We did not rate this inspection.

During the inspection we reviewed the provider’s action plan relating to restrictive practice.

• At the inspection in March 2014, we found people had restrictions in place regarding the use of telephones and visits; these were not in response to individual risk. During this inspection we found that patients were no longer supervised during phone calls and visits unless indicated on their risk assessments

• At the inspection in March 2014, people told us about their meal time experience and said that if they did not attend for meals on time they were not offered a hot meal and would be given a sandwich. During this inspection we found that patients always had access to a hot meal even if they had missed the meal time.

• At the inspection in March 2014 we found that the hospital did not always treat people in the least restrictive manner and often enforced boundaries with actions that could be seen to be punitive. For example staff told us that aggressive behaviour spitting and hitting staff was regarded as physical assault and would lead to a person having their leave cancelled. During this inspection we found that there was a positive culture on the wards and actions were no longer seen as punitive.

• At the last inspection in January 2015 we found that blanket restrictions continued to be in place on some wards. For example, on Merlin, Linnet, Lark and Newtondale wards, patients were subject to routine rub down searches following a period of unescorted leave. These were not carried out on the basis of the risks presented by individual circumstances. During this inspection we found searches were no longer carried out routinely.

• During the inspection of the learning disability forensic inpatient/secure wards at Roseberry Park Hospital in March 2014 we found there was a breach of Regulation 11 HSCA 2008 (Regulated Activities) Regulations 2010: Safeguarding people who use services from abuse. During this inspection we found learning disability forensic inpatient/secure wards were no longer in breach of this regulation.

The visit to Roseberry Park Hospital took place over three days. We looked at seven wards during our inspection and the activities centre.

We spoke with approximately 24 people who use the service, unfortunately people did not have any visitors during our inspection and therefore we were unable to talk with family members and advocates, however we observed how people were cared for, talked with staff and other health professionals and looked at people's records to ensure people were appropriately cared for.

People who use the service talked positively about their experience at Roseberry Park. People told us they were involved in the planning of their care and were also involved in reviews of their progress. People made comments to us such as " the staff are supportive and make the best decisions for me", "The staff are really good I get on with most of them" and "I am involved in my care and feel like my opinions matter." Some people did not make positive comments about the service and told us “staff are overprotective” and “It’s like a prison.”

We looked at how people's care needs were met and considered whether care was safe and appropriate. Although we found many good practices such as people being involved in their care and being supported with alternative methods of communication where this was required, we did find that care was not always planned effectively and staff did not always follow the instructions in people's care plans.

We focused our inspection in areas where we identified concerns during our visit, such as seclusion and restrictions. We found that seclusion was used on occasions to manage complex behaviours rather than manage disturbed behaviour, which could cause serious harm to others or the person concerned. We also found there were a number of excessive and unjustified restrictions in place such as staff monitoring personal visits and phone calls on a routine rather than case by case basis. Appropriate risk assessments had not been completed to demonstrate why restrictions were in place and what the person needed to do to have restrictions removed.

We looked at how people were protected from the risks of abuse and found that the provider had not taken steps to ensure people were protected from the risks of abuse. We found processes to ensure seclusion was not used excessively were inadequate, and we also found restrictions placed on people were not adequately reviewed to ensure people were protected from abuse.

We spoke with people who use the service and asked if they felt safe in Roseberry Park. People told us that they knew how to report incidents of abuse and also knew how to raise any concerns if they had too. People were aware of the services they could contact if they felt abused or vulnerable, such as local advocacy services, the local safeguarding team and the CQC.