Following a focussed inspection carried out in March and April 2016 where a warning notice was issued, we found that:

• The hospital had made improvements and progress occurred against the requirements of the warning notice on how the observations had been carried out. All four wards had an observation policy that had been reviewed in June 2016 and the general observations across the hospital were now carried out every 30 minutes.

• The hospital monitored and had a system in place to ensure that staff had read the policy and signed it. Staff followed the policy and demonstrated a good understanding of the policy. The hospital carried out audits to monitor that staff were carrying out observations in line with the trust’s policy. The manager regularly reviewed closed circuit television (CCTV) to ensure that staff followed good practice.

• The hospital provided us with information that showed that they were monitoring staffing levels. The information demonstrated that the hospital was above their budgeted staffing levels. Patients and staff told us that they felt safe. The hospital reviewed staffing levels daily and used bank staff when necessary.

• The hospital offered patients 25 hours a week of planned meaningful activities. The hospital monitored the uptake of all patients. Those that achieved less than 25 hours of activities were monitored closely with a view to increasing uptake of activities.

However:

• Staff on Jade ward used additional codes that were not on the policy forms to specify certain locations or activity. Staff on Alford ward omitted to use the location codes on a number of occasions particularly at night. Three clocks on Emerald ward showed different times.

• Two staff from women’s services reported that they did not get breaks from observations when on night shifts.

• Eight patients and seven staff across all four wards told us that low staffing levels occasionally led to activities being cancelled and staff moved around wards. The management deployed therapeutic involvement workers from the resource centre on the wards to cover for staff shortages.

We carried out an unannounced focused inspection and found;

• The trust had an observational policy to maintain patient safety. The policy was not followed consistently ,therefore the system of conducting observations was not effective and placed patients at risk.This is a breach of regulation 17 relating to governance systems and processes. We will issue a warning notice. We found that not all staff had signed that they had read the observation policy. The closed circuit television footage was not audited to check that the observation policy was being implemented.

• We found instances of observations being carried out late, there were staff signature gaps in the observation records reviewed, pre-printed times on observation forms were used, therefore, observations were not recorded at the time that they were actually done.

• The responsible clinician had not consistently recorded the review of frequent observations on a daily basis.

• Not all staff had not received further training following recommendations and learning from serious incidents.

• Staff shortages led staff to move from wards to assist other wards.Staff shortages also affected patient activities; particularly on the wards.

• Sickness rates were high on womens’ wards.

• Patients reported spending long periods locked in their rooms.

However;

• The hospital was responsive in implementing an action plan to improve observation practice on the 1 April 2016.It was however too soon to evaluate its impact.

• Staff received counselling and debriefings following serious incidents.

• Staff recruitment was occurring and newly qualified staff had a six week preceptorship programme.

• Clinical supervision was in place for staff.

• Patients reported feeling safe and that staff were respectful and caring.

• Patients had care plans in place and had received copies.