Forston Clinic

At our last inspection in July 2013 patients told us that they did not always feel safe on the unit. Safeguarding procedures were not consistently followed. In the August 2014 inspection we were concerned about the safety of patients. Patients were regularly being restrained. Evidence seen in the incident records and in care notes confirmed that the Mental Health Code of Practice was not being followed. We were concerned about the use of the seclusion room, the staffing levels, care and treatment of patients and the governance system in place to protect patients. We issued compliance actions and the Trust sent us an action plan about the measures in place to address these shortfalls.

At this inspection we visited Waterston Unit and found the staff team had worked hard to address the concerns of the last inspections. The staff team had received training in safeguarding adults and the seclusion room was no longer used. Patients' needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Patients were cared for by suitably qualified, skilled and experienced staff. Staff assisted patients in a caring and compassionate manner.

Patients were asked for their views about their care and treatment and they were acted on. The provider took account of complaints and comments to improve the service. There was evidence that learning from incidents / investigations took place and appropriate changes were implemented.

Waterston Assessment Unit provides an acute admission service. Since our visit in 2013, there had been a change in management arrangements. The previous ward manager had been seconded to another post and an acting manager was covering the ward.

On the day of our inspection there were 13 people on the unit with only one qualified nurse who did not usually work on this ward. In addition there were three regular support workers, a bank support worker and two occupational therapists.

We observed staff were respectful, and asked people if they needed support and assisting when asked to do so.

We found that the provider had taken some steps to improve the reporting of safeguarding and the support of staff. However, although most of the care plans were individualised for mental health needs, they had not been updated to reflect the care each person required. Records such as risk assessments had not been updated to reflect the information we saw in meeting notes and progress records.

We were told by the staff working that staffing levels were below the requirements of the unit, which had been assessed as requiring two qualified nursing staff and four support workers during the day and two nurses and three support workers at night. Records we reviewed showed there had regularly been only one nurse on duty.

On this occasion we identified concerns with care and welfare, safeguarding, and staffing. Whilst there were audits in place we found issues on the ward during our inspection. We saw that the quality assurance monitoring of the service had not led to action to manage these concerns.

We found that the trust had made improvements to the service at Forston Clinic.

Patients' capacity to give consent to their care and treatment was now reviewed regularly.

The refurbishment of the premises meant that care was now provided in an environment that was comfortable, safe and well-maintained. Patients commented positively on the changes that had been made and told us that they liked the facilities available to them.

There were robust procedures in place to ensure the premises were clean and hygienic.

The trust had appropriate arrangements in place to manage medicines.

There was a less restrictive culture on Waterston Assessment Unit (formerly known as Minterne ward) so that patients had greater autonomy and choice. There were more activities available to patients.

However, there were some areas on Waterston Assessment Unit which required further improvement in order for the trust to demonstrate compliance with the regulations.

Care plans were not always in place to show how patients' needs would be met by the service and risks to their welfare were reduced.

Patients told us that they did not always feel safe on the unit. Safeguarding procedures were not consistently followed to ensure that all concerns were reported and could be reviewed.

Staffing was not planned effectively to ensure there were always enough suitably qualified staff on duty at all times.

Although work was being carried out to ensure that all staff received regular supervision and appraisal, these processes had not been fully implemented at the time of our inspection.

Checks were being carried out to monitor the quality and safety of the service but did not always result in timely action to ensure shortfalls were addressed promptly.

Patients told us they had not had copies of their care plans and did not know where they could get one demonstrating that the service did not put patients at the centre of their care, treatment and support.

We found that staff did not always provide correct information to patients detained under the Mental Health Act about their rights. Clear procedures were not in place to ensure that patients who lacked capacity had their human rights respected and taken into account.

We were told there was a blanket ban on patients in Minterne ward being allowed to consume caffeinated drinks, use aerosol deodorants or hairspray. Individual risk assessments for patients around using these items and consuming caffeinated drinks were not in place.

Four patients we spoke with in Minterne ward told us they were bored because there was nothing to do especially in the evenings and at the weekends. One patient told us 'I spend every waking hour planning how to escape from here because there is nothing to do'.

We found that patients did not receive appropriate and safe care because there were ineffective systems in place to assess, plan and deliver their care and to manage risks.