All inspections: NAViGO Health and Social Care CIC

We inspected Navigo’s inpatient wards for older people with mental health problems on the 11 and 12 of November 2025. Navigo’s older persons wards are spread across two sites- The Princess Diana of Wales Hospital, where Konar Ward and Janine Smith Suite are based, and Tees House, a short distance away where Jane Lewington Suite is based. The older persons wards were last inspected in March 2023 and rated outstanding in safe and well-led. Tees house is currently unrated since Navigo completed the takeover in December 2022.

Konar Suite is a 13-bedroom ward for acute mental health admissions. The ward accepts admissions for patients with both organic (such as dementia) or functional (such as depression, schizophrenia or anxiety) illnesses. The Janine Smith Suite is a 10 bedroom ward for patients with complex mental health needs who require a longer stay. This unit was created to prevent out of area placements for the local population. The Jane Lewington Suite is a 15 bedroom ward based at Tees House for patients with a complex mental health presentation either through dementia, acquired or chronic neurological disorder alongside a severe and enduring mental health diagnosis, or a combination of these disorders. Tee’s House is also utilised by both Konar Ward and Janine Smith Suite patients for activities.

The wards provide inpatient treatment and facilitate discharge planning for patients to move into more appropriate care settings or return home. Patients can be admitted either informally or under the Mental Health Act (MHA). The wards had access to a range of professionals that formed a multi-disciplinary team (MDT) to meet the holistic needs of patients in their care.

We visited all three wards and found that the standard of care, the environments and documentation were excellent. We found there were enough staff to meet people’s individual needs, observed warm and meaningful engagement, activities and access to professionals. Staff were quick to respond to people’s needs and did so in a kind, caring and compassionate manner.

We did not identify any breaches of regulation during this inspection.

Mental Health Act and Mental Capacity Act Compliance Summary

Navigo had policies and guidance in place around the Mental Health Act (MHA) and the Mental Capacity Act (MCA). The policies were within date and had a scheduled review date. Staff we spoke with had a clear understanding of the difference between legislation and could identify the five key principles of the MCA. Managers had clear oversight of mandatory training of staff, ensuring staff were working within the regulations.

The ward had a Mental Capacity Act lead who could provide additional support and advice if needed. Leaders completed regular audits of MHA and MCA documentations to ensure patients were safe. Staff knew who their MHA officer was and how to raise any concerns or issues. Additional oversight was provided by the pharmacy team to ensure that people were prescribed medication safely and within regulations of legislation. Overall training compliance was 98.78%.

Our rating of the provider stayed the same. We rated it as good because:

We rated well-led at the provider level as good.
Managers at all levels had the right skills and abilities to run a service providing high-quality sustainable care.
Senior operational roles had business as well as operational roles and responsibilities. They demonstrated understanding of their areas of expertise.
Navigo’s strategy was aligned with the local sustainability and transformational plans and integrated care partnerships. They regularly monitored their progress.
Staff felt respected, supported and valued and were positive about working for the provider. This was evident from the core services reviews that we undertook and also the staff and service user focus groups.
Staff and service users were treated with dignity and respect, at times offering support outside of their commissioned services.
Navigo practiced value-based recruitment and service users were always involved in the recruitment process.
Navigo recognised members’, staff and volunteers’ achievements. In June 2019 they held their first volunteers and members award ceremony and held regular staff award events.
Navigo had a well embedded governance structure.
The provider reported no never events since our last inspection.
Safeguarding governance structures were current and formed part of the providers quality agenda.
Navigo had centralised clinical dashboards that were available at all levels including to the board and to service areas; these were usually reported on quarterly to the board, however this data could be viewed daily.
Navigo had the 12th highest response rate for the NHS staff survey of all NHS providers; they scored in the top 10% of all provider trusts in 11 of the 32 key areas.
Navigo was involved in numerous national research projects.
Navigo was involved in some innovative projects for staff, members and service users.

However:

The long stay rehabilitation service we inspected was rated as requires improvement in both the safe and well led domain.
In both core services we found that the provider did not have a policy on ligature risk or a comprehensive fire policy.
Two bank staff member had not completed any mandatory training.
Some medicine cards had gaps on them.
In the rehabilitation service, not all incidents were reported and acted upon in a timely manner.

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

The ward environments were clean. The wards had enough nurses and doctors. The use of restrictive practices was low, they managed medicines safely and followed good practice with respect to safeguarding.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions

However:

There was no policy on ligature risk reduction and no fire policy at the time of our inspection. However, the provider had written a draft fire policy and added management of ligature risks to their observation policy after the on-site inspection but submitted within the inspection window timeframes.
There were no personal emergency evacuation plans in place for those that needed them.
One bank staff did not have access to the electronic patient record system and had not completed any mandatory training.

