At our previous inspection of Derwent Ward in January 2013 we found that patients' choice, dignity and independence were not consistently promoted. We also found that patients were not always provided with the information they needed about their care and treatment or asked for their views.

During this visit we spoke with 14 out of the 22 patients on the ward, five of their relatives and seven members of staff. Patients told us about their care and experiences on the ward and that they were involved in making choices about their care. Patients told us that most staff were kind and caring and encouraged them to be independent. One patient said, “They (the staff) want you to get better so they have to make you do things for yourself. I think that’s good.”

However we found that patients dignity was not always promoted. Patients and relatives told us that call bells were not always answered in a timely manner. Patients were not always being asked for their views, such as whether they had a preference of receiving care from male or female staff or whether they had a preferred name.

Since our last inspection we found improvements in information for patients. However, relatives told us it was difficult to find the right staff to talk to during visiting hours and that they wanted more information about their relatives care.

We looked at the care records for four patients and found that the nursing records were not always complete and up to date. It is important that records are accurate to ensure patients’ care or treatment is safe and appropriate.

Walton Hospital is a local community hospital providing care for older people with mental health needs who may require assessment or rehabilitation. There are two inpatient wards, Linacre and Melbourne, each with 24 beds. Patients may be detained under the Mental Health Act 1983. There is a day hospital on site, Lea Hurst. This is one of two community day hospitals in the area and also provides the base for the community outreach team. At the time of the inspection there were no patients using Lea Hurst day hospital as services alternate between the two locations. Linacre and Melbourne wards are purpose built one storey buildings which opened in 2010. Both wards provide acute admission services for older people with mental health problems. There are 24 beds on each ward.

Walton Hospital was inspected by the CQC twice in 2013. At the last inspection in July 2013, we found concerns in relation to respecting and involving people in their care, and record keeping. At this inspection we found the provider was now meeting these essential standards.

Some aspects of patients’ safety were well managed, such as the prevention and control of infection and the management of medicines. The admission of patients detained under the Mental Health Act was effectively managed. There were systems and procedures in place to safeguard vulnerable patients and to identify, assess and manage risks. However, the systems and procedures were not always used consistently or effectively which meant that patients were not always protected from abuse or avoidable harm.

Patients and their families / carers were satisfied with the care and treatment provided and reported good outcomes for patients. There was generally effective collaboration and communication amongst members of the multidisciplinary team to support the planning and delivery of patient care. Staffing was stretched at times where the level of support needed by patients was not matched by an increase in staff. Staff were supported with clinical supervision, appraisal, and relevant training. However, there was a lack of clarity about the provider’s expectations for the nature of clinical supervision.

Patients and their families / carers said they were treated with kindness and respect and they were involved in making decisions about care and treatment. However, we found that patients’ views about their care and treatment were not always recorded or taken into account. The ward environment did not always promote the wellbeing of patients.

Patients, or their families / carers, told us their needs were usually met by the service. However, we found that care was not always planned or delivered to meet patients’ individual needs or to ensure the safety and welfare of the patient. Care plans lacked detail of how people’s physical and mental health needs should be met. Care plans to support people with behaviours that challenge were standardised and not specific to individuals and their needs. Mental health care plans were rudimentary and process focussed rather than person centred. Staff did not always understand or apply the requirements of the Mental Capacity Act 2005 when considering people’s consent to treatment or the Deprivation of Liberty Safeguards when delivering care. Patients’ records were filed separately by different professionals which could lead to lack of consistency of care and treatment.

Planning for the patient leaving hospital started on the day of admission. Discussions about discharge from hospital involved the patient and their families and carers. Most staff we spoke with were aware of the Trust’s vision and values. Staff told us they enjoyed working at Walton Hospital. They felt there was good team working and they were well supported by their managers.

As a result of our concerns about inadequate care planning and consideration of consent, we judged the provider was not meeting Regulation 9, Care and welfare of people who use services and Regulations 18, Consent to care and treatment. We have asked the provider to send us a report that tells us what actions they are taking to meet these essential standards.