We carried out our visit on 6 August 2012 to follow up a compliance action and to look at improvements made following our previous visit to the service in January 2012. Our inspection team planned to include a specialist practitioner who is a consultant psychiatrist with expertise in treating people with perinatal mood disorders. Because of unforeseen circumstances the specialist practitioner was not able to participate in a telephone conference that was held with key personnel from The Trust on 16 August 2012.

Because of the nature of the Intensive Home Based Treatment service, we were unable to speak directly with people who use the service.

We carried out a visit to the Chantry Unit on 22 May 2012 to follow up a compliance action and to look at improvements made following our previous visit to the service in January 2012.

We spoke with two patients during our visit.

Both patients said they had been shown around the unit when first admitted and had been given an information leaflet about different aspects of the unit. They told us they are able to spend their time doing what they want and are encouraged to make their own choices. Both patients were able to explain why they had been admitted into hospital and said they were involved in regular meetings to discuss their progress.

The two patients commented that they are involved in discussions about their care and are kept up to date with what is happening. One patient told us they chose not to sign their care plan but was aware of its contents. Another patient said; “The staff are good and we always have a laugh. I have improved a lot since coming here and am now socialising more. The activities are very good and I have been home to visit my family.”

One patient told us their best interests had been protected during their stay on the unit. The other patient said; “One patient hit me three times last night. Staff intervened and gave me attention afterwards. It shook me up but I was not injured. Staff have reported it.”

Within this report CQC refer to the term ‘perinatal metal health problems.’ Perinatal

Psychiatry includes not only postnatal mental illness such as post natal depression, but also the problems faced by women with pre-existing mental health problems who become pregnant. It includes the effects of the mental illness and their treatment on the unborn and developing child.

Because of the nature of the Intensive Home Based Treatment service, we were unable to speak directly with people who use the service.

We carried out our visit on 6 January 2012 to look at progress that has been made following recommendations that were made from an independent review of perinatal services within Kirklees. The review was instigated after the unexpected death of a person with post natal depression who was using the service. Our inspection team included a specialist practitioner who is a consultant psychiatrist with expertise in treating people with perinatal mood disorders. The specialist practitioner did not visit the Trust but held a telephone conference with key personnel from The Trust.

We carried out a visit to the Chantry Unit on 4 January 2012 to follow up compliance actions made following our previous visit to the service in July 2011.

We spoke with two patients during our visit. They told us that they are able to make most of their own choices about their daily routine. This includes times for getting up in a morning and retiring to bed. Both patients said that they receive good care and support from the staff but neither patient knew about their care plan.

The patients told us that when they were admitted into hospital, they were given an information booklet about the unit. The booklet explains that the unit has a locked door system and both patients were aware of the procedure to follow if wanting to spend time off the unit. Neither patient had their own bedroom key. One patient said, “I am not bothered about having my own key. If I want to spend time in my bedroom then I just ask staff and they let me in.” The other patient commented “I am used to having a rest in an afternoon because I can become tired after lunch due to a physical ailment. When I have asked staff if I can go for a lie down after lunch I have sometimes been told that this is not good for me.”

Both patients said they are very satisfied with the care and support they receive. One patient commented “Staff can not do enough for you, they are very good.” Both said, “There is plenty to do with activities going off all the time.”

Patients told us that they have not had any concerns since being in the unit. One patient did say “There is another patient who can get on my nerves but I just move to another area.”

Patients said that staff are always about and easily accessible if support is needed.

Patients spoken with told us that they have been asked to provide their views about the activities on offer and the menu choices.

We carried out a visit to Appleton and Chippendale wards (learning disability units) at Newton Lodge on November 8 2011 to follow up compliance actions made there following the previous review of compliance in June 2011. Because we needed specific information from the management to demonstrate their compliance with the essential standards, we did not need to speak directly with patients from the wards.

One person told us that they understood their care and was able to make their own choices about their daily routine. This included times for getting up in a morning and retiring to bed. This person said that they were asked about their care but had not seen any care plans. Another person had only been recently admitted. They commented that their room was “basic and a bit dour”.

We spoke with one person who said, “I like it here and the staff look after me. The care and meals are very good, I have no concerns”. The person also commented “When I want a bath, staff leave me alone to have one”. Another person told us “I have not been offered the opportunity to go off the ward as yet. There is very little else to do”.

People said that they felt safe whilst on the ward.

People spoken to said that there were always sufficient numbers of staff about and that call bells were answered promptly if they needed assistance.

We carried out this site visit after receiving non-specific concerns about Appleton ward and Chippendale ward. These are medium secure facilities within Newton Lodge for people who have a learning disability.

Appleton ward

We spoke to three patients on Appleton ward. They told us that they receive good support from staff who knew and understood their needs. One person said, “I am hoping to move towards more independent living and staff are helping me with this”. Another comment was “I am involved in reviews about my care and discussions about my progress”. People told us that they enjoy having takeaway meals on a weekend. One person did say that on occasions their planned time off the ward had to be cancelled because of the lack of staff on duty.

One patient on Appleton ward said that staff are “respectful and helpful and that the rules are OK”. This patient had been subject to the use of restraint because of their behaviour. They told us “This was not excessive and was over quickly”. He also said that he was treated fairly and able to do things that he enjoyed such as painting, cooking and going on the exercise bike.

Another patient commented “The staff are beautiful here and really help you” and “Staff listen to what you say and are there for you”.

However patients told us that they had felt frightened and unsettled by a recent serious incident but that things had settled down since the perpetrator of the incident had left the ward.

Chippendale ward

We spoke to three patients on Chippendale ward. They told us that they are fully involved in their care and attend their reviews. They sign their reviews to say they are in agreement with the outcomes from them. One patient said, “I don’t particularly like being in a secure unit, but the staff are really good and treat us well”. Another patient said they like going out and having takeaways. One comment was “I like going out for a cigarette and going on trips”.

Patients said that staff were helpful and knew the support they needed.

Patients told us that they were asked for their views and opinions and encouraged to make their own choices and decisions.

Every patient spoken to on Chippendale ward commented that they felt safe being there.

As part of this inspection, we focussed upon the care which was being provided at:

- Trinity 2: an acute psychiatric ward for adults between the ages of 18-65

- The Bretton centre: a low secure psychiatric unit

- Newton Lodge: a medium secure psychiatric unit

Overall, we found patients were receiving a good level of service. However, we also found some concerns regarding the design and layout of some of the hospital's seclusion rooms, and the general decor and environment of Hepworth ward (within Newton Lodge). We also identified some concern regarding how some patients' seclusions had been reviewed and continued.

Following our inspection, we provided the trust with some initial verbal feedback regarding what we found. We thank the trust for promptly acting on this feedback and taking some initial actions to remedy issues found. We are also grateful to the trust for providing us with details of their proposed refurbishment plan for their seclusion facilities.

Full details of what we found can be read within the body of this report.