Patients we spoke with felt supported and treated with respect by ward staff. Patients told us that staff were helpful. One patient told us “I know I can go to them if I need anything”. There was a ‘named nurse’ system in place. This meant that each patient had an allocated nurse responsible for care planning and other primary duties. Patients we spoke with knew who their named nurse was. Documentation demonstrated that assessments including physical assessments had been completed and that people’s needs were being met according to their assessed needs.

The service had suitable arrangements in place to safeguard vulnerable people and we were shown examples where these had been acted on to keep people safe. We found that the premises were well laid out and adequately maintained, although Kahlo Ward appeared in need of some cosmetic improvement.

We also found there was a suitable number of trained staff to meet people’s needs.

This inspection focussed on Turner Ward; a male acute admission ward within Sunflowers Court.

Most people told us told us that staff were respectful and polite. People felt listened to and were asked their opinions about their treatment and care, “I do feel listened to. I feel listened to by the doctor too. He pays me attention”. Another person told us “I was asked my opinion, very much. I feel safe here now”.

We found that care planning and risk assessments were being updated and accurately reflected what people had told us about aspects of their treatment. People’s opinions were documented too. This was also an accurate reflection of what people had told us.

We found that the environment was clean and safe. People told us that they had been assisted by staff to make a complaint but were unclear about whether a timely response had been made by the trust.

This visit took place to specifically look at the management of disturbed behaviour on Picasso Ward.

People told us that they felt happy with the amount of access to fresh air they had and that the ward based activities were satisfactory. Some of the patients on Picasso Ward told us that they were not given the chance to reflect on what had happened after being restrained and were sometimes prevented from leaving the time out room.

This review was based on evidence sent to us by the trust in relation to outstanding compliance and improvement actions. As a visit did not take place we did not talk to people as part of this review.

We spoke with four patients and observed all patients during both days of our inspection to Moore ward.

Patients told us they were involved in their referral to Moore Ward and contributed to the pre-admission assessment, “I was ill and my doctor told me to come here and get better”.

Another patient told us “they came to my house and asked me and my family questions before I moved in”.

Three of the four patients we spoke with confirmed that they were involved in care planning processes. One patient told us they had not seen their care plan.

Patients told us that activities were provided and we observed patients accessing the community to go shopping. One patient told us that due to the lack of staff they were not able to go jogging. The patient said they had regularly gone for walks and runs prior to being admitted to Moore Ward. The trust forwarded staffing rotas to us, which did not demonstrate insufficient staffing numbers. This was confirmed by observations we made during our inspection.

Patients told us they were given information about how to report abuse. One patient told us that staff advised them during the admission to report if other patients or staff swore at the patient.

Another patient told us about being able to talk freely about abuse. The same patient told us that restraint was used on Moore Ward, but was not able to comment if restraint was used appropriately.

During our inspection we visited five wards. These were the two acute inpatient wards (Ogura and Monet), one older persons ward (Stage), rehabilitation ward (Picasso) and the psychiatric intensive care unit (PICU - Titian). A Mental Health Act Reviewer also visited Moore ward.

We spoke with people who use the service and their relatives/ representatives and staff of different disciplines which included nurses, deputy ward managers, healthcare assistants, consultant psychiatrists, pharmacist and occupational therapy staff.

The majority of people we spoke with said they appreciated the service and that the staff were kind and caring. We observed that the staff generally conveyed a caring attitude with people, though some people spoke of poor communication from staff. People who use the service spoke of being 'bored' and there was a lack of structured and informal activities that took place on the wards.

Where people did not have the capacity to consent, the provider generally acted in accordance with legal requirements in this area though some staff had little understanding of their role within the Mental Capacity Act 2005.

Care plans were regularly reviewed across the service. However, we found there was a lack of involvement of people in their care plans, which meant they were not person-centred, and did not focus on individual needs. Risks to people were identified, but there was a lack of risk management planning in relation to these to promote people's safety.

The staff we spoke with said they enjoyed working at the service and received support in their work through training and supervision.

On Titian ward we found that people were not protected against the risks associated with medicines because the arrangements in place to manage medicines, and good practice in relation to medicines administration, was not being followed. Due to these findings we raised our concerns with the local authority safeguarding team.