This inspection included visits to the following wards: Mount/McMaster, Harbledown, Invicta and Marlowe. We observed and talked with 30 patients and 11 relatives on the wards and spoke to 14 staff, including ward managers and junior doctors. Around half the patients we spoke with had reduced mental capacity, for example dementia or confusion, and needed additional support to understand their treatments and care in the hospital.

People told us the staff explained their treatment to them and gave them enough time to make a decision. One patient on Invicta ward told us “Doctors explain what they are about to do with my treatment, so I always know what’s going on”. All the staff we spoke to were aware of their responsibilities to support people to make decisions about their care and treatment. Some of the relatives told us that discharge planning was an area that needed some improvement as there was confusion about whether patients were ready to be discharged and what arrangements had been made for post discharge support.

The wards were very busy and active. Harbledown and Mount/McMaster had extra beds because of winter pressures such as seasonal infections. Staff, patients and visitors commented on how busy the staff were and some said they were short staffed but all the comments about the staff and the care were positive. Patients and relatives said the staff were friendly. One patient commented, "We have a laugh together which makes it more friendly."

We did not speak to people who used this service as part of this review. We looked at a random sample of medical records. This was to check that current practice ensured that no treatment for the termination of pregnancy was commenced unless two certificated opinions from doctors had been obtained.

Patients on Treble ward and Cathedral Day unit said their care and treatment had been well coordinated and everything had been explained well by the staff.

They said that they had been informed of their diagnosis and had been consulted about the treatment and rehabilitation support they needed.

On Treble ward patients had discussed their preferred routines with staff and that they were well supported to do everyday things such as to wash, get dressed and use the bathroom. On Cathedral Day unit patients had discussed their preferred routines with staff and they said that they were helped with practical tasks during their short stays.

Patients on Treble ward said that there was a choice of meals and that they had enough to eat. On Cathedral Day unit, patients said that there was always drinks available.

Patients said that Treble ward and Cathedral Day unit were orderly, neat and clean.

This Responsive Review of Compliance was completed because we had received concerning information in relation to Kingston Ward about the quality of treatment and care, nutrition and hydration and infection control.

Patients said that they had been consulted about their medical options and that they received the medical treatment and rehabilitation support they needed.

They said that they discussed their preferred routines with staff and that they were well supported to do everyday things such as to wash, get dressed and use the bathroom.

Patients said that there was a choice of meals and that they had enough to eat.

Patients said that the ward was orderly, neat and clean.

Our rating of services stayed the same. We rated it them as requires improvement because:

We rated safe, effective, responsive and well-led as requires improvement, and caring as good. We rated two core services as requires improvement and one as not enough information to rate.