We undertook a responsive inspection on the 15 August 2014 in response to concerns that one or more of the essential standards of quality and safety were not being met, this was specifically in relation to the inpatient ward at the hospital. At this time the hospital was meeting the standard for care and welfare of people who use services but was not meeting the standard for assessing and monitoring the quality of service provision.

Improvements were required in relation to the leadership at ward level and the systems in place that allowed the service to monitor and assess the quality of the service provided. We judged that there was a moderate impact on people using the service and issued a compliance action to the provider for actions and improvements to be undertaken.

We undertook a follow up inspection of the service on 27 August 2015 to ensure that these actions had been taken. We found that the provider had completed and implemented an action plan and improvements had been made. We judged that the provider was now meeting required standards.

We completed our inspection on the inpatient ward only.

We ask five key questions of services we inspect. Are they safe, are they effective, are they caring, are they responsive and are they well-led? Because this was a follow up inspection we focused on three of those five questions; are they safe, are they responsive and are they well led?

Is the service safe?

Patients were properly assessed for pressure area care and specialist equipment was in place where required. Falls risk assessments were completed for all patients on admission to the ward and a multidisciplinary team approach ensured patients were safe.

Is the service Responsive?

Equipment for pressure area care and mobility was available promptly following assessments of patient’s individual needs. The multidisciplinary team undertook home assessments for patients who were planning to go home so that individualised care plans could be made.

Is the service Well led?

Governance and quality assurance processes were not effectively implemented on the inpatient ward. Whilst we found that improvements had been made following our last inspection in relation to medication and hazardous materials storage, we could not be assured that improvements had been made in relation to supervision. This is because the service could not provide us with evidence to demonstrate that this was being monitored. In addition, we looked at other aspects of quality monitoring and found that systems were not in place.

We found that there were processes in place to obtain people's consent to their care and treatment. Staff demonstrated a good knowledge of guidelines under the Mental Capacity Act and how to support people who may lack capacity to make decisions about their care.

We found that there were detailed care records for the six people whose records we reviewed. These included assessments to protect them from harm. People were visited regularly by a doctor, who recommended follow on treatment. People were discharged with the right support to protect them from harm. One person we spoke with told us, "It's been brilliant."

We found that there were processes in place to control the spread of infection and protect people from harm. Beccles Hospital was in a good state of cleanliness on the day of visit.

We found that staff had the right training in key competencies of care, to ensure that they could provide a good level of support to people. Staff had an annual appraisal, which helped them to develop in their role. We spoke with three people about the staff, one person told us, "They can't do enough for you, [and] they're such caring people."

During our visit, we had concerns that the service wasn't identifying poor practice and didn't have systems in place to protect people from harm. People had access to substances that could be harmful to them, and medications were not always secured appropriately.

We found that there was an effective complaints procedure available.

We spoke with three people using the service and with two visitors. They all praised the quality of the care received by people in the hospital. One person said, "It's the best nursing care I've seen, and I was a nurse." Another person told us, "You couldn't find anywhere better." Another person said, "This is the best hospital I've been in, and I've been in a few." People told us that the staff were kind, friendly and very competent. One person said, "They know what they are doing. With them, nursing comes first."

We saw that the service carefully assessed people before they were admitted to check that this service was the right one for them. People were involved from the start of their admission in giving staff a clear picture of who they were, and what their likes and dislikes were. Staff then explained to them what their care and treatment would be.

The service kept care plans up to date with frequent reviews with the individual. They protected people from harm by following safe and proper procedures. One person using the service told us, "I trust the staff. I never thought I'd be happy to let a young girl wash me, but they are so good and give me confidence that they know what they are doing."

The provider had a structured system of monitoring the quality of care in the hospital, using daily, weekly and monthly reports.