Unannounced visits were carried out by two Compliance Inspectors on the 11th and 12th July 2012. A further unannounced visit by one Compliance Inspector took place on the 16th July 2012.

One of our roles as a regulator is to keep the use of the Mental Health Act under review and check that the Act is being used properly. Our Mental Health Act Commissioners perform this work by visiting all places where patients are detained under the Mental Health Act, and meet with them in private. We were accompanied on the 12th July visit by a Mental Health Act Commissioner and their findings are reflected within this report.

This review focused on outcomes for people staying on two wards located at Tolworth Hospital. The wards we visited were as follows:

Lilacs ward which offers inpatient mental health treatment for men and women.

Azaleas Ward for older people which treats a whole range of functional psychiatric conditions, illnesses and disorders. People living with dementia were being accommodated on this ward at the time of this inspection.

A brief visit was also made to Jasmines ward which provides assessment and treatment and an associated specialist therapies service for adults with learning disabilities who also have mental health problems and/or associated severe challenging behaviour. We were informed by the ward manager that this ward was due to close in August 2012.

During the three days of visits we observed how people using the services were being supported and talked to twenty seven individuals about their experience of life on the wards we visited. We also spoke to six relatives or friends of people who use the service, two visiting professionals and informally interviewed fourteen members of staff who worked on the wards.

Some people using the service on Lilacs Ward talked about how the service had improved over the past year and told us ‘it’s improved since I was I here a year ago’, ‘better than it was a few years ago’ and ‘I prefer this to other wards’. Our observation was that both the look and feel of this ward had improved considerably since our last visit in May 2011.

People spoken to on both wards said that staff treated them with dignity and respect. Comments included ‘yes the staff treat me well’, ‘they’ve helped me’, ‘they mean well’, ‘it’s alright, the staff are very pleasant’ and ‘can’t fault them’.

Relatives or friends of people who use the service on Azaleas Ward were generally positive about the staff working on the ward. They told us ‘we have a weekly meeting with the doctor’, ‘communication is good’ and ‘the doctors are fantastic’. However concerns were raised by three relatives or friends of people who use the service about the differing needs of people staying on the ward and how this impacted on the delivery of care and treatment.

Staff spoken to on this ward also commented on the different needs of people being cared for and their feedback included ‘it’s the wrong mix of genders and the wrong mix of needs’ and ‘it’s difficult to manage the needs’.

Lilacs Ward

Comments from people using the service were positive about the staff who worked on the ward and they told us that they were treated with dignity and respect. Comments included ‘they are ok – most are dedicated to the job’, ‘very helpful’, ‘absolutely marvellous’ and ‘fantastic’.

A common theme from individual feedback was that people staying on Lilacs Ward would like to see more of the staff during their stay. They told us that they were sometimes ‘hard to get hold of’ or they ‘were busy all of the time’. One individual said ‘the staff are swamped – always chasing their tails’ whilst another person reported that ‘sometimes they don’t have much time for you’.

A number of people told us that there were too many agency staff being used and this made a difference to their day to day experience on the ward. One individual reported that ‘I feel safe when regular staff are on’ and ‘I can’t talk to strangers’. Other individuals consistently singled out the same members of permanent staff for praise with comments such as ‘they are really good’ and ‘they’ve been very good to me’. On the day we visited, our own observation was consistent with this feedback with much more enriched and positive interaction being apparent when longer serving permanent staff were on shift.

People told us that they enjoyed the activities on offer within the ward but would like to see more sessions taking place. Comments included ‘the groups are lovely – really like them’ and ‘plenty to do’. Two people said they would like to be able to do cooking sessions.

‘Very good’, ‘always on time’, ‘normally pretty good’ and ‘reasonably ok’ were some comments received about the food. Other individuals however said that ‘it has gone downhill’, ‘it’s like school dinners’ and ‘disgusting’.

Jasmines Ward

Due to their needs, not all of the people we met during the visit were able to directly share their views about the care they received on Jasmines ward. Throughout the course of the visit we observed how staff interacted with individuals and we saw this was consistently carried out in a kind, respectful and professional manner.

The people we spoke to liked the meals they were being offered on the ward. One person told us that ‘I would prefer to have metal knives and forks to eat my meals with…I don’t know why we have to use plastic cutlery’.

Relatives of people using the service were generally satisfied with the overall standard of care being provided and were especially positive about the attitude of the staff. However they did express some concerns about the decorative state of the ward with one comment being ‘the decor in the bedrooms and ward in general is a bit basic’.

Other comments included ‘staff are lovely here and always make us feel welcome’, ‘we can visit the ward when we like’, ‘there always seems to be lots of staff around when we visit’, and ‘we are always invited to our relatives care plan reviews but we’ve never actually seen a hard copy of their care plan’,

Fuchsias Ward

Relatives of people using the service were extremely positive about the care and support being given to their family member. One said that they would continue to keep their family member in the service ‘even if I were a millionaire’ and the other individual reported that they were generally ‘very happy’.

Feedback about staff included ‘the staff are great’ and ‘good’. One person expressed concern about the food being served saying it had gone downhill and was ‘too dry’.

Our observation of the care being provided showed some very positive interactions between staff and people using the service. Many of the staff have worked in the ward for a long time and clearly know individuals very well. We did however see a small number of instances where people were moved without being spoken to first which is poor practice. This was discussed on the day we visited.

Tolworth Hospital is in Surbiton, South West London and is close to a range of local amenities. South West London and St George's Mental Health NHS Trust provides the three inpatient wards that we visited as part of this inspection.

We found that the services were safe, the wards were clean and staff were aware of risks. There were ways to report and learn from incidents, but improvements were needed in assessing and managing risks to people's safety.

Staff interacted with people who used the service in a caring and compassionate way. People and their relatives were involved in planning their own care, although records did not always reflect this. People were engaged in activities they felt were meaningful and therapeutic. Ward staff listened to people’s feedback and involved them in making positive changes.

The Mental Health Act responsibilities were being discharged appropriately. Some actions from previous Mental Health Act monitoring visits had not been fully resolved.

We saw good examples of learning from audits and incidents being shared, and changes to practice being made as a result.

All staff we spoke to on the ward told us they received training for safeguarding children and vulnerable adults as part of their annual mandatory training. They also said they would be confident in reporting safeguarding – either internally or to the local authority.

Staff told us they felt supported by the management on the ward and their immediate managers. Some staff told us they did not always feel involved in conversations about their roles, particularly when organisational changes were taking place.

We visited the following wards at Tolworth Hospital as part of this inspection:

Azaleas Ward

Core service provided: Services for older people

Male/female/mixed: mixed

Capacity: 23 beds

Fuchsias Ward

Core service provided: Services for older people

Male/female/mixed: mixed

Capacity: 5 beds

Lilacs Ward

Core service provided: Acute admissions ward

Male/female/mixed: mixed

Capacity: 23 beds