We visited Sycamore Ward with a Mental Health Act Commissioner and spent the day speaking with patients and staff, observing care and looking at patients' records. We also inspected the care environment.

Patients were complimentary about the staff but told us that sometimes they did not feel safe. They were concerned that there were not enough staff on the ward to deal with incidents.

Some patients complained that they were not able to have periods of escorted leave off the ward because there were insufficient staff to facilitate this. Staff confirmed this was the case but the ward did not monitor cancellation or disruption of leave so we could not see how often this occurred.

The ward was secure and provided separate accommodation for men and women to ensure people's safety, privacy and dignity. However we thought the ward was a sterile and unwelcoming environment. People complained that there were insufficient private spaces where they could meet with their visitors. The outside space attached to the ward was limited and was used mainly by people who smoked, which discouraged people who did not smoke to use it.

The ward had experienced a long period of staff shortages and staff changes which had caused instability for patients and staff. Despite this, staff morale was good and they were hopeful that recent and ongoing recruitment would improve this situation.

We looked at patients' records. They were mostly not complete or up to date and we did not think they were person centred.

We met 10 of the 19 people who were using the service at Hillview Lodge on the day of our inspection. People told us how they were supported with their mental health needs by the staff team and the manager. We were told “To be honest the staff have been very patient with me even when I was very unwell”. “The staff are good but some of them do get impatient when people keep going on at them”. “They have been very kind to me but they are very busy”. “They make one-to one time for me when ever I ask for it”." The staff could try harder"." They have been brilliant".

Hillview Lodge like Avon and Wiltshire Partnership Trust’s other locations use an online care planning system. People’s care plan records set out in detail the support they needed to meet their mental health needs. There were detailed daily progress records being kept by the staff about peoples overall health and wellbeing. There were some entries in progress records that were unclear in meaning and sounded subjective when describing people’s mood and behaviour.

People were supported to stay safe and to have their welfare maintained with informative risk assessments records. The risk assessment records explained what risks people faced and what actions could be taken to minimise harm and to keep them safe. We saw evidence that care plans and the accompanying risk assessments had been reviewed, amended and updated regularly.

People detained under a section of the Mental Health Act were helped to understand the reasons for the treatment they were having. We saw that people were also helped to understand why it had been decided they must stay at Hillview Lodge. The reasons would be for their safety and /or the safety of others. We saw confirmation in the online records of people under a section, that their right to access an Independent Mental Health Advocacy service had been explained to them. We also saw that in other people’s records it had not been recorded whether or not they had been made aware of this aspect of their legal rights. People were able to tell us that staff had told them what their legal rights were while being detained under a section at Hillview Lodge.

Staff had either been on training or were about to attend training in the very near future, to help them to understand how to keep people safe from abuse. Staff were clear about who to report an allegation of abuse to within their own organisation. The staff also understood about the roles and responsibilities of other organisations, such as the local authority and when they might need to be involved in a safeguarding allegation at Hillview Lodge.

People were cared for by staff who had a good understanding of complex mental health needs. People received care from staff who understood what sort of support and treatment they needed. Staff felt generally well supported by the managers of Hillview Lodge in their work. There was evidence that structured supervision meetings had taken place for some staff. While for other staff there were no up to date supervision records.

Staff used a number of systems to review and learn from all critical incidents and occurrences that had impacted on people’s health and wellbeing. Peoples’ care and treatment and the overall service they received at Hillview Lodge was being effectively checked, monitored and revised if needed.