We did not rate this service because this was a focussed inspection.

• We were not assured that patient safety was a priority. Managers did not ensure that safeguarding processes and procedures were adhered to by staff. We found a number of occasions when staff had not reported incidents to external bodies as required. This included safeguarding concerns, and serious patient injury. Incident forms were not always completed accurately and had not been signed off by appropriate senior staff. Staff were unable to provide examples of lessons learned from incidents. Many young people self-harmed even when on constant observations with multiple staff observing them.
• Staff did not fully recognise risks associated with anticipated events and emergency situations. Five out of seven patients did not have an initial risk assessment completed within 48 hours of admission as per the provider’s policy. We found that in some instances, staff had not completed a risk assessment for several weeks. Completed risk assessments were not updated by staff following incidents.
• Managers had not identified all potential ligature anchor points on the ward ligature risk assessments. The ligature risk assessments had the same mitigations regardless of the risk or location. For example, the mitigation for ligatures in patient bedrooms stated that there was CCTV. There was not CCTV in patient bedrooms.
• The leadership and governance did not always support the delivery of high quality person-centred care. We found repeated poor application of the safe and supportive observation and engagement policy. We found evidence of the emergency responder being allocated to carry out patient observations. If the alarms sounded, the staff member would either not attend, or they would leave their patient on enhanced observations unsupervised.
• There had been numerous and repeated occasions of staff shortages. Although the provider was able to staff wards at a level they had assessed as being safe, at times there were too few staff to meet all care needs of the patients.
• People were at risk of not receiving effective care and treatment. We found multiple instances where the provider did not follow their section 17 leave policy. We found gaps within the pre-leave risk assessment forms. Leave forms were not sufficiently detailed. Six out of 14 nurses and health care workers knew the location of the Mental Health Act administrators but not who they were.

However:

• The ward complied with guidance on eliminating mixed-sex accommodation. 
• All staff received an induction to the service. Each staff member then had some time on their allocated ward, on a supernumerary basis. When bank and agency staff were used, we saw evidence of a bank and agency induction pack to familiarise themselves with the provider and ward.
• The multidisciplinary team provided a range of care and treatment in line with National Institute for Health and Care Excellence guidance. Staff used recognised rating scales to assess and record severity and patient outcomes.
• Four patients told us regular staff were respectful, caring and polite. We observed patients engaged with members of staff in a range of activities.
• Staff told us leaders were visible on the wards and all staff knew who the senior management team were. Most staff said they felt respected, supported and valued by their colleagues.