We have not inspected this service before. We rated it as requires improvement because:

Our findings from the key questions demonstrated that the service did not always provide safe care and did not always have effective governance processes to manage and mitigate risk sufficiently.
Brocklesby Lodge could and had been easily accessed by patients from the health-based place of safety. Apart from recording this on the risk register, managers had not taken any action taken to try to prevent this from happening again.
The service required further development to ensure it followed a recognised model for rehabilitation care. The service operated without a registered nurse on shift at night which was not in line with the essential requirement set by the Royal College of Psychiatrists and AIMS rehab quality network. There was no policy on self-medication which meant patients could not develop these skills.
One out of the two medication cards had gaps where medicines had not been signed for on two days for a total of nine medicines.
Despite managers being informed of incidents, they had not ensured that the incidents had reported promptly using incident reports. An incident where a patient gained access to Brocklesby Lodge from the health-based place of safety occurred in July which was not reported until after our inspection in August. We raised two medicines incidents with managers during our inspection and there was a three-day delay in completing an incident form to report these.
One bank staff had not completed any training despite working for the provider for 14 months.
Bank staff did not have access to the electronic patient record system. They relied on other staff to be able to read or input information.
There was no policy on ligature risk reduction and no fire policy at the time of our inspection. However, the provider had written a draft fire policy and added management of ligature risks to their observation policy after the on-site inspection but submitted within the inspection window timeframes.
One patient record contained a T2 which was completed on behalf of the Responsible Clinician. When we raised this, the Responsible Clinician rewrote the T2. However, they did not complete a capacity assessment to assess the patient’s capacity to consent to treatment to check that the patient continued to consent.
Two rooms used to support treatment and care were not soundproof and this meant that patients’ privacy may not be upheld.

However:

The ward was very clean and well maintained.
Staff assessed and managed patient risks well including monitoring physical health. The use of restrictive interventions was low.
Staff felt respected, supported and valued. They recognised the provider’s vision and values and could raise concerns without fear of retribution.

This was the first time we have inspected the eating disorders service.

We rated it as outstanding because:

Navigo Health and Social Care CIC provides a specialist eating disorder service for adults with complex eating disorders called Rharian Fields. The inpatient ward admits patients detained under the Mental Health Act 1983 and those admitted informally. It provides assessment, treatment and rehabilitation to patients who require a hospital admission due to their eating disorder. The service has an aftercare, outpatient provision, which patients who live locally can access once discharged from the ward into the community. There is also a day patient service, which sees patients in the community.

The ward has eight beds available for both men and women. The ward is situated on a site within the grounds of the county’s general hospital. Rharian Fields accepts privately funded patients as well as patients funded by the NHS across the United Kingdom.

At the time of our inspection, there were six patients allocated to the ward. All patients were female and there were no patients detained under the Mental Health Act. The outpatient provision was not currently required as there had been no local patients discharged recently. The community day patients’ service was located away from the inpatient ward at NAViGO House, and was not part of this inspection.

We have not inspected this service before and this inspection was unannounced.

To understand the experience of people who use services, we always ask the following five questions of every service and provider:

Is it safe?
Is it effective?
Is it caring?
Is it responsive to people’s needs?
Is it well-led?

Before the inspection visit, we reviewed information that we held about these services, asked a range of other organisations for information and sought feedback from patients and carers at focus groups.

During the inspection visit, the inspection team:

visited the ward and looked at the quality of the environment
attended and observed a clinical review, handover, group therapy session and a lunchtime experience
spoke with three patients who were using the service
spoke with three carers of patients using the service
spoke with the registered manager and the ward manager
spoke with seven other staff members including the consultant, the psychologist, the dietitian, nurses and nursing assistants
collected feedback from patients and carers using comment cards
looked at five care records of patients
looked at six prescription cards of patients
carried out a specific check of the medication management
looked at policies, procedures and other documents relating to the running of the service.

This was the first time we have inspected the eating disorders service.

We rated it as outstanding because:

Navigo Health and Social Care CIC provides a specialist eating disorder service for adults with complex eating disorders called Rharian Fields. The inpatient ward admits patients detained under the Mental Health Act 1983 and those admitted informally. It provides assessment, treatment and rehabilitation to patients who require a hospital admission due to their eating disorder. The service has an aftercare, outpatient provision, which patients who live locally can access once discharged from the ward into the community. There is also a day patient service, which sees patients in the community.

