We carried out this inspection because concerns had been raised in relation to:

•Safe staffing

•Care and welfare of people who use services

The ward Rowan 2 is staffed by registered mental health nurses and healthcare assistants.

The ward offers up to date, comfortable and well-appointed accommodation for between twelve and twenty women. There is a small secluded garden area at the rear of the ward.

There were sixteen patients, fourteen detained under the mental health act and two informal patients.

We spoke to nine members of staff and three patients. We looked at two patient records.

We found improvements were needed to ensure the service was safe.The high levels of vacancies and staff sickness meant a reliance on bank staff which led to inconsistency.

We found the provider had policies and procedures in place to protect people from abuse or harm.

Improvements were needed in staffing to ensure the service was effective.

The service was caring, staff we observed interacted well with patients and patients told us the staff they knew were kind.

Improvements were needed to ensure the service was responsive. The staffing issues on the ward meant that patient's needs could not always be met. This included patients not having access to section 17 leave.

Improvement was needed to ensure the service was well led. There were no senior nurses on duty on the day of our visit and staff spoke of low morale and feeling unsupported.

We did not speak with people who used the service as part of this review.

At our last inspection we found that patient's needs were assessed and care plans and risk assessments were in place to meet their identified needs. Patients and their relatives all made positive comments about the care provided and were confident their needs were being met. Information for patients was generally presented in an accessible way using pictures, symbols, and clear language.

There were eight patients at the Highbury Hospital Assessment and Treatment Unit when we visited. We were introduced to all of the patients and spoke with five in more depth to get their views of the service.

Patients were generally positive in their views of the service. One patient told us the staff could tell what they needed without them having to ask and that staff treated them with respect at all times. Another patient said “The staff are good. When I feel anxious they speak calmly to me and reassure me all the time”. Patients told us they felt safe and well looked after in the Highbury Hospital Assessment and Treatment Unit.

Two patients told us there were not enough activities for them to do and another patient said they were “bored”.

Patients did not always want to be admitted to the unit and most were detained under the Mental Health Act so that they could receive appropriate care and treatment.

We spoke with 17 patients across seven wards and we found mixed evidence about their experience of care. The wards we inspected had different purposes, functions and resources. Most patients and their relatives told us that they were satisfied with the care and treatment they received at Highbury hospital. They said they had been treated with respect and that their privacy and dignity had been well protected.

Although some people said they had been involved in making decisions about their care and treatment, the processes in place to ensure people were able to give informed consent were not always being followed. One patient said, "They [the staff] listen as best they can. I don't know about acting on what I want, but they listen to me, yes."

Most patients told us they were satisfied with the care and treatment they received however, we found that improvements were needed to support the prevention and early detection of physical health problems and to manage medicines safely and effectively.

At some points, staff availability contributed to delays in the delivery of care and the cancellation of patient activities.

We found that most patients were made aware of the complaints system and knew how to make their views known.