Following this inspection, we rated wards for older people with mental health problems at Butterworth Centre as requires improvement because:

• The environment needed work to ensure it was dementia friendly and to minimise disorientation of patients who lived with organic mental health conditions including advanced dementia.

• Whilst overall, the provider maintained safe staffing levels, qualified nurses were under pressure as a result of their workloads. One qualified nurse was employed on each ward at all times, but they were often away from the ward attending meetings elsewhere in the building.

• The provider did not ensure all staff completed mandatory training. In most areas less than 75% of staff had completed mandatory training. Whilst uptake of mandatory moving and transferring training was improving, we saw some instances of patients being poorly support with moving and transferring during the inspection. The provider took immediate action to provide additional training and support to staff in this area.

• The hospital did not meet the requirements of the Department of Health same sex accommodation guidance, meaning that the privacy and dignity of patients could have been compromised. Patient bedrooms were situated on mixed corridors and the service did not provide a female only lounge.

• Whilst the provider had systems in place to protect patients from abuse, staff understanding of their responsibilities with regards to safeguarding was variable and take up of mandatory training in relation to safeguarding was low at 50%.

• A small number of incidents that should have been reported, had not been reported. For one patient at risk of being restrained when supported with their personal care an incident report each time this occurred had not been completed in line with the providers policy and procedure. Whilst learning and improvement as a result of incidents was taking place, a system to routinely share this learning with all staff was not embedded.

• Staff did not receive regular one to one supervision sessions. Supervision took place for some staff sporadically. On occasions where supervision sessions had taken place, clinical discussions were not held.

• Some medical equipment, on the ground floor, used to monitor patients’ physical health had not been calibrated.

• Although group activities took place, there was a lack of person-centred, one to one activities to develop individual interests and promote recovery and wellbeing.

However,

• A carers’ group had recently been set up. Carers told us they were well informed and involved in their relative’s care, and had the opportunity to feed back about the service at the carers’ group.

• The environment was clean, well maintained and there were different areas for activities to take place. All patients had access to lockable spaces to keep their possessions safe.

• Patients and carers were involved in care planning. They had contributed to detailed ‘about me’ sections. Permanent staff showed that they knew and understood the patients they cared for.

• Patients had good access to advocacy. Staff referred patients to the advocate. The advocate also introduced themselves to patients and could be approached directly.

• Physical health care provisions were in place. Ongoing physical health monitoring was detailed and physical health checks took place annually for all patients. A physical health lead nurse worked at the service three days per week and a general practitioner also visited twice per week. Physical health needs were discussed in detail during ward rounds.

• Regular ward rounds involving doctors and nurses and nursing handovers took place. Notes were included in patient care records and were up to date.