The ward has eight beds available for both men and women. The ward is situated on a site within the grounds of the county’s general hospital. Rharian Fields accepts privately funded patients as well as patients funded by the NHS across the United Kingdom.

At the time of our inspection, there were six patients allocated to the ward. All patients were female and there were no patients detained under the Mental Health Act. The outpatient provision was not currently required as there had been no local patients discharged recently. The community day patients’ service was located away from the inpatient ward at NAViGO House, and was not part of this inspection.

We have not inspected this service before and this inspection was unannounced.

To understand the experience of people who use services, we always ask the following five questions of every service and provider:

Is it safe?
Is it effective?
Is it caring?
Is it responsive to people’s needs?
Is it well-led?

Before the inspection visit, we reviewed information that we held about these services, asked a range of other organisations for information and sought feedback from patients and carers at focus groups.

During the inspection visit, the inspection team:

visited the ward and looked at the quality of the environment
attended and observed a clinical review, handover, group therapy session and a lunchtime experience
spoke with three patients who were using the service
spoke with three carers of patients using the service
spoke with the registered manager and the ward manager
spoke with seven other staff members including the consultant, the psychologist, the dietitian, nurses and nursing assistants
collected feedback from patients and carers using comment cards
looked at five care records of patients
looked at six prescription cards of patients
carried out a specific check of the medication management
looked at policies, procedures and other documents relating to the running of the service.

Our rating of the provider stayed the same. We rated it as good because:

We rated the key questions of safe, effective, responsive and well-led as good overall and the key question of caring as outstanding overall. Our rating for Navigo took into account the previous ratings of services not inspected this time.
Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.
We rated well-led at the provider level as good.
We rated wards for older adults with mental health problems as outstanding and Rahrian Fields the eating disorders inpatient service as outstanding.
Navigo’s quality and patient safety strategy covered the next two years and aimed to strengthen the quality of patient care and ensure there was a clear strategic approach for quality governance .
The community interest company board and senior leadership team had the appropriate range of skills, knowledge and experience to perform its role.
Navigo met the fit and proper person requirement.
The Duty of Candour requirements were fully met by Navigo.
Engagement with staff, service users and carers around development of Navigo’s vision and values was exceptional and this was demonstrated throughout the whole organisation.
There was an overwhelming sense that all staff and service users were aware of all of the members of the community interest company board. They felt included in the organisation and they were able to be part of the decision making process.
In the 2016 NHS staff survey, Navigo was one of the best performing organisations.
Navigo has a sound approach to ensuring learning and change following ‘never ‘episodes, serious complaints and safeguarding incidents. The formulation and implementation of action plans was undertaken by a dedicated quality team.
Navigo had a safeguarding policy and procedure and their requirements were fully met under safeguarding.
Navigo was involved with the local sustainability and transformation partnership and the accountable care partnership, these plans aligned with Navigo’s strategy.
Navigo recognised staff success by staff awards and through feedback.

However:

The providers target rate for appraisal compliance was 100%. As at 31 August 2017, the overall appraisal rates for non-medical staff was 78%.
Navigo failed to meet its target of 35 days as detailed in their policy when responding to complaints.
The provider took a significant time to resolve staff grievances. One took six months and one took nine months to complete.
It is a legal requirement to publish a report annually stating what action has been taken to meet the public sector equality duty. Whilst an annual equality and diversity report had been produced and had been utilised to inform action within the organisation, it was not published at the time of inspection.

Our rating of the trust stayed the same. We rated it as good because:

We rated the key questions of safe, effective, responsive and well-led as good overall and the key question of caring as outstanding overall. Our rating for Navigo took into account the previous ratings of services not inspected this time.
Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating.
We rated well-led at the provider level as good.
We rated wards for older adults with mental health problems as outstanding and Rahrian Fields the eating disorders inpatient service as outstanding.
Navigo’s quality and patient safety strategy covered the next two years and aimed to strengthen the quality of patient care and ensure there was a clear strategic approach for quality governance.
The community interest company board and senior leadership team had the appropriate range of skills, knowledge and experience to perform its role.
Navigo met the fit and proper person requirement.
The Duty of Candour requirements were fully met by Navigo.
Engagement with staff, service users and carers around development of Navigo’s vision and values was exceptional and this was demonstrated throughout the whole organisation.
There was an overwhelming sense that all staff and service users were aware of all of the members of the community interest company board. They felt included in the organisation and they were able to be part of the decision making process.
In the 2016 NHS staff survey, Navigo was one of the best performing organisations.
Navigo has a sound approach to ensuring learning and change following ‘never ‘episodes, serious complaints and safeguarding incidents. The formulation and implementation of action plans was undertaken by a dedicated quality team.
Navigo had a safeguarding policy and procedure and their requirements were fully met under safeguarding.
Navigo was involved with the local sustainability and transformation partnership and the accountable care partnership, these plans aligned with Navigo’s strategy.
Navigo recognised staff success by staff awards and through feedback.

