During the inspection we spoke with five people who were receiving treatment at Baldock Manor. The comments people made about their care and treatment were positive. One person told us about a less than positive experience, of which we informed the registered manager.

One person said, “The staff speak to me and treat me as an equal and are polite". Another person said, "I am happy to be here as I know that this is the right place to be but I eventually want to move away and live independently. They are helping me to achieve this, and they know all about my intentions, which have been discussed at the meetings I have with the doctors and nursing support staff".

We found that the medication records used by Baldock Manor for administering medicines to people were in need of improvement, to ensure that they were accurate records of what amounts of medicines were being stored at the hospital.

Staffing levels and staff competencies were sufficient to meet people’s assessed needs.

The hospital's complaints system and associated records were robust. We saw that complaints had been managed in an open approach and that complaints made to the hospital had been appropriately responded to. These had also included external organisations and local communities in the process to resolve issues.

We rated Baldock Manor as requires improvement because:

• The level of patient need on Burberry Ward exceeded the number of registered staff available to deliver interventions.
• The seclusion room did not comply with Mental Health Act guidance due to blind spots both in the seclusion room and in the ensuite toilet.
• The ward was not in line with mixed sex guidance due to the lack of a female lounge on Burberry Ward.
• On Radley Ward, patients did not have access to drinks 24/7 and were unable to access a remote for their televisions. Staff had not individually risk assessed either of these in patient records.
• The filing of patient records was not always carried out correctly. Staff had uploaded some patient records into the wrong patient record.
• The community meeting on Burberry ward did not have a formal agenda and did not always start on time.
• There was limited evidence of statutory consultation with family and carers in relation to the Mental Capacity Act.

However:

• Staff rarely cancelled escorted leave due to staffing shortages. There were effective working relationships between teams and effective multidisciplinary meetings.
• Managers had completed risk assessments on both wards. The wards were clean, presentable and well maintained.
• Compliance with mandatory training was 95%. Staff were trained in safeguarding and knew how to make a safeguarding alert.
• Staff completed comprehensive and timely assessments for all patients on admission. We saw evidence that staff involved patients in care planning. There was a wide range of psychological therapies available to patients.
• There was good access to physical healthcare. Staff met patient’s physical health needs and monitored these regularly.
• Staff were aware of what incidents to report and the process of how to report them. The process for staff to learn from incidents, complaints and service user feedback was robust.
• Staff carried out regular audits to ensure the Mental Health Act and Mental Capacity Act were correctly applied.
• All staff received appraisals annually.
• We saw positive, caring interactions between staff and patients during our inspection.