Our inspection of September 2012 found that there were not always enough qualified, skilled and experienced staff to meet people's needs. This was with reference to the staffing levels on Lavender ward. Information provided by the Trust to CQC in November 2012 reported that staffing levels had been increased on this ward along with other changes made around shift patterns and continued leadership from a Modern Matron.

This unannounced visit to was made to Lavender ward to look at the outcomes for people using the service following these changes. We spoke to nine people using the service, six staff members and one visiting professional during our inspection.

Feedback from people using the service included 'it's ok here, the staff are good', 'I've been looked after really well' and 'everything is ok here'. Seven of the nine people we talked to said that there were generally enough staff around when they needed them with one person reporting ''yes there's more staff around now' compared to their previous experience on the ward. People spoken to said they would still welcome more interaction with staff and said their experience varied according to which staff were on duty.

All of the staff spoken to said that staffing levels on each shift had increased and their feedback included 'things are improving here', 'it's really different now' and 'morale has improved'.

On balance the people we spoke with on the wards were generally satisfied with the standard of care and support they were receiving at Queen Mary’s Hospital. One individual told us, “its a hundred percent better on Lavender ward compared to other places I have stayed”. Another person was more pragmatic saying, “we are looked after in terms of medication and food, in general they get on with their job”.

Specific details of wards and other quotes from people who use the service will appear in the main body of the report.

In general across the wards, people felt that they could express their views and that they would be listened to; this was either via the weekly community meetings or on an individual basis talking to staff. We also received a lot of positive feedback from people we spoke with about the support provided by the Trusts independent advocacy service.

The wards at Queen Mary’s Hospital are modern, clean, well equipped and maintained; although some areas are rather stark with no pictures or artwork on the walls.

We received many positive comments about the choice and quality of food on the wards. People with special dietary requirements are catered for including vegetarians and those wishing to eat Halal meat. There is a kitchenette area where people can help themselves to drinks or prepare snacks throughout the day.

Staff at Queen Mary’s Hospital are well trained and supported to undertake their work. Some individual staff were singled out by people who use the service as being exceptional in the care that they gave, for their ability to listen and for treating people with dignity and respect.

A common theme that did emerge was people felt disappointed with the amount of quality time they could spend talking with their key-worker or nurse, especially on a one-to-one basis. This was further exacerbated they felt by the number of agency staff on duty who they did not know at all.

People who use the service are not generally involved in developing their own care plans. This has been a trust wide issue which is in the process of being addressed.

How we carried out this review

Two Compliance Inspectors carried out an unannounced site visit of Lavender ward on the 19th of July and one Compliance Inspector visited Rose and Laurel wards on the 20th of July 2011.

During the two day inspection we talked to 14 people who were staying on all three of the Trusts wards at Queen Mary’s Hospital, and observed how they were being cared for and treated by staff. We also talked to 14 members of staff, which included: 2 ward managers, 6 mental health nurses and/or care assistants, 2 ward clerks, a modern matron, an occupational therapist, a peer support worker, and a volunteer. Furthermore, we met the relative of someone who was using the service and an independent advocate who was participating in a wards weekly community meeting. We looked around all the wards we visited and scrutinized various information displayed on them and some of the records kept by the Trust and staff on behalf of the people who are using the mental health services at Queen Mary’s Hospital.

Listed below is a brief description of all the wards we visited:

Lavender Ward - Inpatient ward providing assessment and treatment for up to twenty-three younger adults of either gender from the Richmond area who are experiencing acute mental ill health.

Rose Ward - Inpatient ward providing assessment and treatment for up to twenty-three females aged 18 to 65 from the Wandsworth area who are experiencing acute mental ill health.

Laurel Ward - Inpatient ward providing assessment and treatment for up to twenty-three males aged 18 to 75 from the Wandsworth area who are experiencing severe mental ill health.

One of the Care Quality Commissions (CQC) roles as a regulator is to keep the use of the Mental Health Act under review and check that the Act is being used properly. Our Mental Health Act Commissioners perform this work by visiting all the places where people who are detained under the Mental Health Act stay and producing visit feedback summary reports and an annual statement regarding their findings.

The Mental Health Act Commissioners last visited Lavender Ward in August 2010, and Rose and Laurel Wards in June 2011. Some of their findings are reflected within the main body of this report.

We would like to thank all the people using the services, managers and staff who contributed to this review and for all their assistance during our visits.

Queen Mary’s Hospital is in Roehampton, and South West London and St George's Mental Health NHS Trust provides the three inpatient wards that we visited as part of this inspection.

We found that the services were safe, the wards were clean and staff were aware of risks. There were ways to report and learn from incidents, but improvements were needed in assessing and managing risks to people's safety.

Staff interacted with people who used the service in caring and compassionate . People and their relatives were involved in planning their care, although records did not always reflect this. People were engaged in activities they felt were meaningful and therapeutic. Ward staff listened to people’s feedback and involved them in making positive changes.

Staff often did not have direct access to specialist training. However, they responded to people’s needs by engaging other services and working in collaboration with specialist teams.

The hospital worked well with the general hospital (which is on the same site) regarding people's physical health needs.

We visited the following wards at Queen Mary's Hospital as part of this inspection;

Lavender Ward

Core service provided: Acute admission ward

Male/female/mixed: mixed

Capacity: 23 beds

Rose Ward

Core service provided: Acute admission ward

Male/female/mixed: female

Capacity: 23 beds

Laurels Ward

Core service provided: Acute admission ward

Male/female/mixed: male

Capacity: 23 beds