During the 23rd January inspection we visited five wards across the Evington Centre and the Brandon Unit. On the Brandon Unit we inspected the Barnsdale ward and the Beaumanor unit (eating disorders service). On the Evington Centre we inspected three wards; Coleman, Wakerley and Gwendolen and the Beechwood Intensive Community Assessment and Treatment Service (ICATS).

This inspection was carried out to follow up the areas of concern that had been highlighted at our previous inspection of the Evington Centre in March 2011.

We talked to patients on all the wards we visited except for Gwendolen ward due to people's dementia type illnesses. The majority of patients told us they were satisfied with their care and treatment and found staff helpful and supportive. Their privacy and dignity were respected and they felt safe and protected. Visitors to the Coleman and Wakerley wards gave positive comments about their relatives care.

However we saw patients care, treatment and support; and dignity, privacy and independence were not respected on Gwendolen ward. Visitors to this ward told us they were worried about their relatives care and the level of staffing. This is where we saw people were not safe or protected from the negative effects of the behaviour of other patients.

We saw staffing levels on all wards had improved. The only exception to this was on Gwendolen ward where staffing levels did not meet the needs of patients.

Staff training for safeguarding adults and whistleblowing had improved with regular training programmes now available. Dementia staff training had recently started and more opportunities for dementia training were planned by the trust. This would benefit patients and the quality of care they received.

Most patients told us the food provision met their needs, with the exception of patients on Barnsdale ward who were dissatisfied with the meal arrangements. Patients and staff on Beaumanor unit told us they were looking forward to moving to a new building with improved facilities.

Some patients told us they attended ward forum meetings to express their views about the care they received. They told us their suggestions and comments were not always addressed. We saw a consultation event take place on Beechwood between people who use services, their relatives and carers and staff. Staff told us there would be more planned consultation events rolled out across other wards and services, which aims to listen to patients, and improve services.

Following on our visit the trust took immediate action to address the specific issues on Gwendolen ward around staffing and people’s care, treatment and support. The Care Quality Commission (CQC) returned four weeks later on the 28th February, to check the service people received on the Gwendolen ward. We found there had been improvements in the planning and delivery of care, in keeping people safe, in staffing levels and in the support provided to staff.

People were generally satisfied with the service and felt they were treated with respect and dignity. Some people expressed concerns around being unable to use the telephone in private, and dignity issues around the seclusion room. They were dissatisfied with the quality of the meals. People told us about the frequency and good standard of cleaning on the wards. People were satisfied with the premises although access to the garden area was more difficult from some wards. Decoration was taking place on some of the wards and other units will be moving to improved premises soon.

People know how to raise concerns and complaints and would approach staff or advocacy services. Some people told us about their concerns about being moved from their wards once settled, and how this upset them.

“They have explained to me I can't leave the ward. I understand why."

“The meals are not good at all. I ask my family and friends to bring me food in"

" The staff help me to remember things. I ask for a copy of the ward round because you can get a copy. I wrote notes to the nurses and consultants"

Staff are trained but do not always receive timely training to meet the specific needs of people they serve. Some staff spoke of being unable to support people more effectively towards recovery. Staff were not always able to access training and supervision meetings due to limited staff cover. Improvements and consistency in care planning is required to ensure peoples personalised care treatment and support is provided for.