We spoke with six patients who told us of their generally positive experiences of the care and treatment that they had received on the ward and by community mental health staff. One patient told us that staff were “absolutely amazing – they do a great job.” Another person said staff “try to make time for you”.

We found care and treatment was planned and delivered and patient’s needs had been assessed. We saw appropriate care plans were regularly reviewed to take account of patients' changing needs.

We found there were sufficient staff with knowledge and experience to support patients who received a service. However, we also found the trust had taken steps to identify where additional staff was needed and plans were in place to employ additional staff including substantive medical staff.

We found there were suitable arrangements in place to support staff and most of the staff we spoke with told us they were well supported by the team and managers.

We found the trust need to make improvements in relation to records. This included ensuring identified risks were properly recorded, gaps were not made in patient records and ensuring improvements to access to patients records as they were not always accessible or easily located when required. Discharge summaries were not always sent out in a timely manner. This meant that staff did not always have the necessary information about patients to protect them against the risk of unsafe and inappropriate care.

We conducted this inspection to monitor the unit’s progress against the action plan in place which ensured that compliance to standards was achieved. We first inspected the unit on the 09 October 2013.

On the inspection of the 27 February 2014 we saw that there had been a new ward manager appointed for the unit. Supporting the ward manager there had also been an increase in the number of more senior clinical staff available. Supervision and monthly staff meetings had been introduced. We were told that these would be the mechanism for discussion of incidents and complaints. On review of staff rotas we saw that there were adequate staff on duty to provide the support patients needed.

Staff we spoke with were able to describe a governance process which identified ‘learning from events’ in a timely manner. The ward manager told us, “We know what we need to do and we are doing it. Staff feel more supported and we are working tighter and more consistently". When we spoke to staff they were very positive about the changes which had occurred on the ward. We were told, “We are now working much better together,” and “We know the areas we need to improve on and are making sure we work towards that improvement.” All staff we spoke with confirmed that the appointment of the new ward manager had made a big positive difference to the ward.

Overall we found that patients felt they were treated with respect and dignity and we received no negative comments. During the patients forum meeting a patient said, “Nursing staff are excellent and understanding, they have time to answer questions. Meals are good. Care and attention is good as good as you will get anywhere.” Another patient said, “They (the staff) treat everyone with dignity”. We were also told, “As soon as you are admitted the staff look after you.” A relative of a patient told us, “I feel we are kept involved with my relative’s care. We attend weekly meetings to review their care and progress.” We discussed with seven patients their views on the care and support they received. One patient told us, “They saved my life.” All patients we spoke with said that they felt safe. We were told that the most frequent complaint related to the lack of activities and the absence of the gym.

All new admissions to the unit were seen within 48 hours when they had a full history check and a management plan put in place. Staff also told us that each patient’s physical health was checked by the junior doctor and there was also a ‘physical health’ nurse available on the ward.

Following the serious incident that happened on the unit the trust had put into place new documentation and systems to improve the safety of patients who were detained. We spoke with staff about the new arrangements and looked at documentation. We found that the learning from the incident had been disseminated and that the new policy was being followed by staff on the ward.

Five out of the seven patients we spoke with said they felt there was adequate staff. Two patients however did say that they felt that there were occasional staff shortages which meant that they were unable to go on escorted Section 17 leave. On previous visits there had been limited psychology input into the multidisciplinary team however we saw that had been increased to three days a week.