However:

The providers target rate for appraisal compliance was 100%. As at 31 August 2017, the overall appraisal rates for nonmedical staff was 78%.
Navigo failed to meet its target of 35 days as detailed in their policy when responding to complaints.
The provider took a significant time to resolve staff grievances. One took six months and one took nine months to complete.
It is a legal requirement to publish a report annually stating what action has been taken to meet the public sector equality duty. Whilst an annual equality and diversity report had been produced and had been utilised to inform action within the organisation, it was not published at the time of inspection.

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

Clinic rooms were tidy and contained all the equipment required to carry out physical examinations. There were enough staff with the right qualifications and skills to care for patients who used the service. The service used a recognised risk assessment tool to assess and manage potential risks to patients and staff.
Medication was stored in line with national guidance. Staff followed good practice in relation to medicines management. The provider reported serious incidents and carried out investigations where needed.
The service provided care and treatment based on national guidance. There were a range of specialists to meet the needs of patients. Processes were in place for the support and management of staff performance. Staff had a good understanding of the Mental Health Act and the Mental Capacity Act.
Staff treated patients with compassion. Patients were involved in decisions about their care and treatment. Patients were able to make advance decisions about their care and treatment. Patients and carers were encouraged to give feedback on services and the care they received.
Services were meeting the national target for referral to triage/assessment and from assessment to treatment. Staff were flexible with appointment times. Both community health teams had suitable premises to provide care, support and treatment. Information was available to patients in different formats. Patients were given information on how to make a complaint. Learning from complaints was shared during team meetings.
The provider had a robust recruitment process. The organisations values were included in annual performance reviews. Regular audits were carried out to ensure the safety and quality of services. Recommended changes were implemented following incidents. The provider had a risk register in place which was regularly reviewed.
Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Computers and software were password protected to ensure confidentiality. The provider had a website which contained information about services provided, news and events.

However:

Not all staff received regular supervision and appraisal. Some staff had not completed the provider’s mandatory training.
The provider did not include Mental Health Act training in their mandatory training package.
Patients who lacked capacity were not routinely referred to advocacy services.

Our rating of this service improved. We rated it as outstanding because:

Staff truly respected and valued the patients as individuals. They were empowered as partners in their care both practically and emotionally. Patients and carers were continually positive stating that staff care and support exceeded expectations. Staff recognised and respected the totality of the patients’ needs and provided a strong visible person-centred culture.
Staff demonstrated clear evidence that the service was tailored to focus on the needs and preferences of the patients. They understood the individual preferences of each patient and used a flexible approach, found innovative ways to ensure choice and went the extra mile to ensure these needs were met.
The facilities on the ward offered exceptional comfort and were designed to offer patients an environment more associated with a person’s home than a hospital ward. The bedrooms were all individual including en suite facilities. Some had small kitchenette areas and lounges encouraging independence. Some had additional sleeping facilities specifically for the use of family members if this was required.
Staff consistently considered a patient’s privacy and dignity. They found innovative ways to enable patients to maintain their independence as much as possible. The ward ensured a patient’s family were involved in all aspects of the care provided where this was agreed.
The ward had strong leadership, which steered a culture to deliver high quality person-centred care. There was a systematic and integrated approach to monitoring and reviewing progress in line with strategic plans.
There were high levels of staff satisfaction among all staff and an inspired shared purpose. All staff embedded the organisation’s mission to deliver services they would be happy for their family to use. They felt fully involved in decisions about the ward and had no reservations about contributing to ideas or expressing any concerns.
Staffing levels were good. There was a stable workforce with low sickness, turnover and vacancies. The service did not use agency staff; bank staff were all familiar with the ward. Patients received daily one to one support. All patients and carers we spoke with, informed us that staff were always available, responsive and caring.
There was a high compliance for staff completing mandatory training units. They were encouraged to participate in other specialised training additional to their mandatory requirements to develop skills beneficial to the patients on the ward. Staff received regular supervision and yearly appraisals.
Staff assessed patient risks regularly. They managed identified risks effectively and ensured they shared these appropriately. The ward did not apply blanket restrictions on patients.
The service followed best practice guidance to plan patients’ individual care and treatment. Staff ensured patients were active partners in their care, producing personalised care plans which included physical health, mental health, social and emotional needs and goals.
The ward was clean and well maintained. There was appropriate monitoring of environmental risks and health and safety requirements. The provider responded quickly when repairs or maintenance work was required. Staff, patients and visitors to the ward all felt safe.

