Throughout the inspection we spoke with 11 people who use the service and/or their relatives/representatives. We also spoke with staff of different disciplines which included the ward manager, nurses, healthcare assistants, the ward consultant and a senior manager.

People were treated with dignity and received care and support through a multi-disciplinary approach to ensure their needs were met appropriately.

The staff demonstrated a clear understanding of their responsibilities in relation to safeguarding people from abuse and promoting people’s welfare.

The provider had systems in place to regularly assess and monitor the quality of service that people received.

However, at the time of the inspection we found that the provider was not acting in accordance with legal requirements in relation to the Mental Capacity Act 2005. We also found that there were not sufficient numbers of staff on duty to support people with their needs. Ligature risks to people within the environment had not been properly addressed, despite having been identified for a number of years.

At our previous inspection on 7th February 2013 we found the environment on the wards we visited to be stark, unclean and the furniture had been damaged.

At this inspection we found that improvements had been made to the environment. The wards we visited were clean and provided a welcoming environment with pictures and noticeboards on the walls. We found the damaged furniture had been replaced. The wards provided a safe and secure environment for people using the service.

On 17 July 2012, we inspected the Denis Hill Unit, a neurodevelopment disorder service.

On 18 July 2012, we inspected Gresham Psychiatric Intensive Care Unit, Chaffinch ward (ward for mentally disordered offenders), Mother and Baby unit, Eating Disorders Unit, Gresham ward 1 (Female acute ward) and Behavioural Disorders Unit (Witley ward).

People told us they were involved in decisions about their care and treatment. They participated in regular community meetings within the wards.

People told us of the opportunities they had to participate in skills development, fitness and recreational activities, within the ward and hospital grounds.

People were complimentary about the staff, told us they were respectful and treated them well. However, patients noted a difference in the quality of care and treatment they received from bank staff compared with members of the permanent staff team.

The majority of people who use the service that we spoke to told us they were happy with the service they received, and that most of the staff were kind and supportive.

People said they generally feel that they get the right treatment for their needs and that they feel able to talk about this, where they spoke about opportunities they have to feedback about the service they receive. However we found that the systems for gaining people's experiences were not present on every ward. Similarly, we found that not all wards have regular meaningful activities to keep people occupied.

Some people said that they do not always feel safe on the wards, due to less staff numbers at times. Similarly, a number of people said that their main area of concern is that there are not enough staff to support them to go out when they want to, even when this has been arranged.

Most people told us that they were happy with the environment, and that they had their own private space, plus communal areas they could use.

We spoke with nine patients. We spoke with 13 staff of different disciplines which included nurses, pharmacist, consultant psychiatrist, occupational therapist, charge nurse, activity coordinator, social worker, ward clerk, inpatient administrator, and a health care assistant. We also spoke with the ward manager and clinical services manager.

The majority of patients we spoke with said they were happy with the service and the staff were kind and caring. We observed caring and positive interactions between staff and patients on the ward.

We identified concerns across a number of areas that we looked at. Patients' care plans were not always reviewed on time and we did not see evidence of patients' involvement in their care planning. Patients' individual care plans did not include identified risks. Daily planning meetings and weekly community meetings did not regularly happen. Some risk assessments were not up to date.

Patients were not protected against the risk of abuse. Some of the staff were not aware of who the trust’s safeguarding lead was or which local authority to report to. We found that some incidents had not been reported appropriately. Staff did not understand safeguarding procedures and referrals were not made to the appropriate authority immediately.