We found the following issues that the trust needs to improve:

• During the inspection we found issues relating to safety on the inpatient forensic and secure wards. Maintenance issues were not always addressed in a timely manner which could impact on the safety of the environment. Also, we identified two incidents on Westerdale ward that had not been investigated relating to the use of a temporarily decommissioned seclusion room.

• The patient care records we reviewed did not have consistent risk assessment documentation that was fully completed. Blanket restrictions were identified, including the routine searches of patients and restrictions on mobile phone and internet use. These restrictions were not based on individual risk. In addition, the removal of cigarettes from patients until they were discharged appeared to be a disincentive for patients to hand over tobacco products and resulted in patients being searched in line with the trust policy. This procedure was disproportionate and was not person-centred.

• The trust was not fully compliant with the requirements of the Mental Health Act code of practice. The managers’ hearings did not always occur in a timely manner, or in line with the trust’s timescales and the requirements of the Mental Health Act code or practice. The seclusion room did not have a bed and the two-way communication between the inside and outside of the seclusion room was poor, which did not fully comply with the Mental Health Act code of practice. Also, the Mental Health Act information was not always recorded and maintained in line with the mental Health Act code of practice, and the mental health legislation audits completed by staff did not identify, or record any, appropriate actions. Finally, policies we reviewed were out of date and did not reflect the changes brought about by the Mental Health Act code of practice.

• Information provided by the trust demonstrated that training in both the Mental Health Act and the Mental Capacity Act was 62%.

However we also found:

• The wards were visibly clean, staff carried out comprehensive environmental ligature risk assessments and all the identified ligature risks had either been removed or mitigated. In addition, the clinic rooms in each ward were clean and tidy and daily checks were carried out on resuscitation equipment and fridge temperatures.

• Staff were committed to building the therapeutic relationship and using de-escalation and distraction techniques with patients, and used as a last resort. As a result, the use of restraint and rapid tranquilisation was low. This was in line with the Department of Health guidance positive and proactive care 2014 with regard to ‘relational security. Also, staff could describe the types of abuse and could explain the safeguarding procedure and how to raise an alert.

• All care records we reviewed showed the patient had a routine physical examination on admission and ongoing physical health monitoring. Care plans were holistic and developed in collaboration with the patient and care involved the multidisciplinary team, including doctors, nurses, occupational therapists, activity coordinators, support workers and a psychologist. The staff we spoke with reported that they received regular supervision to fulfil their role in delivering care and treatment.