However:

Staff had not received training specifically around the Mental Health Act and the code of practice.
The provider’s recording of restraint was inaccurate. The system did not differentiate between different levels of restraint and indicated the use of prone restraint, which had not occurred.

Our rating of this service improved. We rated it as outstanding because:

Staff truly respected and valued the patients as individuals. They were empowered as partners in their care both practically and emotionally. Patients and carers were continually positive stating that staff care and support exceeded expectations. Staff recognised and respected the totality of the patients’ needs and provided a strong visible person-centred culture.
Staff demonstrated clear evidence that the service was tailored to focus on the needs and preferences of the patients. They understood the individual preferences of each patient and used a flexible approach, found innovative ways to ensure choice and went the extra mile to ensure these needs were met.
The facilities on the ward offered exceptional comfort and were designed to offer patients an environment more associated with a person’s home than a hospital ward. The bedrooms were all individual including en suite facilities. Some had small kitchenette areas and lounges encouraging independence. Some had additional sleeping facilities specifically for the use of family members if this was required.
Staff consistently considered a patient’s privacy and dignity. They found innovative ways to enable patients to maintain their independence as much as possible. The ward ensured a patient’s family were involved in all aspects of the care provided where this was agreed.
The ward had strong leadership, which steered a culture to deliver high quality person-centred care. There was a systematic and integrated approach to monitoring and reviewing progress in line with strategic plans.
There were high levels of staff satisfaction among all staff and an inspired shared purpose. All staff embedded the organisation’s mission to deliver services they would be happy for their family to use. They felt fully involved in decisions about the ward and had no reservations about contributing to ideas or expressing any concerns.
Staffing levels were good. There was a stable workforce with low sickness, turnover and vacancies. The service did not use agency staff; bank staff were all familiar with the ward. Patients received daily one to one support. All patients and carers we spoke with, informed us that staff were always available, responsive and caring.
There was a high compliance for staff completing mandatory training units. They were encouraged to participate in other specialised training additional to their mandatory requirements to develop skills beneficial to the patients on the ward. Staff received regular supervision and yearly appraisals.
Staff assessed patient risks regularly. They managed identified risks effectively and ensured they shared these appropriately. The ward did not apply blanket restrictions on patients.
The service followed best practice guidance to plan patients’ individual care and treatment. Staff ensured patients were active partners in their care, producing personalised care plans which included physical health, mental health, social and emotional needs and goals.
The ward was clean and well maintained. There was appropriate monitoring of environmental risks and health and safety requirements. The provider responded quickly when repairs or maintenance work was required. Staff, patients and visitors to the ward all felt safe.

However:

Staff had not received training specifically around the Mental Health Act and the code of practice.
The provider’s recording of restraint was inaccurate. The system did not differentiate between different levels of restraint and indicated the use of prone restraint, which had not occurred.

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

Clinic rooms were tidy and contained all the equipment required to carry out physical examinations. There were enough staff with the right qualifications and skills to care for patients who used the service. The service used a recognised risk assessment tool to assess and manage potential risks to patients and staff.
Medication was stored in line with national guidance. Staff followed good practice in relation to medicines management. The provider reported serious incidents and carried out investigations where needed.
The service provided care and treatment based on national guidance. There were a range of specialists to meet the needs of patients. Processes were in place for the support and management of staff performance. Staff had a good understanding of the Mental Health Act and the Mental Capacity Act.
Staff treated patients with compassion. Patients were involved in decisions about their care and treatment. Patients were able to make advance decisions about their care and treatment. Patients and carers were encouraged to give feedback on services and the care they received.
Services were meeting the national target for referral to triage/assessment and from assessment to treatment. Staff were flexible with appointment times. Both community health teams had suitable premises to provide care, support and treatment. Information was available to patients in different formats. Patients were given information on how to make a complaint. Learning from complaints was shared during team meetings.
The provider had a robust recruitment process. The organisations values were included in annual performance reviews. Regular audits were carried out to ensure the safety and quality of services. Recommended changes were implemented following incidents. The provider had a risk register in place which was regularly reviewed.
Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. Computers and software were password protected to ensure confidentiality. The provider had a website which contained information about services provided, news and events.

