This was a follow up inspection to check that the trust had made the improvements stated in their action plan following our visits in March 2013 and September 2013. We spoke with eight patients. We also spoke with two carers, two managers and four staff.

Everyone we spoke with on the wards told us they had been treated respectfully and their wishes had being listened to by the staff on the wards. One person told us, “They (the staff) have being fantastic, they have really helped me to get better even when I was not cooperative.’’ Another person said, “I have done really well because of the help and care from the staff here.’’ We found well-structured and detailed assessments and care plans were in place to support patients' recovery.

We found that people received their correct medicines at the right time. We saw that medicines given were accurately recorded and medicines were safely stored.

There were systems in place to monitor how the trust was run, to ensure people received a quality service in a safe environment.

The purpose of this inspection was to check that the trust was doing everything it needed to do to keep patients as safe as possible. This followed the death of a patient who had been admitted to the hospital for care and treatment.

We were told that the trust was satisfied that the safeguards in place to manage ligature risk on the wards and keep patients safe were effective. There was no policy in place, setting out how the trust assessed and managed ligature risks to support staff to keep people safe. The trust was also not able to fully show us how these risks had been kept under review.

When we inspected, there were still a number of visible and accessible ligature points on all three wards we visited. A reassessment of ligature risks on the wards had been completed and some works had started to remove some of the more accessible ligature risks. At the time of our inspection, there was no clear plan or timescales for the completion of any further work required.

The awareness of staff on ligature risks told us that the risks were not fully understood. This meant that although the risks from patients themselves were recognised and reflected in their care plans, the risk to patients’ safety from the environment were not always recognised and reflected in the management of their care.

Our inspection took place over a number of different days. During this time we visited four hospital wards and spoke with a number of specialist community mental health teams. Staff generally felt well supported and positive about access to ongoing training.

We spoke with 19 patients. We also spoke with two carers and a representative from the local mental health support group. Patients told us they were involved in decisions about their care. One patient told us, “I received all the information I need verbally and in writing when I came in, it has been explained to me and I fully understand it.”

Without exception, everyone we spoke with on the wards felt they had been treated with dignity and respect and that staff had taken the time to form a relationship with them. One patient told us, “They (staff) made me feel human during a difficult time for me.”

The planning of staff ensured that patients received the right care, at the right time. We found well structured and detailed assessments and care plans were in place to support patients’ recovery. We found some improvements in the management of medicines were required. There was evidence that patients did not always receive the right medicines, at the right time. The storage and recording of medicines across the wards needed to improve.

We found some inconsistencies in the assessment and reporting of risks. This impacted on the quality of the assessment and monitoring of the quality and safety of care.