At our visits on 10 and 11 July 2012 we visited four wards at the hospital. We went to an acute ward, a psychiatric intensive care unit ( PICU), a rehabilitation ward and an older person’s ward. The inspection took place over two days. One of our inspectors (known as Mental Health Act Commissioners) who visit people detained under the Mental Health Act also visited the hospital on 2 July and 13 July 2012 and we have also referred to those findings in this report.

We met 25 patients and two relatives during our visit. Patients told us how they were supported with their mental health needs by the staff team and the managers. We were told “They are sound”. “They are kind and considerate and they don’t play head games”. “The staff are very approachable”. “I would have liked to talk to the staff more". “They are very good, I could have spent more time with them "."They’re good ".

We met three psychiatrists, five hospital managers, two domestic staff, seven nurses, and ten care staff as part of our inspection of the service.

Patients detained under a section of the Mental Health Act were helped to understand why they were detained. The reasons would be for their safety and /or the safety of others. We saw in the records of detained patients that their right to use an independent mental health advocacy service had been explained. It had also been recorded when patients had been made aware of their legal rights. Patients told us that staff had advised them of their legal rights were while detained in hospital. This was an improvement from we visited Larch Unit on 2 July to review the care of people detained under the Mental Health Act. At that visit we found that patients were not being properly involved in making decisions about their care in accordance with the requirements of the Mental Health Act and the associated code of practice.

Patients’ care plan records explained what support and treatment they required to meet their mental health needs. There were informative daily progress records kept by the staff about patient’s mental health and wellbeing. Patients were supported with their safety and well being with informative risk assessment records. The risk assessment records set out the risks patients faced and what actions were required to take to keep them safe.

Patients were cared for and treated by staff who had an understanding about different complex mental health needs and the impact this had on all aspects of their lives.

Staff told us they felt supported by managers at Callington Road. Hospital staff benefited from regular formal supervision meetings to help them in their work.

There were systems in place to review and learn from critical incidents and occurrences that impacted on patient’s health, safety and wellbeing. There were systems in place to ensure care and treatment that patients received was checked and monitored and revised where needed.

People we spoke to who use the service told us they understand their treatment and are supported in making choices for their health and well being. They also told us they are “looked after” and “the staff are kind”. However they feel “more activities are needed. It is very boring at times especially at weekends”.

People also told us they feel care is provided that respects their privacy and dignity and enables them to be as independent as possible. They feel safe.

We saw people are accommodated in single rooms and corridor areas are designated single sex areas.

This inspection was arranged in response to concerns raised by the Avon & Somerset Constabulary (A&SC) in early January 2014. A multi-agency meeting took place, attended by police, CQC, the relevant clinical commissioning groups (CCGs) and local authorities. Police concerns related to what they perceived to be excessive and inappropriate use of their resources to support Callington Road Hospital (CRH). There was particular concern about high numbers of patients who were reported missing, either because they had absconded from hospital or were absent without leave (AWOL), i.e. they had not returned from periods of authorised leave. There were concerns about the safety of these vulnerable people and the safety of the general public. There had been a number of incidents where large scale police searches had been necessary in order to locate and return patients to safety. We heard about examples of some patients repeatedly going missing and putting themselves or others in danger. There were questions asked as to the robustness of the risk assessment processes undertaken, the adequacy of patient supervision and about the accountability of the trust, who did not appear to take the concerns of the police seriously. It was recommended by the multi-agency group that a responsive review take place to look into these concerns.

Prior to our inspection we requested further detailed information from the police, the Bristol CCG and from the provider Trust, Avon and Wiltshire Mental Health Partnership NHS Trust (AWP).

We visited Silver Birch, Lime, Larch, Alder, Laurel, and Hazel units. We spoke with staff and managers. Because of the nature of our lines of enquiry, we did not speak with patients, other than a few brief conversations. We looked at a sample of patients' records, in particular those who had a history of absconding and/or AWOL. We looked at ward security, the processes for observing patients and the arrangements for patients who took periods of leave from the hospital.

We found that staff had a detailed knowledge of their patients needs', including the risks that they posed to themselves and others. However this was not supported by accurate record keeping, with inconsistent information recorded about patients, posing the risk that their supervision, care and treatment may not be appropriate.

There were established systems in place to ensure that patients were properly supervised to ensure their safety, and this included arrangements for periods of leave form the hospital. Leave was an integral part of people's rehabilitation and recovery plans, and as such, 'positive risk taking' was encouraged. We were unable to judge whether the level of AWOL incidents or missing persons at CRH was excessive. However we were concerned that the systems to monitor risk, both on an individual and on a ward/hospital wide basis, were not effective.