During our inspection we spoke with twelve people who use the service and a minimum of seven staff. People who use the service generally spoke positively about the support they received. They said the majority of staff were caring and attentive to their needs.

The staff conveyed an in-depth knowledge of each person's needs and how they liked to be supported. We observed that the people who use the service and the staff had developed positive relationships with each other and there was good communication and a relaxed atmosphere within the hospital.

People were involved in identifying where they needed support and how this was to be provided. This was reflected in the care plans and risk management plans which detailed how people’s needs were to be met during their stay at the hospital.

Staff received support and training to ensure they were competent to support people with their needs.

During our visit we spoke with ten people who use the service and five staff.

The majority of feedback we received from people who use the service was that they felt the treatment they received was well structured and met their needs. People said they were treated well by the staff. They said they felt the majority of staff were committed to their work and that there were generally enough staff to meet their needs.

People said they were given explanations about what to expect from their treatment and their stay at the hospital, though some people said that they would like to have known more about the ‘rules’ before they starting using the service. One person commented that they would like a slower pace of treatment. The staff we spoke with were knowledgeable about different people’s needs and how to give individualised support. We saw staff being respectful towards people and speaking to people calmly and discreetly.

There was appropriate documentation to show that people consented to their treatment, or their capacity to consent had been assessed. The care planning was individualised to each person’s needs and involved people in identifying what was important to them and where they felt unsafe.

There were systems to oversee the administration of medicines and to minimise risks of people being given incorrect medicines.

At the time of our inspection there were 20 people using the service and the staffing was sufficient to meet people’s needs.

Almost all the patients we spoke with told us that they had received a full assessment of their medical and personal needs when they began to use the service. All patients are involved in decision-making about the service through fortnightly community meetings which they attend by choice.

Patients told us that they have access to their care plans and that their treatment is discussed with them during weekly ward rounds. They confirmed that there is a range of activities available to them each week and that they are involved in making decisions about trips and other activities. One patient on the eating disorders unit (EDU) told us that “It’s a really good unit – the manager listens” and another said that they couldn’t fault the care there.

All of the interactions we witnessed between staff and patients were polite, respectful and friendly.

Most of the patients we spoke with reported no problems with their medication.

Patients we spoke with on both units told us that they felt that their dignity and human rights were upheld and that they felt safe. Those who had experienced the use of restraint told us that it was never excessive and only used when necessary.

We did not re-rate this hospital as a result of this focused inspection. This was because we only looked at specific issues on one ward that staff and patients had contacted us about. We issued two warning notices immediately after the inspection telling the service it must make immediate improvements around the documentation and management of risk and the governance of the service. We will return to inspect the service shortly to ensure that actions taken by the provider are embedded and that patients at the service are safe.

We found:

• Sunrise ward did not have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Many of the patients were being supported using one-to-one observations. High numbers of temporary staff were used to carry out this role. This meant permanent staff, including registered nurses in charge of shifts, spent a disproportionate amount of time managing staff who were unfamiliar with the ward. This had the potential to impact on the quality and safety of patient care.
• Despite the high use of temporary staff there were still shifts with insufficient staff on duty to carry out one-to-one observations of all patients with an assessed need for this.
• Staff did not keep up-to-date and accurate records of patient care and treatment. Key information about risk was missing from patient records. This meant that information needed by staff to keep patients safe was not always available. This was a concern as many of the staff on the ward did not know the patients well and therefore relied on the accuracy of these records.
• The one-to-one observations were not recognised as a restrictive practice, so their use was not kept under careful review.
• Patient and carer feedback indicated that patients were not consistently listened to and provided with compassionate care by all staff.
• The ward did not have effective governance systems in place to monitor actions to improve the service. The hospital risk register and the CQC action plan did not accurately reflect work that still needed to take place.
• Staff had little opportunity to discuss learning from incidents, complaints and audits.
• Staff morale on the ward was low. Staff told us about divisions within the ward team and this affected the ability of staff to work together productively for the benefit of patients.

However:

• Staff and patients were positive about the impact of the new ward consultant who had recently started at the service
• The service management along with the new ward consultant, were committed to the improving the care model provided within the service. We received positive feedback about the moves already taken to improve the service.
• Patients told us that there were some staff who responded to them with kindness and care.
• The service provided an independent advocacy service which patients were positive about.