We visited St Mary’s Hospital in August 2013 in response to concerns that one or more of the essential standards of quality and safety were not being met. During our visit we identified areas that required improvement in relation to medication and quality assurance. Following our visit the trust sent us an action plan detailing how they would make the necessary improvements. We visited on 04 March 2014 to check that these improvements had been made.

As part of this visit we looked records relating to the two wards for older people and the three wards for adults with mental health problems. We also spoke with ward matrons and managers from the trust. We did not speak with any people who used the service as part of this inspection but at our visit in August 2013 we spoke with approximately 20 patients who spoke highly of the service.

We found that the trust had made improvements to the storage and recording of medication.

During our visit we found that the trust had not made the necessary improvements to the monitoring of the use of seclusion. Following our visit the trust sent us details of the actions they had taken following our visit. This gave us some assurance of how they would ensure seclusion was being used safely and effectively.

People staying on the wards spoke highly of the care and treatment they received. One person told us “it’s very nice here”, adding “staff are brilliant”. Another person told us that “the nursing staff are the best I have ever come across”. Relatives of one person told us staff, “have been amazing”.

During our visit to St Mary’s Hospital we spent time on five inpatient wards. We spoke with approximately 20 patients and one relative. We also spoke with ward managers and ward staff as well as occupational therapy staff, pharmacy staff, staff from the safeguarding team and managers from the trust.

People told us that they were happy with their care and treatment and spoke highly of the staff. One person told us, ‘’They are terrific! The nurses and doctors have my best interest in mind all the time’’. Another person told us “I could not fault any of the staff on this ward; they treat me with the utmost respect”

People told us that they had been involved in their care planning. We found that meetings were held each day on the wards where people could discuss the activities they would like to do that day and or to make suggestions about how things could be improved.

There was a comprehensive recording chart available to record medicines prescribed and when they were given to people. We found a number of unexplained omissions in five of the records we looked at. This meant that the trust did not know whether people had received their medicines or not.

Staff told us that they felt supported and could raise any concerns they had.

Trust managers were unable to provide assurance on how the use of physical intervention and seclusion was monitored to ensure it complied with trust policy and relevant national guidance and legislation.