We carried out this follow up inspection to monitor how Longfox Unit had responded to the compliance action and improvement actions we made, when we visited in August 2011.

We met four people who were using the service during the inspection. The people we met expressed positive views about the staff who worked with them on the ward.

At our last inspection we had found people who use the service received care and support from sufficient numbers of staff. Availability of additional staff at times of increased patient dependency was variable. We had set an improvement action to address the variability of the availability of additional staff when needed. On this inspection we saw evidence that a recruitment programme had been put in place to recruit more suitably qualified staff to work at Longfox Unit. Since the last inspection new qualified mental health nurses and new care staff have been recruited to address the variability in the numbers of staff. Staff said there were still times when they were very busy and needed extra staff. They said that when ever possible extra staff were now made available to them when needed.

We had also found at out the last inspection that staff did not always ensure incidents were reported centrally and reviewed at ward level. This would be to ensure investigation and learning took place from what had happened. We found that action had been taken to address the area of non compliance. All of the staff we met were able to confirm for us that as part of their regular supervision meetings the learning from critical incidents and occurrences was now always part of the agenda of topics discussed. We saw a new supervision template that included critical incidents and occurrences as a heading to ensure they were always discussed at supervisions meetings. We were told by staff that the trust was going to use this new template with the staff in its other services. We saw that the subject of critical incidences and occurrences that had occurred on the ward and at other trust locations were now included in the agendas of the weekly team meetings. The staff also us told us that the trust use their own intranet to cascade learning across the trust from critical incidents and occurrences. Staff told us this was a helpful way of keeping up to date about matters across the trust. The staff also told us they used information learnt from the review of incidences and occurrences to inform how peoples care was planned and what was written in peoples risk assessments and care plans. We also saw confirmation in peoples care records that incidences were written about in detail and followed up after the event by staff and managers.

At our last inspection we had also found that staff were not clear on the trust's arrangements for recording of seclusion incidents to support risk management and ensure compliance with the Mental Health Act code of practice guidance. We had made an improvement action around these issues. We were told this may be associated with the staff’s understanding of using the new computerised care records system. Staff competency in use of the new electronic care record system meant they may not always have been able to access information about peoples needs in a timely manner. We had made an improvement action about the need for staff to be fully competent in the use of the computerised care records system. At this inspection we saw written records had been kept when the seclusion room had been used with a person who used the service. The use of a seclusion room is defined as the supervised confinement of a patient in a room, which may be locked to protect others from significant harm. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others. The records were sufficiently detailed to show that staff had followed the Mental Health Act code of practise when they had used the seclusion room. We also found that staff were competent and knowledgeable in the use of the online care planning system known as RIO.

We had received information of concern about Juniper ward at the Long Fox unit in August 2011 from our inspectors who check care arrangements for people detained under the Mental Health Act 1983. They were concerned that some patients on the ward had said that they did not feel safe. There were also concerns expressed by staff that, following the closure of an adjacent high dependency unit earlier this year, the ward was not adequately staffed to provide the level of care required by some very ill patients, some of whom exhibited challenging behaviour. It was felt that the impact of having to provide more intensive care to some patients meant that other less dependent patients did not receive the level of care that they needed.

On the day of our visit patients did not make us aware of any concerns about safety. One person told us “I feel safe with the fence; there are always staff around or a room to go to with staff in it.” They told us that they had access to staff when they needed it, although some said that they would have liked more time.