Patients we spoke with told us that they were treated with dignity and respect and one patient stated "My space was always respected by staff". Detained patients told us that they were informed of their rights under the Mental Health Act 1983. Informal patients told us that they were allowed to leave the wards at any time, if they wanted to.

Most patients we spoke with told us that they had designated key workers and individual care plans. The majority of patients told us that there had been a recent improvement in the standard of the food and it was nutritious, with sufficient choice.

Most patients we spoke with told us that staff gave them adequate support. One patient described the staff as "helpful and hardworking".

We rated the service as good because:

• Improvements had been made following the serious incident that occurred in June 2018 in which a patient was injured after fixing a ligature. The window fixtures had all been replaced. Changes had been made to the admission process so that both a doctor and a nurse made a joint initial assessment of patients. Additional checks were made during each shift to ensure the alarm system was working.

• Overall, the service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents. Staff and patients were debriefed and offered support following incidents.

• The service provided care and treatment based on national guidance and evidence of its effectiveness. Comprehensive assessments were completed on admission to the service. Care plans were personalised, holistic, included the patient’s views and were regularly reviewed and updated. Staff monitored patients’ physical health and took appropriate action when needed. Outcome measures were used to measure the effectiveness of treatment programmes. Regular clinical audits were completed.

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. There were always enough staff to safely deliver care and treatment.

• The service made sure staff were skilled and competent for their roles. Managers appraised staff’s work performance and held regular supervision meetings with them. The service provided mandatory and specialist training in key skills to all staff and made sure everyone completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

• The service assessed and managed individual patient risks appropriately. An individualised approach meant that patients were not subject to blanket restrictions.

• Staff gave patients specialist care to ensure their nutrition and hydration needs were met safely and their health improved. They used special feeding and hydration techniques when necessary and staff were trained in these areas.

• The service prescribed, gave, recorded and stored medicines safely. Patients received the right medicines at the right dose at the right time. A pharmacist visited the ward each week and completed a regular audit to check that medicines were managed and administered safely by staff.

• Staff of different disciplines worked together as a team to benefit patients. The service also worked well with external teams and professionals.

• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They knew how to support patients experiencing mental ill health and those who lacked the capacity to make decisions about their care.

• Staff cared for patients with compassion. Patients were partners in their care. Staff worked hard to involve patients’ families and carers, despite some of them living far away.

• People could access the service when they needed it. Most patients were admitted to and discharged from the unit to the outpatient part of the service. Staff planned effectively for patient discharge and worked well with other professionals and teams to ensure effective transfers of care.

• The service had suitable premises and equipment and looked after them well. The service was clean and well maintained and staff followed infection, prevention and control procedures. The facilities promoted comfort, dignity and recovery.

• The service took account of patients’ individual needs and staff worked hard to meet the diverse needs of the patient group. This included providing support to make LGBT+ patients feel welcome and protect their needs. Staff supported patients’ engagement with ongoing education opportunities and important relationships.

• The service had managers at all levels with the right skills and abilities to run the service effectively. Staff also told us that senior leaders had been especially supportive following the serious incident that took place in June 2018. Managers across the service promoted a positive culture that supported and valued staff. Staff achievements were recognised by local leaders and through a trust wide annual awards ceremony.

• Governance systems to ensure the effective running of the service were in place. The trust had effective systems for identifying risks and managing and reducing these. The service treated concerns and complaints seriously. Staff understood their responsibilities regarding complaints and made sure information was available for patients.

However;

• Whilst appropriate arrangements were in place to protect patients against the risks associated with ligature anchor points, the unit ligature risk assessment did not include some ligature anchor points and did not clearly state how staff should mitigate the risks that had been identified. This was escalated to the manager at the time of the inspection.

• Whilst overall the service managed patient safety incidents well, further improvements were needed to ensure that lessons learnt were always consistently shared with the whole staff team.

• The induction process for temporary staff was not formalised which meant there was no assurance that temporary staff could consistently meet the specific needs of the patient group.

• A small number of patients said that some temporary staff had occasionally acted in an abrupt manner.

• Staff we spoke with were not aware of who the trust’s freedom to speak up guardian was or how to contact them.