We carried out this inspection to check whether improvements had been made since our last inspection of the service. Over the course of separate visits made in December 2013, we found the provider did not have suitable arrangements in place to reduce the risk to people’s safety and wellbeing. For example the provider had not detailed when staff should use control and restraint to deliver care interventions. In addition people were not always protected against the risk of abuse because the provider failed to respond appropriately to allegations of abuse. Furthermore the systems in place to identify, assess and manage risks to the health, safety and welfare of people were not always effective. In view of our concerns we served two warning notices informing the provider that they needed to take action to address the areas of non-compliance identified by 7 February 2014. In addition we found them non-compliant with assessing and monitoring the quality of service provision. The provider submitted an action plan showing they would be compliant with this before the end of March 2014.

At our inspection on 20 May 2014 we found significant improvements had been made. The provider had put an accelerated programme in place in the service to bring the service up to standard. This included bringing in senior staff from within the trust to ensure improvement was sustained in the long-term.

Key policies related to the management of control and restraint had been reviewed and updated. A review of the provider’s management of violence and aggression policy had been updated to provide staff with clearer guidance of how to de-escalate potentially difficult situations and how to carry out control and restraint if required. Additionally the provider had developed a local policy on physical intervention (restraint) for personal care developed specifically for older people.

The provider’s governance arrangements for the service had been strengthened. The service had introduced regular meetings for management staff to consider issues of quality, safety and standards. Minutes from the inpatient safety and care quality meetings showed that a wide range of issues relating to the quality of the service were monitored and discussed. This included oversight of physical interventions, incidents such as falls, safeguarding and staff training. These were being monitored regularly by senior staff in the service. This helped ensure quality assurance systems were effective in identifying and managing risks to people using the service and others.

However we found that some physical risks were poorly assessed, monitored and did not include management or care, support or treatment plans. As a result people did not receive safe or appropriate care and support.

People using the service told us a mixture of both being and not being happy to be on the unit. One person stated that she wanted to leave the unit, but her capacity assessment indicated that she did not have the capacity to make the decision to leave the ward on her own.

Some patients using the service are very impaired due to their dementia while others are not so. However, staff are treating everyone in a similar way. Some patients spoke highly of the staff and treatment they are receiving. Conversely, some of the most able persons unit told us that staff did not speak to them much and did not sit down and listen to them.

We carried out a follow-up inspection at 3 Beatrice Place on 4 and 5 December 2013. On 9 December 2013 we received information that was not previously provided to us. The information sent to us required further clarification so we returned to 3 Beatrice Place, for a third visit on 12 December 2013. This report reflects evidence obtained over our three visits.

Overall, people who use the service were positive about staff who worked at Beatrice Place. Comments ranged from “okay” to “jolly and kind”. We observed staff interacting with people in a respectful manner. Staff had gained considerable knowledge about the early lives of the people who use the service and also knew about their important family relationships.

Whilst there was good information about people's life stories, the service had failed to use the information to ensure that people’s needs were appropriately met. We found examples where the failure in linking people’s early life experiences led to care that at times undermined people's safety and wellbeing.

The provider failed to respond appropriately to an allegation of abuse both in terms of how it was investigated and how it failed to protect the person who made the disclosure. Sometimes people had to be restrained in order to deliver care or to keep them safe. We found that half of the clinical staff had not been trained to restrain people appropriately and safely. This put people at risk of harm. Strategies to de-escalate potentially violent situations were inadequate.

We saw that the provider had invested resources and implemented systems to improve the service. This included auditing people’s care arrangements and reviewing incidents in the service. However, we found that that these were not sufficiently robust to protect people from the risk of unsafe or inappropriate care and treatment.