer required.

We carried out this inspection to ensure that action had been taken following the findings of serious concerns at our last inspection.

We found a number of improvements had been made. However, we rated The Breightmet Centre for Autism as requires improvement because:

  • The management and mitigation of risk to staff and patients was not always managed effectively. Staff had not always taken action as a result of incidents, not all staff were trained in the same restraint techniques and staff worked alone with patients without sufficient support.
  • Levels of restrictive interventions were high, and staff had been injured as a result.
  • Not all staff had received basic autism training and the majority of staff had not received any specialist autism training or training in specialist communication techniques.
  • Managers did not always support staff with supervision and new staff were not always offered an adequate induction.
  • Effective governance systems were not in place to ensure that all policies and procedures were adhered to by all staff working at the hospital.
  • Communication between the hospital staff and parents and carers was not always effective.
  • Discharge and transition of patients to alternative services was not always effectively managed.

However;

  • All apartment environments were safe, clean, well equipped, well furnished, well maintained and fit for purpose.
  • Patients had access to psychological therapies, to support for self-care and the development of everyday living skills, and to meaningful occupation.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity.

Although some improvements have been made some areas of concern remain and there remains a rating of inadequate for the safe key question. Therefore, this service will remain in special measures and we will continue to monitor the progress being made to meet the regulations. Where necessary, another inspection will be conducted within six months, and if there is not sufficient improvement, we will move to close the service by varying the provider’s registration to remove this location or cancel the provider’s registration.

06/06/2019, 14/06/2019, 20/06/2019

During a routine inspection

Due to the concerns we found during this inspection, we used our powers under section 31 of the Health and Social Care Act to take urgent and immediate action against the provider.

We have imposed the following conditions on the provider's registration:  

1. For six months commencing 1 November 2019, the registered provider must not admit more than one new patient every three weeks, subject to a maximum number of twelve patients being placed at the Breightmet Centre at any one time.

2. The registered provider shall, until the CQC considers it no longer necessary, submit a monthly report to the CQC on governance systems and processes that it has put in place, and/or any changes in such systems or processes that it has implemented, to ensure that care and treatment for each patient is safe, effective and responsive to their needs.

3. By the end of April 2020, the registered provider shall report to the CQC, using an appropriate quality audit toolkit, on the views of families, staff and other stakeholders on the quality of the service being provided.

4. The registered provider shall, until the CQC considers it no longer necessary, submit a monthly report to the CQC providing details of the risk assessments and care plans for all newly admitted patients.


We rated Breightmet Centre for Autism as inadequate because:

  • Safety was not a sufficient priority with monitoring of safety not adequate. The care premises, equipment and facilities were unsafe. There were significant environmental concerns in this service, with broken furniture and fixings that placed patients at risk of harm. The foam padding in some furniture was exposed. This presented an infection control risk. Walls and flooring were damaged with holes and cracks present in a number of patient bedrooms. There were urine splash marks in one bathroom and staining on the toilet and walls. In one ward, half eaten food including hot dogs and pizza had been left out in the dining area.
  • Substantial or frequent staff shortages or poor management of agency or locum staff increased risks to people who use services. Staff did not assess, monitor or manage risks to people who use the services. Opportunities to prevent or minimise harm were missed. This had led to incidents in which preventable harm to individuals had occurred.
  • Effective governance systems were not in place to ensure that all policies and procedures were adhered to by all staff working at the hospital. Systems and measures put in place to improve some areas of practice were ineffective and not being maintained and kept up to date to ensure effectiveness.
  • Patients did not have their rights protected. Patients received care from staff who did not have the skills or experience that was needed to deliver effective care. Staff could not develop the knowledge, skills and experience to enable them to deliver good quality care.
  • People’s privacy and dignity was not respected. Their basic needs were not met with the hygiene and cleanliness needs of patients not consistently being met. At the time of our visits, two patients were dressed in soiled clothing and one patient had very unclean feet. People did not know or did not understand what was going to happen to them during their care. People did not know who to ask for help. They were not involved in decisions about their own care or treatment.
  • Patients did not feel cared for and the feedback about staff interactions was negative.
  • Patients did not find it easy to, or were worried about, raising concerns or complaints. When they did, they received a slow or unsatisfactory response. Complaints were not used as an opportunity to learn.
  • The facilities and premises used were inappropriate with very little furnishings present in most rooms. The limited activities present did not meet people’s needs.

However:

  • Positive behavioural support plans were individualised. Staff developed individual care plans, which contained positive behavioural support plans. Care plans were personalised and included the voice of the patient.

