5 to 8 October 2015
During an inspection of Forensic inpatient or secure wards
We rated Forensic inpatient/secure wards as good because:
All of the wards were clean, tidy and well maintained. Staff completed regular checks on the ward resuscitation equipment. These checks were recorded.
Staff managed physical, relational and procedural security well. The outdoor areas met the secure service standards set out by the Department of Health in its Environmental Design Guide (2011). The wards had airlock systems at their entrances and a central office managed keys and alarms so that staff collected these on their way in and left them on their way out. Staff used the ‘see think act relational security explorer’ during handovers. Staff knew how to access the security policies that were available on the trust intranet. These were all in date.
Care plans focused on recovery. Ward staff understood the principles of positive behavioural support and applied these when developing care plans.
All of the care records we reviewed showed that staff checked the physical health of patients regularly. The trust ensured that patients had good access to a range of physical healthcare services including GP services, opticians, dentists, dieticians and podiatrists.
The staff worked well together as multi-disciplinary teams.
Staff at all levels were kind and respectful when speaking to patients. They respected patient privacy and dignity and maintained confidentiality. Staff involved patients in all aspects of care planning, including in the development of positive behavioural support plans.
The trust ensured that advocacy services were available and present on the wards. Patients told us that they had good relationships with advocates.
The trust made a wide range of therapeutic and social activities available to patients on all of the wards. Patients could use the outdoor areas at any time. There were good facilities for children to visit away from the ward areas.
The care was discharge-oriented. Staff actively planned for discharge to appropriate alternative placements, taking account of patient needs and risks. The ward teams worked collaboratively with community teams mental health and learning disability teams that would support patients post-discharge, and with commissioners.
Staff at all levels understood and supported the trust’s vision for the service. Ward staff knew who the members of the trust board were and told us that they saw them regularly. The trust ensured that there were systems in place to monitor quality and to give feedback on performance to staff throughout the organisation.
However:
Managers had not undertaken an appraisal of all ward staff in the previous 12 months.
On Maplewood 1 and 2, the managers had not put in place a system that allocated staff to respond when an alarm was activated.