However:

Not all staff received regular supervision and appraisal. Some staff had not completed the provider’s mandatory training.
The provider did not include Mental Health Act training in their mandatory training package.
Patients who lacked capacity were not routinely referred to advocacy services

We rated community-based mental health services for adults of working age as good overall because:

Following our inspection in January 2016, we rated the service as good for effective, caring, responsive and well-led.
During this most recent inspection, we found that the service had addressed the issues that had caused us to rate safe as requires improvement following the January 2016 inspection.
The community-based mental health services for adults of working age were now meeting Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We rated community-based mental health services for older people as good overall because:

Following our inspection in January 2016, we rated the service as good for effective, caring, responsive and well-led.
During this most recent inspection, we found that the service had addressed the issues that had caused us to rate safe as requires improvement following the January 2016 inspection.
The community-based mental health services for older people were now meeting Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We rated the provider as good overall because:

Following our inspection in January 2016, we rated the provider as good for effective, caring, responsive and well-led.
During this most recent inspection, we found that the provider had addressed the issues that had caused us to rate safe as requires improvement following the January 2016 inspection.
The provider was now meeting Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We rated NAViGO Community Interest Company as good because:

The service structure included patient and staff members who were involved in making decisions regarding the organisation through member votes, this included setting the organisations vision and values at an annual meeting. As a result, all the staff we spoke to knew the organisations vision and values.

Patients records were all held on a central electronic recording system enabling all staff to access the relevant information for the patients they were supporting.

Staff were seen to be kind and respectful when supporting patients and carers. We saw evidence that staff performed regular physical health checks with patients, staff referred patients to a GP if they had any concerns.

Risk assessments were up to date and staff regularly reviewed and updated them. Assessments contained crisis plans, including what actions to take and where to get support. We saw evidence that the service had a process in place to respond in times of crisis.

The care plans were holistic and included a pen picture summarising the individual needs of the patient. They also covered a range of needs including mental health, physical health and wellbeing, medication, housing, spiritual needs, and patient strengths. Patients and carers were involved in decisions around the care provided and staff recorded their views in the care plan.

The service provided a range of therapeutic interventions in line with The National Institute for Health and Care Excellence (NICE) guidance including Cognitive behavioural therapy and Dialectical behaviour therapy. One member of staff in the memory service received training in Cognitive Stimulation Therapy.

We saw evidence of capacity assessments within patient records including evidence of best interest decisions being made and communicated where patients did not have the capacity to make a decision.

Where staff completed capacity assessments, we saw evidence that staff had assessed patient’s ability to understand, retain, use and weigh up the information necessary to make a decision.

The service offered access to complimentary therapy including reiki and sleep therapy for patients and carers

The service assessed new referrals within 10 days of a referral; or four hours for emergency referrals. Where this was not possible, there was a process in place to enable the home treatment team to complete the initial assessment. at the time of the inspection there were no waiting lists for assessment or treatment. staff provided care under a multidisciplinary framework, staff held regular multidisciplinary meeting and we saw evidence that the teams worked well together.

The memory service has achieved a rating of excellent under The Memory Services National Accreditation Programme (MSNAP).
The service had processes in place to listen to staff patients and carers including staff representation at board meetings and managers attendance at team meetings. The service had an effective complaints process and all the patients and carers we spoke to knew how to make a complaint.

We rated the integrated services for older people with mental health problems as good because:

Staff did a comprehensive risk assessment for each patient, highlighting risks and setting out the individualised care and treatment required. They reviewed and updated risk assessments regularly. Each patient’s records could be seen by staff in the community and on the ward, which helped provide continuity of care.
Staff did a physical healthcare assessment of each patient admitted to the ward and patients had good access to physical healthcare. Care plans were person-centred and holistic; they were updated for patients as they moved in and out of hospital.
The integrated team included a wide range of mental health trained professionals. Staff applied recommended best practice and guidance to ensure patients received a high quality of care. They received professional development and ongoing managerial supervision to ensure they could meet the needs of patients in their care effectively.
We found staff well informed about issues of capacity and the application of the Mental Capacity Act, including Deprivation of Liberty Safeguards. The Mental Health Act code of practice was understood by staff and had become part of practice both on the ward and in the community.
Patients and relatives told us the staff treated them with dignity and were respectful at all times. Where patients were unable to tell us, we saw staff treat patients with kindness and compassion. Staff supported carers and kept them involved in the care of their loved ones. Staff across the service promoted support groups for patients and carers.
Patients were admitted to Konar ward if a full assessment showed it was where their needs would best be met. Staff planned patients’ discharge with care given to prepare patients and their relatives. Ongoing support from the older people's home treatment team gave continuity of care before and after discharge.
The ward environment and associated outside areas, optimised patients’ recovery by meeting their needs and offering stimulation. The ward had achieved accreditation for inpatient mental health service wards for older people (AIMS-OP) with excellence.

