We carried out the visit to check whether improvements had been made since our last inspection of the service in September 2013. Previous concerns identified that the provider was not meeting the standards for consent to care and treatment, the care and welfare of people, safeguarding people who use services from abuse, and staffing levels. Prior to our inspection the trust declared they were compliant with most of the actions raised from the previous inspection apart from several points which they said were 'partially met.' These related to the completion of risk assessments and person-specific information within these, and concerns that people using the service encountering delays in being transferred from the psychiatric intensive care units (PICUs) back to general wards.

We also received information about serious incidents in the service. We reviewed information from stakeholders prior to the inspection to ensure we inspected against concerns that had been raised since the last inspection.

We visited four wards including an older people’s ward (Redwood ward), one acute admission ward (Thames ward) and the two psychiatric intensive care units (PICU - Nile and Shannon wards). From the compliance actions submitted from the last inspection in September 2013 the provider took the decision to implement an Accelerated Service Improvement Programme (ASIP) across both of the PICUs to implement and ensure sustainability of improvements on the wards. We were assured that the trust’s board had sight of the developments and challenges inherent to the PICUs. We were informed by senior management in the service that the ASIP process would be signed off by the board once they were satisfied the required improvements had been made.

At our inspection we found improvements had been made against the previously identified non-compliant areas. Although systems had been embedded across the service the pace of change since the last inspection had been slower than expected against the action plan and this was confirmed by senior management staff we spoke with in the service and findings on the day of the inspection. For example there were continuing issues in relation the development of care plans and appropriate risk assessments and staff documenting the relevant detail around a person’s ability to consent to specific decisions.

We observed positive interactions between staff and people across the wards.

We visited five wards which included an older people’s ward, three acute adult wards and the male Psychiatric Intensive Care Unit (PICU). We spoke with patients and staff on all the wards visited. We also looked at feedback from service user meeting minutes. Patients gave mixed feedback about the care and treatment received.

The centre had policies on consent procedures. Staff had been trained in how to assess mental capacity and were aware of their responsibilities however, we did not see records of capacity assessments. We were told that by staff that patients had their rights explained to them. Patients confirmed that they had their rights explained to them, but we did not see records of this.

Care plans and risk assessments were completed. However, the level of detail was not consistent in all wards visited. There were examples of practices which was not conducive to the care and welfare of patients.

The Trust had appropriate policies in Safeguarding Adults and staff had received training in safeguarding. Staff in different wards gave explanations of the signs of abuse and provided examples of the various forms of abuse. However, we were given examples of incidents which had not been reported in line with the Trust policy in one ward.

There were systems in place to monitor the quality of service people received. People were asked for their feedback through patient surveys and service user meetings. We saw evidence that feedback was acted upon.