We last inspected forensic wards provided by East London Mental Health Foundation Trust at the John Howard Centre in December 2012. We carried out that inspection under our previous inspection regime. Consequently, we did not rate the service. The service complied with all the regulations we checked at that time.

We will rate forensic wards at our next comprehensive inspection of East London Mental Health Foundation Trust.

We carried out this focused inspection on 11 November 2015 in response to information we had received about the safety of the service. Some patients had gone absent from the service without leave. Additionally, in July 2015, there was a serious disturbance on Westferry ward.

This inspection was focused on checking whether the service was meeting the required standards in relation to:

• How staff managed risks to ensure the service was safe.

• Patient involvement in planning their care and treatment.

• Patient access to activities.

This inspection found:

• The service robustly assessed and managed risks. The service obtained information about each patient prior to their admission. This included detailed information on risk. Ward staff developed plans to manage risks to the patient and others which were put into practice as soon as the patient was admitted. The multi-disciplinary team (MDT) on each ward regularly reviewed risks and amended management plans to ensure they were effective.

• The MDT kept patient leave arrangements under constant review. Patients were only granted leave when staff had followed trust procedures and made the appropriate safety checks.

• The trust had undertaken detailed investigations when patients had gone absent from the service and after the disturbance on Westferry. The trust had ensured the learning from these investigations had been shared with staff to improve the security of the service.

• Staff safely administered patients’ medicines.

• The MDT assessed each patient’s needs and developed a comprehensive care plan. Patients’ mental and physical health needs were effectively met.

• Staff had the appropriate skills and knowledge in relation to working with patients in a forensic service.

• Staff supported patients to plan and review their care.

• Staff treated patients with dignity and respect.

• Patients reported that they were able to participate in a range of activities.

We asked patients if they had been involved in the referral process one patient told us that he had been detained under the Mental Health Act 1983. One patient told us that he had been asked to come here and did agree because Woodbury Ward is a low secure facility.

Patients we spoke with told us that they had a care plan and that they were involved formulating and reviewing the care plans. One of the patients told us that he would “meet with the nurse every three to four weeks and talk about their care plan”.

We asked patients and relatives if access to a general practitioner (GP) was available. One relative told us, “there is a GP accessible on the ground floor”.

We asked patients if they had access to advocacy services. Two patients spoken with told us that the independent advocate visited regularly. Comments included “my advocate took part in the recent care plan approach (CPA) meeting”.

We discussed with patients how behaviour was managed and one patient told us that he had a behaviour plan, which he formulated together with staff.

Patients told us that they felt safe at Woodbury Ward and had confidence in staff that they would deal with any allegations of abuse appropriately.

People who use the service told us that staff are approachable and listen to their concerns. Everyone we spoke to stated that they had a care plan that was developed with their co-operation and was regularly reviewed. They also told us that their treatment had been explained to them as well as the law around detention, appeal and consent.

People who we spoke to said that they felt they their needs are being met by the staff on the ward. Each person we spoke to knew they had a primary nurse and who that person was. People who use the service told us that they enjoyed participating in the various groups and activities. The people we spoke to gave us mixed views about the quality of the food.

People who use the service told us that they each had a Care Co-ordinator in the community, who visited them regularly whilst they have been in hospital and attended planning meetings. All said that they were given information on their medicines and could discuss them with nurses, pharmacist or doctors.

People who use the service told us they are knew how to make a complaint. We were also told by people using the service that they felt confident that any complaint they might make would be listened to and acted upon.

The inspection covered inpatient services at the Forensic Services Directorate. We inspected Clissold, Woodbury, Butterfield and Hoxton wards at Wolfson House, and West Ferry ward, a psychiatric intensive care unit at the John Howard Centre.

A previous inspection at Woodbury ward and recent Mental Health Act Commissioner reports identified issues with the use and recording of seclusion at the trust. We checked that practice on seclusion and restraint in the Forensic Services Directorate was in line with national guidelines and the trust's own policy and procedures.

Patients told us they had been involved in their care planning. We saw evidence of multidisciplinary team working and positive interaction between staff and patients on the wards. Seclusion was used rarely on most of the low secure wards in Wolfson House. We observed that staff were concerned to protect patients' dignity and privacy when they were held in seclusion. The seclusion facilities for Wolfson House and West Ferry ward conformed with national guidelines to protect people's dignity, rights and their safety.

Staff teams were supported to care for patients. Staff received training and support on the appropriate use of seclusion and restraint. Staff on one ward said they were experiencing staffing pressures. The trust was recruiting to fill two vacancies on this ward.

We reviewed a range of records, including the seclusion records, and found these to be accurate and up to date.