Staff spoke about being part of an excellent team. Work across the multidisciplinary team was respectful in the way it shared practice and morale was high.
The whole team had a strong commitment to positive practice that would improve the quality of care for older people with mental health needs. Staff felt involved in service development and believed that if they had an idea it would be listened to.

However:

The separation of patients with organic illness (caused by disease affecting the brain) and functional illness (a diagnosed mental health problem) was not always possible. This could mean that at times patients, particularly those with functional illness found the ward noisy and distressing. The inpatient unit was originally two five bedded units; one that cared for functional patients and the other for organic patients. Due to a reduction in funding from the clinical commissioning group, this was amalgamated into one unit.
Half the ward’s patients prescribed ‘as required’ medication had their prescription recorded across two medication cards. This could lead to dispensing errors. The prescribing doctor assured us that this would be changed.
On Konar ward 82% of staff had completed all mandatory training and 60% of the older people's home treatment team, making a joint figure of 71%. Each team’s figures fell below the provider target of 85%. The senior operational leader and team leaders had a specific action plan to address this, with actions identified for both the service areas and the training team. Managers expected all staff to have met the provider target by April 2016.

On Konar ward, 67% of staff had completed intermediate life support training. Staff that had not yet accessed this training were expected to receive it within the next three months.
Staff used Restraint Elimination System Practical Effective Control Technique (RESPECT) training to de-escalate difficult situations. Staff were required to update their RESPECT training every six months. All staff had completed their initial training however, the proportion of staff who had completed refresher training was low at 42% compared with the provider’s target of 85%. Managers had an action plan to address this, which included a RESPECT instructor on site helping staff if required.
Following the decommissioning of fifteen care beds, which had provided step-up, step-down support, the range of care options had reduced.

We rated NAViGO Community Interest Company as good because:’

The premises were clean and tidy with separate spacious waiting areas. The teams worked to a lone working practice protocol. Interview rooms were alarmed or systems were in place to keep staff safe. Staffing levels were safe to meet the needs of patients.

Staff were aware of safeguarding requirements and showed they understood the referral process into the local authority. Caseloads were managed and re-assessed regularly and were discussed in supervision.

There was an effective incident reporting system in place and there was learning from serious incidents. All staff knew how to report an incident.

Risk assessments were recorded and updated regularly. Comprehensive assessments were completed in a timely manner. Care records showed personalised care, which was recovery oriented. Physical healthcare needs were considered during assessment and throughout treatment. There was consideration of mental capacity assessment throughout treatment and this was documented. Outcome measures were used to evaluate the effectiveness of care and treatment. Medicines were managed safely and there was learning from medication incidents.

Staff were respectful and caring when they spoke with people. People said they felt involved in their care planning and treatment and this was documented in the care record.

There were no waiting times from referral to triage due to the single point of access. Referral to assessment waiting times were 11.5 days against a10 day target and referral to treatment or second offered contact date was 22 days. The east team did not have a waiting list and the west team were monitoring those on the waiting list.

Managers monitored performance and addressed any issues. Staff received appraisals and regular supervision. All staff said they could raise issues with their manager if required and action would be taken. Staff knew the senior managers and were aware of the trust’s vision and values. The chief executive attended regular staff meetings and some staff were members of the board. They said they felt supported by the board members and senior management. Team morale was good and staff worked well together.

However:

There were continuing staffing issues at the east team and the team were under pressure to manage the workload. The staffing issues had continued for a considerable amount of time. This meant that caseload sizes were increasing and the west team had started to give assistance.
Mandatory training compliance was below target for safeguarding adults, safeguarding children, and information governance.

