We visited Harlestone ward which is a low secure ward situated over two floors (Lower Harlestone and Upper Harlestone) and is part of St Andrew’s Healthcare Men’s Service.

We spoke with seven patients and they all expressed satisfaction with the care and treatment they received at the hospital. They told us that the staff treated them with respect. We found that each patient had a daily schedule of therapeutic activities. We saw that records were kept of when patients had engaged in scheduled activities and also when patients had declined to carry out their activity. Patients told us that they had access to escorted leave. One person said sometimes their escorted leave had been cancelled due to staff shortages. The staff confirmed that leave had been cancelled on some occasions, due to staff shortages, but was not a regular occurrence. During our visit we saw that six patients from Upper Harleston ward were out on escorted leave to Milton Keynes shopping centre to do some Christmas shopping.

Patients told us they had opportunities to use the on site gym, but were dissatisfied with the limited space within the secure courtyard facility. An example was given as there not being enough space to run and kick a football.

We visited two wards within the Men’s service: Foster low secure ward that provides forensic treatment for men and Ferguson a low secure ward that provides rehabilitation and recovery. We interviewed seven detained patients and asked questions in relation to their care.

Patients said they had a “good rapport” with staff, and confirmed there were good links with the advocacy service. They said there was good access to the medical team and opportunities to discuss their ongoing care and treatment with the psychologists’ at St Andrew’s Healthcare.

All of the patients we spoke with told us they participated in one to one and group activities. These included using the on site gym and swimming facilities, going on bike rides, playing squash and badminton, and shopping. Some patients spoke of taking part in an allotment and music group. Some people spoke of attending social events held within St Andrew’s grounds and some said that they enjoy their escorted visits into town.

One person said “St Andrew’s has a lot to offer; they are helping me to move on”.

We rated Men’s services as requires improvement because:

• Seclusion practices were not compliant with the Mental Health Act code of practice. Medical and nursing reviews had not taken place as required in 36% of records checked. Staff had not completed seclusion care plans for patients in 70% of records checked.
• Doctors advised that they were not always able to complete seclusion reviews within the timescales required by the Mental Health Act code of practice. We reviewed data for weekend on call provision, which evidenced that the demands on doctors providing this support exceeded available on call medical staffing.
• Managers had not identified all environmental risks in patient areas on forensic, learning disabilities and older adult’s wards. We found unidentified ligature risks and blind spots.
• The provider had not ensured that all risk assessments and care plans were in place and updated consistently in line with changes to patients’ needs or risks.
• The provider had not ensured that patients’ physical healthcare needs were met in accordance with care plans. There was no out of hours physical healthcare provision on site.
• Managers had not ensured that all patients requiring observation had appropriate care plans.
• Staff had not created personal emergency evacuation plans for patients with restricted mobility on the older adult’s wards. Staff had limited access to specialist equipment for moving patients with restricted mobility down stairs in the event of a fire.
• Staff had not followed safe procedures for the recording of medicines administration on one forensic ward.
• We found issues with cleanliness and maintenance on the forensic and learning disabilities wards.
• The provider had not ensured all medical equipment was regularly tested to check it was in working order. On upper Harlestone ward, we found staff had not regularly tested the oximeter and blood pressure machine.
• The decor and furnishings on Foster ward were poor.
• There were insufficient numbers of staff to provide safe care, treatment and access to leave and activities on the forensic, older adults and learning disabilities wards.
• There was a lack of consistent management on Foster and Harlestone wards.
• The provider had implemented changes to staff roles without fully assessing the impact and had not communicated the changes effectively.

However:

• Staff treated patients with kindness, compassion and respect. We observed interactions between staff and patients during the inspection and saw that staff were responsive to patient's needs.
• Staff were open and transparent and would explain to patients and carers when things went wrong.
• Staff knew what constituted a safeguarding, and could explain the process of reporting and escalation to senior staff. Staff put protection plans in place for patients when required.
• Staff had access to appropriate alarms and radios to call for help in the event of an emergency.
• Staff reported incidents in line with policy. Senior staff cascaded information about lessons learnt to staff at ward level.
• Staff were aware of the provider’s whistleblowing policy and were confident they could raise concerns without fear of reprisals. Staff spoke positively about the support received from managers.
• Ward managers were able to adjust staffing levels to meet the changing needs of patients requiring high levels of monitoring linked to individual patient risks.
• Wards had fully equipped clinic rooms with access to resuscitation equipment, which was regularly checked and maintained.
• Staff had a good knowledge of the Mental Health Act and Mental Capacity Act.
• Wards had a variety of rooms for patients to use including quiet, therapy, fitness and activity rooms.
• Staff had good access to training and received the necessary specialist training for their roles.
• The provider held regular governance meetings to monitor the service. Managers used key performance indicators to monitor their wards performance.