At our last inspection in July 2013 patients told us that they did not always feel safe on the unit. Safeguarding procedures were not consistently followed. In the August 2014 inspection we were concerned about the safety of patients. Patients were regularly being restrained. Evidence seen in the incident records and in care notes confirmed that the Mental Health Code of Practice was not being followed. We were concerned about the use of the seclusion room, the staffing levels, care and treatment of patients and the governance system in place to protect patients. We issued compliance actions and the Trust sent us an action plan about the measures in place to address these shortfalls.

At this inspection we visited Waterston Unit and found the staff team had worked hard to address the concerns of the last inspections. The staff team had received training in safeguarding adults and the seclusion room was no longer used. Patients’ needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Patients were cared for by suitably qualified, skilled and experienced staff. Staff assisted patients in a caring and compassionate manner.

Patients were asked for their views about their care and treatment and they were acted on. The provider took account of complaints and comments to improve the service. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

Patients we spoke with felt involved in discussions about their care and treatment. They told us that staff were courteous and polite and maintained their privacy. They told us the care and treatment was good and was helping them.

Most patients on Minterne Ward were detained under the Mental Health Act. Those we spoke with understood their detention arrangements and were aware of their rights. A patient who was not detained told us that had been informed to speak to member of staff if they wanted to leave the ward, and the door would be unlocked for them.

Patients we spoke with were pleased to have their own single bedroom. They told us that they were able to lock their bedroom door and had a locked drawer to keep valuables. They were pleased with the newly refurbished bathroom, shower and toilet facilities. However, one patient told us that there was ‘orange water’ coming out of taps in the bedrooms, they thought it was due to rusty pipes. We also observed this problem and some other issues relating to the patient environment.

We had previously carried out an inspection between 8 June 2013 and 2 July 2013. At this inspection we identified concerns with care and welfare, safeguarding, staffing, support of staff and the monitoring of quality of the service. We identified what actions the trust should take in order that we were reassured that people were in receipt of safe and adequate care. The trust provided an action plan and then an update on their actions in September 2013. They told us they would be compliant in every area by December 2013. We inspected on 4 and 5 August 2014 to review the progress the trust had made and because we had received information of concern regarding people’s care on the unit.

Waterston Assessment Unit provides an acute admission service. Since our visit in 2013, there had been a change in management arrangements. The previous ward manager had been seconded to another post and an acting manager was covering the ward.

On the day of our inspection there were 13 people on the unit with only one qualified nurse who did not usually work on this ward. In addition there were three regular support workers, a bank support worker and two occupational therapists.

We observed staff were respectful, and asked people if they needed support and assisting when asked to do so.

We found that the provider had taken some steps to improve the reporting of safeguarding and the support of staff. However, although most of the care plans were individualised for mental health needs, they had not been updated to reflect the care each person required. Records such as risk assessments had not been updated to reflect the information we saw in meeting notes and progress records.

We were told by the staff working that staffing levels were below the requirements of the unit, which had been assessed as requiring two qualified nursing staff and four support workers during the day and two nurses and three support workers at night. Records we reviewed showed there had regularly been only one nurse on duty.

On this occasion we identified concerns with care and welfare, safeguarding, and staffing. Whilst there were audits in place we found issues on the ward during our inspection. We saw that the quality assurance monitoring of the service had not led to action to manage these concerns.