We rated NAViGO Community Interest Company as good because:’

The design and layout of the environment allowed for effective observation of patients, all areas were clean and well maintained, and furniture and fittings were anti-ligature, designed to reduce the potential risks for patients with risks of self-harm. The service also maintained a comprehensive ligature audit.
There was an alarm system that operated in times of emergencies and where patients required additional assistance in vulnerable situations.
The service had a clearly established staffing establishment and had employed a range of effective methods to address shortages and vacancies.
The service operated an effective handover process that involved doctors, managers, clinical leads and staff.
Incidents were managed efficiently and the service worked at being open and transparent with patients and staff. They operated a confidential 24 hour advice and support service for staff.
The service had achieved recognition for Accreditation for Inpatient mental health Services (AIMS) and star wards as the overall winner.
Patients received comprehensive and timely risk assessments on admission.
The service worked closely with other teams and organisations to ensure patients received the best mental health support.
Staff had a good understanding of the Mental Health Act (MHA), the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards. The service adhered to the MHA and MHA Code of Practice, and MHA documentation was in place and up-to-date.
Patients gave positive feedback about the service, staff and management and all patients. All patients were given an opportunity to voting members of Navigo CIC and opportunities to be engaged with such functions as the Tukes Employment Scheme
The service had a clear governance structure, with effective systems and processes for overseeing all aspects of care including regular management meetings, a programme of audits and access to a service improvement team.
There was good morale among staff. They experienced job satisfaction, they felt valued and supported by colleagues and managers.They shared the provider’s vision and values for their service.

However:

At the time of inspection the service did not have a full multidisciplinary team but had access to psychology and occupational therapy which underpinned the model of care for assessment, treatment and recovery.
The provider had only one pharmacist who was responsible for the whole service. Navigo did have a contract with Lloyds Pharmacy which ensureed regular pharmacy cover to take account of sickness and leave”.
Not all staff received regular supervision.
Not all care plans demonstrated evidence of person centred care.

We found that Navigo Health and Social Care CIC was performing at a level which resulted in a rating of good because:

We found that Navigo as a social enterprise had embraced the concept of patient involvement to its utmost with patients having an active voice in decision making as members of the community interest company. They also through their Tukes employment scheme work actively to engage patients to maximise their working potential to re-integrate patients with mental health problems back into the local community.
Laing Buisson present annual awards to organisations dedicated to innovation, effective practice and high quality delivery of healthcare in the United Kingdom. In March 2015, Laing Buisson awarded the specialist care award for Excellence in Dementia Care to the Konar team.
Restraint was only used once de-escalation techniques had failed. The service operated restraint elimination system practical effective control technique (RESPECT) training to de-escalate difficult situations training in response to managing the risks of patients.
The ward layout on all inpatient areas allowed staff to observe all parts of the ward, with clear lines of sight from the main lounge area.
None of the incidents of restraint were of prone restraint or resulted in rapid tranquilisation.
In the adults of working age community teams each patient had a care programme approach (CPA) assessment carried out at least annually and the east team had 95% completion with the west team having 93%.
We saw examples of staff following National Institute for Health and Care Excellence (NICE) guidance in the older adults inpatient service.
The Memory Services National Accreditation Programme (MSNAP) accredited the Navigo memory service. The memory service had achieved a rating of excellent for their previous reviews under the scheme
Navigo had amended their policies in order to adhere to the revised Mental Health Act (MHA) Code of Practice which was issued in April 2015
We received 173 comment cards from service users, carers and staff, an exceptional amount based on the size of the provider. Of these comment cards 152 were positive and 21 were negative.73 of the positive cards commented about the caring attitude of staff.
Konar Suite family and friends test had remained at 100% for over a year.
Navigo had been involved in the development and delivery of a joint training programme to support police officers understanding of personality disorder and Section 136 of MHA
Navigo had a membership of over 750 people made up of staff, people using the services and carers. All members had equal voting rights.
Low sickness and absence rates and reports from staff showed Navigo had a healthy culture. Staff throughout the organisation referred to Navigo as a family. Staff felt supported and were able to contribute and challenge decisions in their areas.
It was clear from senior management that the organisations greatest risk was financial sustainability.

However

The community memory service had some issues with control and storage of medication
The process in place at the Eleanor Centre for the disposal of the sharps box stored on the premises did not meet the requirements of the hazardous waste regulations
At the time of inspection the service did not have a full multidisciplinary team but had access to psychology and occupational therapy which underpinned the model of care for assessment, treatment and recovery.
On the acute services all staff had received their annual appraisal however the service had identified that’s some staff had not received their supervision as frequently as was expected. The service had implemented changes to address this
Navigo had provided training for staff on awareness of mental health and this included Mental Health Act awareness, however the provider has recognised that this training needs to be separate and has been addressed on their training action plan
There were some discrepancies in training figures that were provided to us. Navigo told us that this was due to the electronic system that collated training data.
We looked at seven complaint files. We found that all complaints were thoroughly investigated with balanced responses. Navigo’s policy on complaints stated that responses to complaints should be within 35 days. However, only one of the seven complaints met this target

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