We visited all three wards as part of this inspection and spoke with eight people. People told us they were generally treated with respect and their dignity maintained. Comments included “Staff treat me with respect and observe my dignity” and “Most staff treat us with respect and observe our dignity but sometimes the bank staff can be a little difficult to get on with.” People felt listened to and able to express their views about how the service was run.

People were supported to maintain their independence and community involvement when safe and appropriate to do so. Each person had an individual activity plan, and were encouraged to take part in activities.

People spoken with told us their care plan had been explained to them, and they were aware of their rights. Care plans were detailed and set out the care, support and treatment required to meet people’s needs. People told us their general health care needs were met.

There were good links with a wide range of providers and agencies, to ensure that people received safe and co-ordinated care, treatment and support.

People told us they received their medication as required, and their medication had been explained together with the possible side effects.

We visited Litchurch Ward during our visit and spoke with three people. They all told us they had been involved in planning their care, had seen their care plans and signed to indicate that they agreed with them. People also told us they were involved in weekly ward rounds with medical staff.

People told us they chose what activities they took part in. People were interacting with staff during our visit, playing pool or sitting chatting. We saw people were supported to access the community, either with support from staff or independently. Risks associated with involvement in community projects, or access to community facilities, for example the local gym, was clearly documented and planned for.

All of the men we spoke with told us staff treated them with dignity and respect. They told us staff always knock on their room door prior to entering. People told us they all felt safe and comfortable to raise any issues. One person told us that staff were very good at calming down people when they were angry as well as protecting everyone else. We found systems were in place to protect people and staff had a good knowledge of the procedures.

We saw staff had been recruited safely, and were provided with on going training to maintain their skills and knowledge. Staff received regular supervision, to ensure their practice was satisfactory.

We found the service maintained records appropriately and securely, so confidentiality was maintained.

People we spoke with told us they were generally satisfied with the service. They were involved in decisions about their care and treatment. They had access to a range of therapeutic activities including IT, a gym, gardening and arts and crafts. One person told us the food was, “always fresh and we have plenty of variety but sometimes it's a little exotic.” People had complained to the service about smoking breaks. One person said, “There is not enough staff to allow cigarettes at night and staff sometimes have to send for someone from another ward to cover.” They thought the management team was working with them to resolve this.

We rated this service as Good because:

• The hospital provided a good standard of accommodation to patients. The hospital was clean and records demonstrated this. There were adjustments in place for people requiring disabled access, support of patients’ spiritual needs and an extra care facility for patients needing seclusion or long-term segregation.

• The hospital was staffed safely and all shifts occurring from staff sickness, absence and vacancies were filled. Each ward had a multi-disciplinary team. Employment records demonstrated that staff were qualified and experienced for the positions they held, and all staff received an induction and mandatory training.

• Information needed to deliver care was stored securely and was available to staff when they needed it. Risk assessments and care plans were present and up to date in patients’ records. Care plans were recovery focussed and demonstrated that staff shared copies with patients. The Recovery Star provided a visual record of a patients’ recovery progress.

• Patients said that staff were caring, respectful and polite, and we saw evidence of this in interactions. Patients felt involved in their care and had the opportunity to make decisions about how they would like to be treated if they were unable to make that decision in the future. The hospital had initiatives in place to involve patients in making decisions about the service.

• The hospital had an established recovery college, offering educational and recovery focussed courses that were co-produced and facilitated by staff and patients. Outcome measures demonstrated the effectiveness of the college and patients described the college’s activities as meaningful.

• The hospital had a strategy and delivery plan for reducing restrictive practice. Following a risk assessment from staff, where safe to do so, patients could have a key to their bedroom and their own mobile phones. Figures demonstrated that occurrences of restrictive practice including restraint, rapid tranquilisation, seclusion and long-term segregation, were low.

• The hospital used key performance indicators to gauge the performance of ward teams and had effective governance systems to monitor performance. There was an overarching local action plan that brought together all the actions from risk assessments, incidents, the Peoples Council, peer review assessments, and staff, patient, and carer surveys.

However:

• Staff had not always completed medicine charts to confirm administration of medicine or record a reason why the medicine had been omitted. Staff had not always kept records of high dose antipsychotic monitoring updated with the correct dates and outcomes of physical health checks.

• Staff did not routinely record return details on leave risk assessment forms. This meant that a record of the outcome of Section 17 leave was not maintained to inform future decision-making.