We undertook a routine inspection of the unit in October 2013. As a result of what we found the provider was issued with three compliance actions. These related to respecting and involving people who use the services, the care and welfare of people who use the services and staffing. This inspection was carried out to review the improvements made in relation to the compliance actions previously issued.

From our observations and what people told us, it was clear that there had been improvements in the service since our previous inspection and we saw evidence to support this. During our inspection we spoke with people who use the service, a family member, seven staff members and a variety of professionals, we observed interactions and activities in the unit.

We spoke with a relative by telephone who said that the care provided was ‘’excellent’’ and that the team were “always polite and responsive”. There was a carers’ support group held monthly which we were told was valuable and enabled relatives to be involved and informed about their relatives’ care.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. This was documented and people told us they had been consulted. Issues of capacity were identified appropriately in keeping with legal requirements. People who use the services spoke well of the care they received and how they were involved in their care. People said the staff were kind and treated them with respect.

During our inspection we saw that staff had built up a positive rapport with people and responded promptly to people’s needs in a kind and respectful manner.

Staffing levels were reviewed daily and additional staff employed in response to the needs of the service users. There were systems for managing complex mental and physical health problems in the service with involvement from the multi-disciplinary team including the GP.

We received varied comments from people who used the service regarding their experience. Overall people we spoke with were happy with the care provided at the hospital location. One person we spoke with said, “the staff here are very caring. They really look after me well.” However when asked about activities and things to do one person we spoke with said, “I am bored. (there are) not enough activities.” Staff we spoke with told us that there were not always enough staff with the appropriate skills and experience to meet people's needs in a timely manner. “Personal care of patients is often interrupted as I keep getting called for other duties,” said one staff member we spoke with.

On our visit we found that patients were safeguarded from the risk of abuse and the staff worked with other healthcare professionals to ensure people’s health, safety and welfare was protected. The provider had some arrangements to monitor the quality of care. However on our visit we found concerns with the way care was planned and delivered, lack of involvement of patients in all aspects of their care, and insufficient staffing levels to manage the complex care needs of patients using the service.