Rowan Ward provided acute mental health services to adults of working age and Magnolia Ward specialised in the care of people who had a dementia. Some people we met were unable to fully express their views to us verbally. We therefore spent time observing care practices and talking with staff in addition to speaking to people staying on the wards.

People told us that staff were always kind and respectful. One person told us “I always feel that they respect me and my privacy. They always knock on my door and never just come in.”

Everyone we spoke with was very happy with the care and support they received. Comments included; “I feel very well cared for here, all the staff are very nice” and “It has been a much better experience that I expected, I feel I am getting the support I need.”

We saw that there were leaflets available on each ward which gave people details about how to make a complaint and the timescales that they could expect a response in. On both wards we were told that any concerns were usually dealt with informally on the ward. This ensured that any concerns were quickly resolved.

Everyone that we asked said they felt that there was always enough staff on duty to meet people’s needs. We saw that all requests for assistance were responded to promptly and people did not have to wait to speak with a member of staff. People told us there was always adequate staff available to support them to leave the ward if they required an escort.

The purpose of this visit was to follow up the progress on addressing concerns identified on Magnolia Ward at our last inspection. We did not need to visit Rowan Ward at this inspection.

The majority of people on Magnolia Ward were unable to engage in conversations with us due to their varying degrees of dementia, we therefore spent the majority of our time observing staff interactions with people. Staff interactions were observed to be kind, respectful and unhurried.

We observed the lunch time experience to see how patients on the ward were supported to make choices following concerns raised at the last inspection. We noted that significant improvements had been made which had resulted in the patients being able to make informed choices and to enjoy a more relaxed and sociable dining experience. Staff were observed sitting with patients who required support and prompting to eat. One member of staff was observed taking meals to people and they checked that each individual was happy with their choice of meal. We saw that patients were able to change their mind if they wished. Sauces were offered at the time of serving the meal and a choice drinks were offered throughout the meal.

A menu, along with photographs of the meals had been displayed in a communal area. This meant that patients had a daily reminder of the day’s menu in an appropriate format thus enabling them to make an informed choice.

An orientation board provided patients with information about the day, date, season and of the names of the staff on duty.

At the last inspection we found that care plans relating to the management of certain behaviours did not contain sufficient information which would ensure that individuals received a consistent approach to care.

Improvements were noted at this inspection. Care plans seen contained more detailed information and also included any ‘triggers’ which might exacerbate certain behaviours. Clear information about how behaviours should be managed had been recorded which meant that patients would receive a consistent approach from staff.

Patients are now provided with opportunities to say how they would prefer to be supported whilst on the ward. On admission to the ward staff meet with patients to discuss and document their preferences relating to daily routines, diet and activities. Information is reflected in individual’s care plans thus ensuring that staff can deliver a more person centred approach to care.

The first day of our inspection was spent talking to people on Rowan Ward and the second day was spent with people receiving inpatient care on Magnolia Ward. People on Rowan Ward told us that they were involved and supported to make decisions about their care and treatment. One person said “My care plan was developed with me and I get the chance to say if I don’t agree with something”. People told us “I get regular one to one time with my co-worker where I can talk about anything”, “The staff are very supportive and I can talk to them”. One person said “I have been given a copy of my care plan and I have protected time with my co-worker”. People on Rowan Ward told us that they had ‘weekly community meetings’. They said “we are kept up to date about what is going on and we are encouraged to express our views”. One person told us “You can discuss what is happening on the unit and you know that things will get done if you raise issues at the meeting”.

People on Rowan Ward told us that they were “always treated with respect” and that staff respected their privacy.

The majority of people on Magnolia Ward were unable to engage in conversations with us due to their varying degrees of dementia, we therefore spent the majority of our time observing staff interactions with people. Staff interactions were observed to be kind and respectful and we saw that staff knocked on people’s bedroom doors before entering. Those able to mobilise without staff assistance were observed moving freely around the ward. We observed the lunch time experience to see how people were supported to make choices. We observed a staff member plating meals from a hot trolley and were informed that people had made their meal choice earlier in the day. Plated meals were placed in front of people and we did not observe staff checking whether people were happy with their choice. We saw that puddings were served with custard without asking people if this was what they wanted.

People on Rowan Ward told us that they felt ‘safe’ and that they were satisfied with the care they received. People on Magnolia Ward were unable to express their views in the same way as those on Rowan Ward but we observed those on Magnolia Ward to be comfortable in their surroundings and in the presence of staff. People on Rowan Ward confirmed that they would be comfortable in raising any concerns or worries with the manager or a member of staff.