We visited two of the wards - Ambleside and Langdale. When we visited Ambleside ward in June 2011 we were concerned about the lack of ventilation and the temperature which was very hot. We were told at that time that the ward would be moved which would solve this problem. We found that the ward had not moved but plans were progressing so this would be completed this summer. We talked to patients about how this affected them now. One patient said, "The heating is terrible, it can’t be turned off or adjusted, when it’s really cold I have to put lots of layers on, when it's really hot I’m sweating and I feel like crying." We asked the trust to inform us what action they would take to reduce the effects of this on patients until the building work is completed and the ward is moved. They have provided us with a plan about what action they will take to reduce this.

Since we last visited Langdale ward had been refurbished. This had improved the environment for the benefit of the patients. The lighting was better and the heating could be controlled, so making it a comfortable temperature to spend time in.

Patients told us that they can choose what time they go to bed. One patient said, "I can go to bed when I want but staff wake me up in the morning as I need to take my medication at a certain time."

Some patients were detained at the hospital under the Mental Health Act 1983. They told us that they saw the doctor regularly who discussed with them and the team of professionals working with them when they could go out of the hospital. Some patients told us they did not get enough leave to do what they wanted to do. We looked at their records and saw that this had been agreed to ensure the health and well being of the patient and to protect the public.

Patients told us how staff had supported them. They said, "Staff make you feel welcome here." "Staff are alright.” "Staff are brilliant, they have held my hand through my problems and gone well out of their way to help me. I can open up to the ward staff and the doctors. I can see improvements in my health day by day."

We talked to patients about what activities they did. They told us they did exercise activities, played games and did some art and craft activities on the wards. Activity staff were employed to work on the wards and to take patients to other areas of the hospital where they did cooking, gardening, used the gym and spent time in the Faith room. Some patients who were able to went to the canteen on their own or out into the hospital grounds. Other patients needed staff to go with them to these activities. Staff told us that another benefit of moving Ambleside ward will be that all patients would be able to go out in the garden when they wanted to. Staff would be able to observe patients who need to be observed from the ward area. Staff felt that this would reduce some patients' frustration.

Patients told us that the doctors talked with them about the plans for when they would be discharged. They said that the support they would get when going home was discussed, so it could be arranged. They also had a chance to go home on leave before they were finally discharged to help to make sure they were ready for this.

Ambleside

Core service provided: Acute admission ward

Male/female/mixed: female

Capacity: 21

Langdale

Core service provided: Acute admission ward

Male/female/mixed: male

Capacity: 18 + 3 bed extra care area

Core service provided: Psychiatric Intensive Care Units and health based places of safety

Male/female/mixed: mixed

Capacity:

Grasmere

Core service provided: Longstay/forensic/secure services

Male/female/mixed: mixed

Capacity: 10

Dorothy Pattison Hospital is based in Walsall and provides assessment and treatment for people with mental health problems. It has three wards: Ambleside and Langdale wards are acute wards, while Grasmere ward provides longer-term rehabilitation for adult male and female patients.

We found that the services were safe and that there were enough staff in most wards. However, some wards were occasionally short of staff and relied on temporary staff who did not always have the skills and knowledge to fully meet people’s needs.

There was evidence of good risk assessment taking place and every patient record we saw had a completed assessment. However, there was not always an associated risk management plan to manage the identified risks.

We saw that people who use services were treated with dignity and respect and saw staff and people who use services interacting positively with each other. Some people were involved in developing their care plans.

The Mental Health Act responsibilities were discharged appropriately, although actions from previous Mental Health Act monitoring visits had not been fully resolved.

We saw good examples of learning from audits and incidents being shared, and changes to practice being made as a result.

The hospital worked well with the general hospital (which was on the same site) regarding physical health needs.

The health based place of safety did not meet the recognised environmental standards.

We saw that the rehabilitation ward was mixed gender and placed people at risk of receiving care that compromised their dignity.