Melbury Lodge

We carried out an inspection on 9 December 2013 when we identified concerns with the assessment of patients' capacity and consent to care and treatment. We made a compliance action asking the provider to take action. The provider wrote to us and told us what action they were going to take.

On the day we inspected there were 15 patients on Stefano Olivieri unit. Some were there informally and some were detained under the Mental Health Act 1983.

We spoke with two patients and four staff, this included nurses and senior staff.

We looked at eight patient records specifically the capacity assessments and progress notes completed after a ward round.

Although the content of the assessments varied, for example some were more personalised than others, all the records we looked at had been completed. We saw that the capacity assessment had been reviewed in the ward round and any changes had been noted.

We carried out an inspection in August 2013 when we identified concerns on Kingsley ward with medicine records, the suitability of the premises and records kept regarding the care and welfare of patients. We made compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take or had already taken in September 2013.

We inspected on 9 December 2013 to review the progress the provider had made. We found that the provider had taken steps to improve medicine records and the records of patients' needs and support plans and changes have been made regarding the use of the premises. Individualised care plans detailed the support and care each person required. Patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We observed staff being respectful, asking if people required support. The atmosphere on both wards was calm and relaxed.

We found that appropriate action was being taken regarding falls and falls prevention, although the matron told us that further work was being carried out.

However, we identified concerns with the assessment of patients' capacity and consent to care and treatment on Stefano Olivieri ward.

During our two days at Melbury Lodge we spoke with 13 nursing staff, one visitor, one visiting professional and four other professionals such as consultant psychiatrist, psychologist and occupational therapists. We also spoke to four senior managers and seven patients.

We observed staff talking to patients in a friendly and professional way. This indicated that staff had a good knowledge and understanding of the patients and had been able to build up a degree of rapport with them. Not all the patients at Melbury could tell us what they thought about the service. However one patient was upset and told us this was because they were being moved to another hospital and they did not feel this had been discussed with them or that their opinion mattered. Staff told us that they were being moved to a hospital nearer their home.

Staff told us about the training they had received and the support they had from senior staff. They said that training they attended was good and enabled them to support patients. Senior managers work with staff to monitor and assess the quality of the service. However, we did find that the service was not disposing of medicines in line with the trust's policy and care plans and other records were not reviewed and updated to reflect patient's needs.