• We were assured from our inspection that the trust were managing a serious allegation of patient abuse in line with trust policy.

• We did not find any evidence to suggest that the incident was part of a culture of abusive practice. It appeared to be a one off incident which the police had begun to investigate.

• Staffing levels on the day of the incident were low due to unexpected sickness. However, rotas and staff confirmed that this was not usual.

• The trust had sought independent reviews and conducted internal assurance visits over the last six months to monitor safeguarding concerns raised.

However

• We found two out of five risk assessments had not been completed.
• Staff told us that since the no smoking policy was implemented in May 2106, there had been an increase in the amount leave granted to detained patients for the purpose of leaving the premises to smoke. This impacted upon direct patient care, as it generated extra paperwork.

We focused this review on the psychiatric intensive care unit. There were ten patients on the unit on the day we visited. People were admitted to the unit for stays of usually three to four weeks. Staff advised us that this could sometimes be longer, and that the longest current stay was ten weeks. Staff advised that this delay was caused by issues external to the unit. We spoke with the patient affected by this longer than usual stay. They did not raise it as a specific concern.

We spoke with two patients at length, and with two other patients more briefly. Other patients did not wish to engage with us. Staff advised that we did not speak with one patient unaccompanied as they had been unpredictably violent and aggressive recently.

One patient told us they did not feel safe on the unit and were concerned about attacks from other patients. Discussions with staff and another patient enabled us to put this concern into context. We saw staff responding promptly and calmly to alarm calls during our visit. One patient noted approvingly that staff were “pretty sharp” in responding to incidents. They also commented “staff quite helpful”.

During our visit we noted the availability of staff. Patients were able to take part in one to one activities with activities staff in accordance with assessed risks and therapeutic needs. We also noted extensive use of the well-maintained outside courtyard/garden area.

We spoke with seven staff, including the manager. They showed commitment, enthusiasm for the work, and concern for and commitment to the well-being of patients.

Overall the unit was much improved from our last visit and had developed a wide range of activities as part of a therapeutic approach.

Patients told us they did not feel safe on the unit. They were not happy with the quality of the food served, nor the portion sizes. They were often bored as there was a lack of activities and they would like more one to one sessions with staff.

They also said they did not have a copy of their care plan, and some of them said they would like to discuss their treatments and medications further.