We rated safe, effective, caring, responsive and well-led as good.

We rated it as good because:

• Patient safety and quality improvement were high priorities on the ward. Management had identified lessons from incidents and complaints and were implementing changes to improve nursing practice and quality of care.
• Staff were familiar with the systems in place to escalate patients for admission to acute care or assessment in the local accident and emergency department. We saw evidence that assessment for sepsis had been acted upon appropriately resulting in a patient transferring to acute care.
• Staff took a proactive approach to safeguarding and were familiar with mental capacity assessment and application of deprivation of liberty safeguards. Patients and family were involved in care and discharge planning decision-making and told us they felt supported.
• Appraisal rates for nursing staff had significantly improved during 2018 and training rates were improving with outstanding sessions booked. A band six nurse was assigned to manage training and development and nursing staff were involved in link nurse roles.
• People’s emotional and social needs were seen as being as important as their physical needs. We saw the emotional benefits to patients of socialising at meal times, having music therapy and allowing long-stay patients with pets to have contact on the ward. Events were organised to encourage patients to be involved with national celebrations such as the royal wedding in 2018.
• We saw evidence of different teams and services working well together to enable patients with long-term complex needs to achieve a safe and timely discharge.
• There had been positive cultural changes on the ward in 2018. Transparency, honesty and challenges to poor practice were established as the norm. Staff told us morale had improved and they felt supported by ward leadership.
• Leadership was accessible and visible at every level with executive ward visits, daily visits from the matron and proactive team building by the ward manager.

However:

• Medicines prescribing lacked sufficient pharmacy monitoring on site.
• The room where medicines were stored had no facility for room temperature monitoring.
• There no clinical handwashing sinks available to staff in the corridors of the ward.
• We saw a lack of nursing representation at the department of medicine for older people quality board in the minutes reviewed.