The service provided was safe. This is because we saw clear assessments of risk and care plans to manage any potential risk to people who used the service or others. Evidence was seen of staff attendance at mandatory safeguarding training. Safeguarding concerns were being appropriately referred to the relevant statutory agencies.

The service was effective. Each person had an individual care record which included assessments of specific needs. We saw that care plans were in place for each assessed need. This demonstrated to us that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The service was caring. People told us that staff had time for them and provided them with the appropriate levels of support. We found that people were having their rights protected under the 1983 Mental Health Act. We noted that people had been granted Section 17 leave following a multi disciplinary assessment of risk..

The service was responsive. Staff were receiving their mandatory training and progress was being made on ensuring that staff received clinical supervisions and annual appraisals. Systems were in place to manage and investigate formal complaints made to the service.

The service was well led. We saw that a clinical assurance framework was in place to ensure that the provider had an effective system to assess and monitor the quality of service. Actions had been taken to address any identified audit concerns.

We undertook this visit to follow up on a warning notice which we issued about seclusion being used inappropriately, for long periods and without staff working at the unit following the Mental Health Act Code of Practice in respect of how seclusion should be used and managed. The warning notice was also issued about the use and records of restraint and the efficacy of the admissions procedure.

In assessing compliance, the inspection team spent most of the first day on each of the wards, speaking with staff and patients. We spoke with 13 staff, 16 patients, the manager, occupational therapist and the responsible clinician as well as more senior managers in the organisation. The team consisted of two compliance inspectors, a national advisor and a Mental Health Act Commissioner.

We found the use and length of seclusion had significantly decreased and that this was being used for the right reasons. However, patients and staff and the records we saw provided evidence to show this was not always being recorded consistently.

Two patients told us that they were cold in the seclusion room; some staff acknowledged that it was hard to keep the room warm enough and the manager said they were working on improving the level of heating in these rooms. We found mixed evidence about whether staff offered patients food and drinks whilst they were in seclusion. Some patients said they were offered or provided with regular food and drinks, others said they were not.

Some of the patients we spoke with who had experienced recent seclusion raised concerns about the conduct of some staff. We saw that there was a space for patient views about the period of seclusion in the seclusion packs, but most of those we saw had not had this part completed. This was a useful source of information to assess staff conduct and was not being utilised effectively.

We spoke with patients about the use of restraint. Only one person we spoke with talked to us about being restrained and they said they felt that this was needed at the time. Most of the staff we spoke with felt restraint was used fairly and for the right reasons.

There had only been one new admission since our last inspection. We spoke with staff about the new patient and were told they had settled into the ward well and they felt the admission was appropriate.

We spoke with all of the patients we interviewed about the care they received from staff. One person said “I want to praise staff for showing they care.” Several patients told us they felt they staff provided good care and support and most people knew who their key workers were. We observed that one healthcare worker in particular was lively, engaging and positive with patients.

However, two patients expressed their opinion that not all of the staff cared about their welfare. Two patients told us they had regular “talk time,” with staff others told us this did not happen regularly, or they were told to wait.

We were concerned about the admission of a patient on one ward due to their behavioural risks. One patient told us they had been “terrified” of this patient.

One patient told us that they had been denied a drink for four hours whilst in seclusion. We found that fluids given to patients whilst on seclusion were not recorded in the seclusion booklet so it was unclear if this patient had been offered a drink.

It was apparent from conversations with patients and staff, and from reviewing patient records, that patients were sometimes secluded for hostility, making threats or for non compliance with directives. The rationale for this was not always clearly documented so we did not find evidence in all cases that the least restrictive principle was being adhered to.

We were told by some patients that staff sometimes spoke with them disrespectfully, in a way which they experienced as demoralising and degrading.

People who used services told us they were fully involved in planning their care and recovery. They told us that the staff were very supportive and respectful.

The Commission received 4 separate whistle blowing concerns about Calverton Hill Hospital over the previous six months.

The concerns were that the hospital had insufficient staff and had young inexperienced staff working there, and that patients were being given too much sedative type medicine. Concerns were expressed about staff being unable to manage the challenging behaviour and how a serious incident had occurred on

11 June 2011 in which the police were called to assist the hospital staff at Calverton Hill to control an incident that could have jeopardised the well being of patients and staff on one ward.

When we visited we saw some positive staff patient interaction and some patients said they were satisfied with the range of activities available to them. Although the manager told us that people were consulted about activities some patients told us they were not satisfied with the choice available during weekends and evenings.

Some of the patients and staff told us there were often insufficient staff on the wards to meet patients’ needs. They talked about one to one sessions being cancelled on occasions and of being unable to access off ward activities. Staff reported feeling unsafe when there were few staff on the ward and some may have little experience.

We saw that people received their medicines at the correct time, and that (with one exception) the administration of medicine was accurately recorded on prescription charts. Forms that were necessary to authorise the prescribing of certain medicines had been completed.

We spoke with one person during our visit who told us;

"I don't always feel safe."

"I have the opportunity to speak to an independent advocate."

"I've got an appointment with the social worker to discuss my concerns."

"I meet with my key worker to talk about my care plan."

"I've got a copy of my care plan."

"There is a physical healthcare coordinator who helps me make appointments with GP's and dentists."

"There's a new activities co-ordinator and it's better now."

We rated Calverton Hill as good because:

• The building was safe and generally well maintained.

• The provider employed enough staff to support the patients and keep them safe. They trained, supervised and supported staff well.

• Nursing staff managed patients’ medicines safely and made sure that emergency equipment was safe and available when needed.

• Staff knew how to safeguard patients from abuse and harm.

• The multidisciplinary team worked well together to meet patients’ needs.

• Staff from the hospital worked well with other teams in and outside the organisation to benefit patients.

• Staff followed national guidance to make sure they met patients’ needs.

• Staff had an understanding of the Mental Health Act and the Mental Capacity Act and how it affected the patients in their care.

• Patients told us that staff supported and cared for them. We observed that staff were kind and respectful to patients.

• Staff developed an individual care plan with each patient that showed all staff how to support the patient to meet their individual needs.

• Staff supported patients to keep in contact with their family and friends during their stay in hospital.

• Staff offered patients a range of activities to meet their needs and appropriate to their interests.

• Staff supported patients to meet their religious and cultural needs.

• The provider had good governance systems in place. This meant that staff could identify risks and make improvements to the service where needed.

• Staff morale was generally good and communication between staff across the hospital was good.

However:

• Staff searched all patients on return from escorted leave and did not risk assess for searching individuals.

• Doctors had not regularly reviewed medicines they prescribed for patients to take when required.

• Several patients thought the food portions were too small and it was sometimes over or under cooked.

• There were no pictures or easy to read signs around the hospital.