We rated The Copse as requires improvement because:

• Staff did not always carry out or document that they had carried out physical health checks for patients. They had not checked a patient for signs of over sedation, after administering rapid tranquilisation medicine to reduce their aggression; over sedation can lead to breathing complications and potentially suffocation. We found mistakes had been made with the administration of clozapine (a medicine with potentially serious cardiac effects. Despite clear documentation to tell staff not to administer a full dose of clozapine (national guidance is to build up to the full dose) staff had administered the full dose straight off. Staff had not recognised that this should have been reported as an incident. Once we highlighted this to staff, they reported it as an incident. Patients on this medicine were not checked regularly for any signs of side effects.
• The systems in place did not ensure that allegations of abuse were raised in a timely manner to the appropriate bodies. Staff had received training on how to identify and raise concerns, but they left this task to a single member of staff. There were poor cover procedures or protocols for when this staff member was on leave or sick. We saw that this meant two alerts had not been made to the local authority, and staff had not notified CQC of the allegations of abuse as is required. We raised this and staff made the alerts retrospectively. Delays in raising safeguarding alerts potentially puts patients at risk of further abuse.
• Processes to ensure that learning from incidents was recorded did not always work. Staff discussed changes in patients’ risks, and incidents that took place, but did not always document this appropriately or update risk assessments following incidents.
• The process that staff followed when assessing a patient’s capacity to make decisions about their care did not ensure these assessments were always completed or available to relevant staff. We saw incidents where staff had acted against patients’ wishes without assessing their capacity to make that decision. When staff did carry out best interest assessments they stored this on a staff member’s individual computer drive, rather than in the care records. This meant that staff could not always access the documentation they needed.

However:

• Staff had started to implement a new recovery model based on the Recovery Star to help guide patients through their recovery and reach their individual goals.
• Patients said they felt staff were caring and supportive and involved them in their care planning and care decisions.
• A new hospital director had taken up post six months before this inspection, which staff saw as a positive. They felt the new director was approachable, supportive and willing to listen and act on any concerns their concerns. This had helped develop a culture of respect and pride in working at the hospital.
• The admission and discharge process at the hospital allowed patients to be discharged when they were ready (if there was an appropriate placement for them to go to).
• There were facilities to ensure that people with disabilities could receive care at the hospital, and the service could provide meals to meet patients dietary, cultural and spiritual needs.