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Inspection carried out on 9th July 2019

During a routine inspection

We rated Combat Stress/Audley Court, Specialist community-based mental health services for adults of working age as good because:

  • The provider had a high standard of managerial, medical and clinical leadership and made effective use of multi-disciplinary team working.

  • Clinical governance at Combat Stress/Audley Court was well established and linked to local and national quality improvement initiatives, research and audit.

  • Risk assessment and care planning were of a high standard and helped clinicians and therapists provide safe care.

  • The services provided were responsive to the needs of patients and based on the existing and emerging evidence for effective treatment.

  • Combat Stress/Audley Court had been through a successful period of organisational change and redesign and developed a model of service that patients told them they found helpful and of high quality.

However;

  • Patient feedback indicated that patients needed more help managing their physical health and accessing community activities

  • Some staff thought that the provider had not effectively communicated the implications of organisational change for themselves and the service.

Inspection carried out on 30 & 31 July 2015

During a routine inspection

This unannounced inspection took place on 30 and 31 July 2015. At our last inspection on 13 December 2013 we found the provider was meeting the requirements of the regulations we inspected.

Audley Court provides rehabilitation services with nursing and personal care for up to 29 people. The service provides specialist care, support and treatment for men and women discharged from the armed forces who experience mental health problems. At the time of our inspection there were eight people receiving support from the service. Sixteen people were due to be admitted to the service for treatment over the next couple of days. The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe at the service. We saw that the provider had systems in place to protect people from potential harm. Staff understood their responsibility to report issues of concern. People received their medicines as prescribed and medicines were managed, stored and administered safely.

People had personalised risk assessments and care plans in place that detailed their health and support needs. We saw these were developed and reviewed with people regularly to ensure they continued to meet people’s needs.

People told us there were sufficient numbers of staff to meet people’s individual needs. The provider ensured staff were safely recruited and received the necessary training and support to meet people’s needs.

The service took the appropriate action to protect people’s rights and all the staff were aware of how to protect the rights of people.

People we spoke with were happy with the food and felt that they had a choice of what they would like to eat and drink. Healthy option meals were available for people to consider. People had access to a variety of healthcare professionals to ensure their health needs were met.

People told us staff were kind and caring in their approach and treated them with dignity and respect. Staff interacted with people in a positive manner and were responsive when people needed assistance.

People said the management team was approachable and visible. People told us they felt comfortable to raise any concerns or complaints with the staff team or the manager. The provider had a system in place to respond to people’s complaints and concerns.

There were audit systems in place to monitor the quality of the service people received. There were regular checks of people’s care plans, medicine administration, incident and accidents. There was evidence that learning and improvement took place from audits and changes were made to improve the service.

Inspection carried out on 13 December 2013

During a routine inspection

We spoke with seven people who had come to the end of a six week intensive treatment programme for post-traumatic stress disorder (PTSD). People described their support and treatment as �exceptional�, �absolutely brilliant� and, �unique�. Comments from people included, �It�s like having a pair of arms thrown around us�. �Within a day or two of being here, you know it�s worth being here� and, �They�ve given me a new lease of life�.

Everyone we with spoke with told us they felt they had been fully involved in their care, support and treatment. They considered their treatment had been centred on their individual needs and requirements. People told us they had been involved in their assessment process and with the support of their designated workers had chosen to attend treatment sessions of benefit to their recovery and wellbeing.

People described the staff as welcoming and �experts in their field of work�. They considered staff were competent and knowledgeable and understood their individual needs. One person said, �The staff know us better than we know ourselves�. Another person said, �Their commitment is unbounded and they are very proficient in what they do�. Staff told us they had the training to keep people safe and carry out their roles effectively. They told us they were supported in their work.

The service had effective systems in place to seek people�s views and assess and monitor the quality of service people received. The provider had implemented significant changes since our last inspection to improve overall outcomes for people. The newly registered manager demonstrated commitment to implement change in conjunction with the people that used the service and their staff team.

People told us they had no complaints about the service they had received. We saw people had been provided with a copy of the complaints procedure. The manager acknowledged this needed to include the escalation process in the event of a person not being happy with the outcome of their complaint or how it had been managed.

Inspection carried out on 25 January 2013

During a routine inspection

During our visit we spoke with five people, and seven members of staff, including a senior manager of the organisation.

People told us they felt safe and welcome at Audley Court. They said they were very pleased with the treatment and support they had received. People agreed the staff team had a good understanding of their needs and preferences. One person told us, �I take my hat off to them. You can't fault the help and support you get here." Everyone agreed members of the care team were respectful and demonstrated their rights to privacy.

We saw people had been involved in the assessment of their needs and planning for their support and treatment. Recordkeeping reflected people were involved in all stages of this process.

Staff had received training on protecting the people they supported. They were able to describe how they would recognise abuse and knew how to respond to protect people.

Staff told us they enjoyed their work and being part of the Audley Court care team. They praised the training and support the service provided.

We saw the company recruitment process had not always been followed when new staff started work at the service. Records could not confirm all appropriate checks had been carried out.

Audley Court ensured that people's views were considered and listened to. People had been provided with information about how to use the complaint process.

Inspection carried out on 21 November 2011

During an inspection looking at part of the service

We visited Audley Court to see what changes had been made since we last visited. We met with five people who used the service, four staff and the manager. People shared very positive experiences of the service that they received.

People told us that they were fully involved in the assessment of their needs and development of their treatment plan. They told us they had �definitely benefited� from using the service and being with other people who had shared similar experiences. They said the service had equipped them with strategies to help them understand and manage their illness. One person said, �I feel secure coming here, security heals in a big way�. People said they enjoyed the 1:1 and the group work and particularly enjoyed partaking in the occupational activities available which included relaxation classes, art, music, cookery, computer sessions, quiz nights and organised trips out.

People we spoke with were very grateful for the service they received. They said if it was not for Audley Court they most probably would not be alive today. They were passionate about the help and support they had received and spoke extremely highly of the staff that supported them. People told us that the staff were available to speak with whenever they needed them, day or night. Comments included, �They are an amazing bunch of staff, as soon as you walk through the door they understand and really care. They�ve helped me move forward. It�s a great place and I love it here�. �I could never repay the staff for the help they�ve given me. Every time I leave here I take something more away with me. The staff are extremely approachable and they are the only ones that have helped me�.

People who used the service told us that they were happy with the meals provided and said the service was able to meet their dietary needs. They told us they liked the new kitchen and dining room facilities and that staff had worked hard to make these more homely. One person said, �There is a very good choice of food and alternative meals are always made available�. People told us their rooms were comfortable and that staff respected their privacy and dignity.

We spoke with four staff from different disciplines. They told us they enjoyed their work and were well supported. They said they were provided with many training opportunities to meet the specific needs of the people who used the service and to keep them safe. They spoke about the service empowering people and providing people with specific goals for their treatment and support to help them move on. One person said, �I seriously love my job with passion. It�s all about giving them the power and freedom of choice�. Another person said, �We work in partnership with our service users and support them in their journey�.

Reports under our old system of regulation (including those from before CQC was created)