People received the care and support they required to improve their health and well-being. Care records were written in enough detail, but did not always provide clear guidance for specific care needs that were usually met by patients’ relatives.

There were not always enough staff members available to fully open the service to all patients who required care and treatment.

We completed this follow up inspection to check that the trust had acted on improvements that we said needed to be made in relation to the day case area, the assessment area and the inpatient ward at our inspection of 5/6 February 2013. We had found that improvements needed to be made to the way that the nursing care was documented and recorded, to the access arrangements for two utility rooms and to the number of nurses on duty in the ward.

After the inspection of 5/6 February 2013 the trust wrote to us and said that it had introduced the improvements necessary to address each of the problems we had identified.

At our inspection of 3 September 2013 we spoke with two patients and five parents. They told us that patients were receiving all of the treatment and nursing care they needed. However, they were concerned about inadequate staffing levels on the ward. A patient said, “I’m confident with the medical help I get here. I’d like it if the nurses had more time. Sometimes they have to rush."

We noted that the two utility rooms in question were locked shut. However, we found that some important elements of the nursing care being provided were not being fully documented. We also found that on a number of occasions medical and nursing staffing cover across the ward had been below the minimum level that the trust considered to be necessary to enable patients to safely receive the care they needed.

We saw staff treating people using services at Holly Ward with dignity and respect. People we spoke with told us they could approach staff with questions about their children's care and treatment and they would be listened to.

We reviewed the care plans of children and young people located on Holly Ward. Although people we spoke with told us they were happy with the care and treatment provided to their children, we saw that the care plans we reviewed did not contain sufficient and detailed advice to staff about how to meet people's care needs.

Staff we spoke with demonstrated to us an understanding of safeguarding vulnerable children from abuse guidance and procedures.

At the time of our inspection we saw that people were not protected against the risks associated with unsafe or unsuitable premises.

There were not always enough qualified, skilled and experienced staff on the ward to meet people's needs and ensure their safety and welfare.

There were effective systems in place to regularly assess and monitor the quality of services provided to people on Holly Ward. People were asked for their views and they would be acted on.