There were six people at Penrose House and 14 people at Gerry Simon Clinic on the day of our inspection. We spoke with four people who used the service, five members of staff and looked around the premises. We provided feedback of our findings to three trust managers and a representative from the trust estates department.

During our inspection in August 2013 we found non- compliance with one of the essential standards for quality and safety, which was safety and suitability of premises. At that time we issued a compliance action. We carried out this inspection to find out if improvements had been made and found that they had.

We observed that staff interacted well with people who used the service. People were supported to do activities of their choice which promoted their independence skills.

We saw that some work to improve the safety and suitability of the premises had been completed to benefit people who used the service. Other work required was planned and people and staff spoken with told us they had been involved in these plans.

We visited Penrose House and the Gerry Simon clinic. There were eight people at Penrose house and 15 people at the Gerry Simon clinic. We spoke with 17 people using the service, four relatives and 15 members of staff, including senior managers who we discussed our findings with, at the end of our visit.

Staff knew how to support people to meet their individual needs. A relative told us, “We are very happy with the care provided.”

We saw that some people in Penrose House were not engaged by staff in meaningful activities which could impact on their wellbeing.

People had been given their medicines as they had been prescribed by their doctor to ensure their health and wellbeing. One person told us, “I am happy with how my medicine is managed and I get what I need.”

Some areas of the environment required refurbishment and maintenance to ensure people’s safety and wellbeing.

Staff were supported in their job role and received the training they needed to safely support the people who used the service. One member of staff said, “I get good support from the managers and can ask their advice at any time.”

People were asked for their views about the service and these were listened to. One person said, “I can talk to the staff, they are okay.” Audits were completed and action taken where needed to make improvements to ensure people's safety and welfare.

There were 10 patients at Penrose House and 15 patients at the Gerry Simon Clinic when we visited. We met and introduced ourselves to 20 of the patients. We spoke to eight patients in more depth to get their views of the service. We spoke with seven relatives of the patients.

The ward managers did not have a copy of and were unaware of the ‘Guidance about compliance: Essential Standards of Quality and Safety.’ This means that they did not know what they needed to do to be compliant with the regulations that govern health and social care services. Copies of these were ordered at the time of our visit.

Patients had their needs assessed as soon as possible so that staff knew how to support them. Nursing and care staff did not have enough information to know how to support patients to meet their health needs.

Patients did not know what was in their care plans and did not have a say in how they preferred to be supported.

At the Gerry Simon Clinic, patients were involved in a range of activities that they enjoyed and helped them to develop as an individual. Patients at Penrose House said they were bored and we saw that they did not do much. We saw that care staff were observing patients closely, as this is what they needed, but they did not engage them in meaningful activities, which may impact on their well being.

Plans told staff how to manage patients’ behaviour to make sure they and other patients were not at risk of being hurt.

Nursing and care staff knew how to report abuse and what to do if an allegation of abuse was made to ensure patients were safe from harm. Patients did not know how to report this, which may mean that they are at risk.

Nursing and care staff only used restraint as a last resort if they had tried to calm a patient down but this had not worked. Patients said they were not restrained unless it was really needed. Evidence showed that restraint was used appropriately and patients were not harmed.

Patients said they felt safe at the hospital and that all staff spoke to them in a respectful way. This helps to promote patients’ self esteem and ensure their well being.

We visited Penrose House and the Macarthur Centre. There were seven people at Penrose House and six people at the Macarthur Centre when we visited. Nobody knew that we would be visiting that day. We spoke with six people living there and eighteen members of staff, including senior managers who we discussed our findings with, at the end of our visit. We looked at the records of four of the people living there and sampled the provider's records. Some of the people living there were not able to tell us about their experiences due to their needs. To help us understand the experiences people have, we used our SOFI (Short Observational Framework for Inspection) tool. This is a specific way of observing care to help us understand the experience of people who could not talk to us.

People told us they were asked for their views and could make choices about what they wanted. We saw that people made choices about what time they got up and what activities they did.

People told us that staff supported them to meet their needs. One person said, "I've done good here, the staff have helped me. The tablets are good and there are no side effects."

We saw that staff knew how to support individuals and treated them with dignity and respect. One person told us, "The staff are fantastic here."

We saw that staff supported people to promote their independence and do what they could for themselves.

People told us they felt safe there. Staff spoken with demonstrated that they knew how to safeguard the people living there from harm.

Staff told us that they were well supported and that there was always a manager on call to ask for advice and support if needed. They said this was important, particularly when supporting people who displayed behaviour which could be challenging.

We saw that staff had not received all the training they needed to know how to support the people living there. However, managers had recognised this and action was being taken to improve this.

People told us they knew how to complain if they were unhappy. We saw that people's views were listened to and improvements were made that were based on these.