14/07/2019

During an inspection looking at part of the service

  • Following an initial inspection, which identified risks to patients in June 2019, we revisited the hospital because of further concerns around risk to patients and a failure by management to urgently address our original concerns.
  • Clinical and environmental risks were not being managed effectively by the provider. This left patients at risk of avoidable harm.
  • Staff did not assess and manage patient risks, risk assessments were not always updated following incidents and changes in presentation. Staff were not aware of patients known risks as risk assessments were incomplete and out of date.
  • Staff did not learn from incidents. Incident information was not used to update risk assessments and care plans. We did not find evidence of incidents being reviewed and the lessons learned shared with staff.
  • Patients were left at risk following the potential for harm following episodes of restraint. Staff were not trained in the skills needed to support patents in a medial emergency through basic life support and there was no medical cover on site.
  • The ward environment across most of the hospital was dirty with food and human waste evident in some of the bedrooms and social areas. These posed an immediate infection risk to patients.
  • Two wards contained furniture and fittings that was damaged creating further infection risks. We found chairs, sofas with their protective covers missing or torn. We found mattress covers to be torn or missing with the mattress foam exposed allowing for contamination.
  • The building showed signs of wear and tear throughout. This included cracks on the walls, damaged flooring, and the ceiling in one patient’s room damaged with a number of large holes and insulation exposed.
  • A number of items of wooden furniture including tables, bed bases and chairs were cracked or chipped. These posed an infection risk or a potential risk of harm and injury to patients.
  • Full information about our regulatory response to the concerns we have described will be added to a final version of this report, which we will publish in due course.

4-5 June 2018

During a routine inspection

We rated Breightmet Centre for Autism as good because:

• Patients received comprehensive care assessments which involved input from a multidisciplinary team which including psychiatry, nursing, clinical psychology, occupational therapy. Care plans showed evidence of patient involvement in care planning, risk assessment and management and activity planning. There were sufficient nursing and support staff available to ensure patients were cared for in accordance to their care plans.

• Patients had access to physical healthcare and the service ensured their physical health needs were assessed and monitored on a regular basis. Patients with underlying physical health conditions had appropriate health action plans to monitor and manage these.

• We observed kind and respectful interactions between staff and patients. Both patients and carers gave positive feedback about how staff treated them. Staff knew the patients well and their needs.

• Patients could access telephone facilities within each apartment by either using their own mobile phone if this had been risk assessed or the cordless office telephone which could be used in their own bedrooms or in the quiet rooms.

• Patients had access to drinks and snacks throughout the day, with drink facilities kept on each apartment and snacks stored in the main kitchen.

• Patients had personalised activity planners, which were person-centred and designed to support their individual rehabilitation needs. Activities were available seven days a week both on and off site.

• There was an effective governance structure in place, which included systems and processes to ensure monitoring of the service. The provider was committed to service improvement. As well as having a comprehensive internal audit programme in place, the provider had commissioned a number of service specific reviews to ensure approaches and strategies were most appropriate for the patients within their care.

However:

• Although staff were aware of the processes in place for raising safeguarding concerns, the service manager did not immediately demonstrate that the threshold for these were understood when a concern was raised during the inspection.

•         Though the service had psychiatry provision provided by a part time locum psychiatrist with the support from an assistant psychiatrist, there was no assurance to ensure all patients had received regular psychiatry assessments and reviews.           

8 and 9 July 2015

During a routine inspection

We rated wards for people with learning disabilities or autism as good because:

  • The ward layout enabled staff to observe all parts of the apartments, and there were no blind spots. The provider had completed ligature risk assessments, and put appropriate mitigating actions in place.
  • There had been staffing issues in the past but this had improved significantly. The established staffing levels consisted of 51 whole time equivalent (WTE) staff but the provider had purposely over-recruited and had a full staff team of 54 permanent staff members in post at the time of our inspection. Reliance on agency staff had reduced accordingly. Staffing numbers were good and all shifts were filled with sufficient levels and grades of staff. Staffing rotas took into account the gender mix in the unit, and there were male and female staff on all shifts.
  • Patients received multidisciplinary assessments, which included input from psychiatry, nursing, clinical psychology, occupational therapy (OT), and speech and language therapy teams.
  • Patients had good access to physical healthcare and the service ensured their physical health needs were assessed and monitored.
  • We observed kind and respectful interactions between staff and patients. Patients gave positive reports of how staff treated them. Staff knew the patients and their needs, which reassured patients. All care plans showed evidence of patient involvement in care planning, risk assessment and management and activity planning.
  • Patients had access to private telephone facilities as they could use the apartment’s cordless telephone in their own bedrooms or in the quiet rooms.
  • Patients could make hot and cold drinks and snacks throughout the day. Comments from patients about the food served at meal times were mainly positive. Food choice and quality was good, and there was a strong focus on healthy eating.
  • Patients had activity planners, which were person-centred and supported their individual rehabilitation programmes. Staff completed individual activity planners in accessible formats for patients with limited verbal communication. Patients had access to a range of activities on and off-site, including at weekends.
  • Staff knew the organisation’s visions and values. Ward systems and processes were working effectively. Staff reported increased trust in management and said that the new manager was visible on the unit. Staff recognised that the provider had made improvements to the service and were positive about the future.
  • There was an effective governance structure in place, which included adequate systems and processes to ensure regular monitoring of all areas within the service. The provider was committed to service improvement. As well as having a comprehensive internal audit process in place, the provider had commissioned a number of external audits and peer reviews.

