People understood the care and treatment choices available to them and said they were treated with respect and courtesy. One person said “the staff are so lovely and nothing is too much trouble”. They said they had the opportunity to have their views heard when they attended the weekly meetings when their care and treatment was reviewed. People explained how they gave consent before having a treatment or examination. One person told us they had signed a form to give consent for a procedure and consented to receiving an anaesthetic. Some patients were detained under the mental health act and did not have to give consent to treatment. Records did not demonstrate that the detention of one person complied with the code of practice. People said they happy with the care they received and that they experienced safe and appropriate care. People told us the staff were “very skilled” and “had the right attitude”. Records showed that people using this service had plans of care and support that they were involved with, and which met their physical and mental health needs. Medicines were managed safely. Plans were clearly recorded and detailed. People felt safe and staff demonstrated a good knowledge of abuse and how to escalate concerns. Staff received training and supervision. Risk and quality monitoring systems were in place and were implemented.

Torbay Hospital is in Torquay. The hospital has both acute and mental health services on site provided by two different NHS trusts. This inspection looked at the mental health services only, which are run by Devon Partnership NHS Trust.

The mental health services provided by Devon Partnership Trust consist of one acute admission ward for adults of working age, Haytor Ward which has 17 acute beds and 2 detox beds. Haytor Ward provides assessment, care and treatment for men and women with mental health needs. Also based on this site is Beech ward currently providing care and treatment for 14 older patients. The ward provides assessment and treatment for older people with mental health needs, such as depression, anxiety and psychosis.

We found areas of good practice and many positive findings across adult and older inpatient services in Torbay. Patients were mostly positive about staff and told us they were compassionate and caring. Patients confirmed there was a recovery approach to care and support, which they found responsive to their needs and experienced at all stages of their hospital stay. On the ward for older people, potential risks associated with ageing, such as falls, were well managed and meant that people’s health was promoted.

Patients confirmed the accommodation was comfortable. The hospital environment offered people privacy. All areas of the hospital were clean and staff followed good infection control practice.

Staff morale was generally positive and multi-disciplinary teams worked well together. There was an open culture on both wards and staff were confident about raising concerns. Governance arrangements were in place and monitored the performance of the services. Both ward managers demonstrated they had a good knowledge and understanding about their services and wanted them to succeed.

There were a number of improvements needed in the services, specifically for people using the acute services on Haytor Ward. Too many patients in crisis are being taken to police stations or the local emergency department rather than to the trust’s own 136 suites (which are the designated health-based places of safety). In the year ending November 2013 in South Devon, 47 patients used the trust’s own place of safety suite and 134 went to police custody.

For the past six months, 44% of adult patients from South and West Devon needing an acute admission had to go to Exeter and a few to North Devon. This means they are a long way from relatives, carers and their community care professionals. At the time of our inspection the acute older adult ward in Torbay was occupied by 40% of working age adults although many were over the age of fifty. The staff of the older people’s mental health community service in Torbay expressed difficulties in finding beds for older adults who required admission.

We were also concerned about the safety of patients who may need restraint or seclusion. In Torbay there is one seclusion room which is in a potentially unsuitable location on a suspended ward and different floor to Haytor Ward. We found that some recording of the use of seclusion is poor impacting on the effective monitoring of its use across the trust. In addition 21% of staff on Haytor Ward had not received up-to-date training to manage incidents where physical restraint might be required. We also found that some patients were staying in seclusion for long periods of time based on their clinical need while a bed in a Psychiatric Intensive Care Unit was found.

We found patients were lawfully detained; however there was room for improvement in the recording of procedures required under the Mental Health Act and Code of Practice. This included the recording of risk plans associated with section 17 leave.

Patients and staff told us that engagement with patients does not occur as frequently as they would like. This was attributed to periods of high activity and being busy with office duties. Some patients on the older people’s ward told us there was not enough to keep them occupied. Beech Ward had less occupational therapy input and access to activities.

In Torbay engagement with staff was variable. The trust has been running a ‘Listening into Action’ programme with mixed feedback about these events. In Torbay some staff felt the trust was not really listening or acting on what staff had said. Some staff on Haytor were negative about the trust’s performance management. They said the trust had its priorities wrong and focussed too much on “targets rather than quality of care”.