14, 15, 16, 17, 21 & 24 September 2021
During a routine inspection
Our overall rating for the service stayed the same. We rated it as Requires Improvement because:
There were lots of staff vacancies and the services relied on temporary staff to ensure the wards were safely staffed. This affected the continuity of care for patients, who reported that they were not always familiar with the staff who cared for them.
Staff on the forensic wards did not always make the necessary physical health checks when patients had received medicines by intramuscular rapid tranquilisation. This meant that potentially harmful physical health deterioration may not be identified and acted on by staff.
Staff had not taken any action to escalate problems with emergency alarms not working in two bedrooms on Coleridge ward a forensic service. This meant that staff or patients requiring assistance in an emergency in these rooms would not be able to call for assistance.
Patients on Blake ward, the acute ward for adults of working age, reported that there were not enough therapeutic activities to keep them occupied and they did not have access to support from an occupational therapist. Patients on the forensic wards reported that there were not enough activities to keep them occupied during evenings and at weekends.
The forensic mental health ward environments were not therapeutic in nature and the provider had made very limited progress in improving the ward environments since the last inspection.
The service had not yet made much progress with its approach to reducing restrictive interventions, like restraint and seclusion. The reducing restrictive interventions project group was newly formed and was not systematically reviewing themes and trends from data about the use of restrictive interventions.
Some concerns identified during the inspection had not been identified by the provider through their internal governance assurance processes.
However;
The ward environments were clean. Blake ward had recently opened as a new acute mental health ward. The provider had completed a robust programme of environmental works to ensure the ward was fit for its intended use.
Patients told us they had good therapeutic relationships with the regular staff who worked on the wards.
Patients were encouraged to give feedback on their experience and the quality of the service. They also contributed to discussions about their care and treatment and were given treatment options where appropriate.
A positive staff culture meant that staff felt well supported in their roles and could access support from colleagues. Leaders were committed to delivering a high-quality service and supporting staff. They managed to provide enough support to staff and oversight of wards despite some ward manager posts not being filled at the time of the inspection.
Improvements had been made since the last inspection. These included learning from incidents, patients knowing how to access IMHA, and access to personal emergency alarms.
Different members of the multi-disciplinary staff team were dedicated to supporting patients in their recovery. They explained how they tailored their approach to individual patients and supported patients to re-integrate to the community and boost their skills and experience where appropriate.
Staff held close professional links with colleagues in other agencies and teams which helped them plan for effective patient discharge.