We looked at the care records for eight people on the ward. We found all care records had an up to date risk assessment in place which was updated weekly. Staff told us that the health check booklet booklet that was currently being used on the Hadrian Unit will be reviewed with a view to extending its use across the trust. We saw that a blood pressure recording chart had been completed for each person before a specific drug administration. This chart was kept with the medicines prescription card.

The advance nurse practitioner (ANP) held a well being clinic on the unit once a week and every new person admitted underwent a full physical health screening. One member of staff told us, “The trust has invested more into the physical health needs of people during the last six months.”

We saw evidence of care plan audits and handover audits being undertaken to ensure that staff were completing these correctly. The audit undertaken by the ANP in November 2012 demonstrated that there had been an improvement in the completion of records.

We conducted a desk top review of the information; we did not undertake a site inspection or talk to staff and patients at this time. The information supplied to us by the trust confirmed that they had addressed concerns and had put systems in place to ensure compliance with this standard. We saw documented evidence that ward staff log all safeguarding and restraint incidents on the trust’s risk management database through the online reporting system.

The ward manager provided a summary report each month for the LD Clinical Governance Committee regarding safeguarding and restraint incidents, actions taken and any lessons learned. The trust confirmed that the logging and incident protocol had been reviewed and strengthened. This was to ensure that repeated incidents which were associated with the same person, were now included and assessed as part of the monitoring systems.

All patients we spoke to felt that staff treated them well. They said they were offered access to independent advocacy services, and that staff listened to them and were approachable.

However other comments were: ”I try not to ask them because I feel I am getting in the way” and ”they are understaffed.”

The reports from the patient feedback meetings reported that the ward was extremely busy and staff had been “run off their feet” to the extent that some patients said that they had not felt able to approach staff with simple needs as they felt this would take the staff away from “important duties”.

There were five patients staying on the unit when we visited, of those we spoke to four, and observed all five over the two day period. All those we spoke to said that staff treated them well and that they liked spending time talking to and going out with staff. One patient and their family told us that on occasions they had not been able to go out as other patients needed more help, and although they had understood the reasons for this, they found this to be a problem.

Patients told us that staff were helping them to sort out their problems and to move on.

When staff had used restraint on them, those spoken to said that this had been agreed prior to it happening and was part of their care plan.

Patients were all very focused on their plans for discharge, and had a good understanding of why they had been admitted to the unit. One patient was being discharged on the day we inspected after being at the service for two weeks. They were keen to tell us that they had enjoyed their stay and were feeling much calmer and was ready to go home.

Two relatives told us that although Edenwood was along way from home, they felt well informed and included in the care of their relative. They commented that the experience and stay at Carlton Clinic for their relative had been a positive one.