However:

  • Although there was one psychiatrist supporting the service on a part-time basis, who was available out of hours, there was no additional capacity available to cover sickness or annual leave.
  • The provider’s vision was for the service to become a highly specialist centre for autism. The provider acknowledged that to achieve this, the service required further development and staff required additional specialist training on autism.
  • Patients did not have advance statements in place, that is, a record of their wishes for future care. However, there was information recorded in care records to guide staff on supporting patients’ preferences for managing their distress.
  • Although two staff were trained in total communication methods and the use of “now and next” cards to help patients with limited verbal communication structure their day, during our inspection, we noticed that staff had not changed the cards to show the next activity.
  • Staff had occasionally cancelled activities unnecessarily, for example, not going to a café because it was raining. In response to this, the provider had developed an individual activity-recording sheet to monitor activities, and these were reviewed weekly.
  • The centre did not have a sensory room, but the provider had plans to install one in the future. In the meantime, staff supported patients to access sensory rooms in community settings.
  • We found two occasions where there were delays in meeting patients’ individual needs for specialist clothing and hairdressing.

14 August 2014

During an inspection in response to concerns

This was a joint inspection visit with a Mental Health Act commissioner and two specialist advisors. We spent time talking with people that used the service, managers and staff. People who used words told us they were safe, though one person reported staff member had sworn at them. We were told this was an agency staff who had not been allowed back to work at the service. People told us staff were, "A good laugh" and "There's more staff around to do things with, like activities". Where people did not use words we saw that staff understood their individual communication gestures and language..

People told us they were not involved in contributing toward their care and support plans and some decisions made without being consulted. For example menu planning.

We found there had been changes to the management team, who recognised the monitoring of the quality of the service provided needed to improve so people received safe, effective care and treatment which responded to their individual needs.

Following an investigation by the local authority safeguarding team the provider put an action plan in place to address the concerns highlighted as part of the investigation. The action plan has been monitored by the safeguarding team, commissioners and the care Quality Commission, including this responsive inspection and Improvements had been noted.

We found the action plan put in place had not been risk assessed to ensure the most important priorities were being addressed.

30 January 2014

During a routine inspection

We visited the hospital on 30 January 2014. We found the hospital to be safe, secure, warm and clean.

We were told six patients were currently being accommodated. Throughout the course of the day we spoke with all the patients. For some patients communication was limited, however one person told us they were going out shopping and what breakfast they had helped staff to make for them. Another told us about how they spent their day and they had a nice bedroom.

One visitor told us communication between staff could be improved. They explained they should receive a telephone call from staff twice a week for an update on their relative's wellbeing was often overlooked and messages left were unanswered.

We saw patient's views and opinions were taken into account in the way the service was provided and delivered in relation to care.

Care and treatment was planned and delivered in a way that was intended to ensure patients safety and welfare.

Patient's staff and visitors were protected against the risks of unsafe or unsuitable premises.

Patients were cared for by staff that were supported and trained to deliver care and treatment safely.

We saw patients records were 'person centred', with updated risk assessments in place.

3 September 2013

During a routine inspection

We carried out a responsive inspection at the service due to receiving information of concern regarding the care and welfare of the patients. Information was also received about the skills and ability of the staff to care for patients. We found adequate person centred care plans, with up to date risk assessments available for the patients.

We found staff had policies and procedures to support the safe management and care of the patient's within the hospital.

Staff had been recruited following a robust recruitment policy with all relevant checks having been carried out prior to patients being admitted to the hospital.

As this was a new service staff had recently undergone induction training but we highlighted some training needs to be addressed, to ensure the safety and security of both patients and staff within the service.

Staff told us they felt supported and valued in their roles. They acknowledged there had been some problems since patients had been admitted to the service, but felt the management had supported them fully to carry out their roles.

We saw incidents had been fully documented and care plans and risk assessments had been updated as required.

We spoke with patients who were receiving care but they were unable to provide any comments due to their medical condition.