This was an unannounced follow up visit to the Bleasdale and Whinfell wards as at our previous inspection in November 2013 we found concerns. The trust had provided us with an action plan on how they would meet the essential standards. This inspection was undertaken to review their improvements.

At this inspection we spoke with two patients, Integrated Business Manager, Modern Matron, Assistant Network Director and each of the ward managers. We reviewed the individual care records for four patients. We also toured both wards and the facilities, observing the staff/patient engagement and activities, meeting informally with patients and members of the care team.

We observed a variety of communication methods had been implemented and re-launched to encourage involvement of patients, their families and friends. This meant that they were involved in decisions relating to the way in which the services were provided promoting their autonomy, independence and community involvement.

The trust had re-launched the “my shared pathway”. The care documentation was holistic and referenced particular focus to individualised care.

The wards had systems in place to continuously monitor the quality standards of their service.

We saw that care records contained more comprehensive detailed information both within the electronic and paper records. Staff explained to us how the record and filing system supported them in the delivery of care.

The inspection looked at the care and treatment people received within Guild Lodge hospital on two wards, Whinfell and Bleasdale. These two wards provided care and treatment in a medium secure unit to patients with an acquired brain injury (ABI). All of the patients we spoke with were detained under the Mental Health Act.

We found Guild Lodge had produced a consultation document for agreement by the trust board in relation to a new model of care for the acquired brain injury services at Guild Lodge. This had been completed as a result of adverse incidents on a particular ward and identified a new philosophy of care and identified staff training needs throughout this service. We found the trust had undertaken an initial review of the service provision on the wards we visited following the incidents and were in the process of implementing staff changes and role specific training prior to the consultation document being agreed.

We spoke to patients during our time on site at Guild Lodge hospital and we also conducted telephone interviews with carers and family members of patients who had been admitted to Guild Lodge.

Some of the patients who were admitted to these wards told us they did not feel they had any say on how the service was run or managed and did not feel able to make suggestions or express their opinions about things. They told us they felt their views and opinions were not respected by staff. We found patients were not routinely consulted with or debriefed following restraint used on the two wards we visited.

We found suitable arrangements were in place to obtain and act in accordance with the consent of patients in relation to the care and treatment provided for them.

We found the physical health checks of patients had not been fully implemented to meet the patients’ individual medical needs.

We found arrangements were in place to safeguard patients who were on the two wards we visited. Most patients we spoke with about feeling safe on the wards told us they did feel safe but some patients told us they did not feel safe on one particular ward.

We found some systems were in place to assess and monitor the services patients received. However, we found at ward level checks and systems were not in place to regularly assess and monitor the quality of service provided to patients.

We found accurate records were not maintained in relation to the care and treatment of patients at the hospital on the wards we inspected.