We rated Southern Hill as requires improvement because:

• The provider had not ensured the patient had a care plan which was holistic, included agreed goals, a review date and the patients voice, in a way the patient understood. This had not been identified as a need by the management team. The patients had not routinely been offered a copy of the care plans.The patient had to rely on memory or ward staff to reflect on actions agreed at multidisciplinary meetings.
• Staff did not consistently implement systems to ensure the security of the environment on the PICU ward. The provider had not ensured the premises used by the service were safe for their intended purpose. There was a lack of effective systems, checks and processes in place. There was a failure to meet best practice guidance as per the national association of psychiatric intensive care units.
• The seclusion room did not meet all the specifications recommended in the Mental Health Act code of practice.

However:

• We saw evidence of a culture were staff used least restrictive practices, using techniques requiring physical intervention as a last resort. Where it was necessary, these incidents were reported and staff and patients held a debrief. There was a lead staff member who reviewed any restraints for learning.
• The hospital employed a nurse who was dedicated to ensuring the physical health needs of the patients were met. The nurse had developed systems to ensure information was captured on admission and identified actions were carried out. We saw one-page care plans for staff to follow, aimed at supporting the person to address their physical health needs. Staff received training during induction and beyond to ensure all staff received the appropriate skills and awareness to carry out basic physical health monitoring, and the nurse was available on site to respond to queries.