We conducted this inspection on Bucklebury Ward. We found that staff respected people's rights, involved them in their care where possible and were thoughtful about the care provided. Staff we spoke with demonstrated a good understanding of people's needs and the ethical issues involved in treating people who were detained. However, one person told us “They don't speak to me with respect”. Other records and information looked at did not support this view.

There was a programme of activities which took place daily that people could choose to participate in. One person said “The activities are OK, and you can stay on the ward and play games”. Information was displayed at several points around the ward to inform people about a range of topics. Some of this information was out of date. Meetings were held with people three times a week to discuss how the ward operated. One person told us “I leave the meetings because it's a one-way conversation”. However records seen did not support this view.

Staff felt supported in their role and had access to regular recorded one to one supervision meetings. There were regular team meetings, role specific meetings, debriefing sessions and reflective practice discussions.

Patients told us that generally the staff were supportive and that they felt safe within Thornford Park.

We rated Thornford Park as good because:

• Risk assessments and risk management plans were detailed, thorough and up to date and patients had been involved in the development of the plans. The assessment of patients’ needs and the planning of their care was thorough, individualised and had a focus on recovery. Physical healthcare assessments and associated plans of care were thorough and consistently delivered to a high standard. Care plans had either a National Institute for Health and Care Excellence (NICE) guidance reference to an identified intervention or another nationally recognised intervention such as from the Quality Network for Forensic Mental Health led by the Royal College of Psychiatrists.

• There were enough suitably qualified and trained staff to provide care to a safe standard. We consistently saw respectful, patient, responsive and kind interactions between staff and patients. Staff displayed a high level of understanding of the individual needs of patients. There were innovative practices used consistently across the service to engage and involve patients in the care and treatment they received, for example, the recovery star. There was a confident and thorough understanding of relational security among all of the staff. Relational security is how staff use their knowledge and understanding of their patients to ensure the ward environment is kept calm and any conflict is kept to a minimum.

• Bed management processes were effective and there was a clear care pathway through the service from medium secure wards to the least restrictive environments, such as the shared flats. The service model optimised patients’ recovery, comfort and dignity. The needs of patients were considered at all times.

• The service had clear guidance in place to report incidents and we saw evidence that staff learnt from when things had gone wrong. The service was responsive to listening to concerns or ideas made by patients and their relatives to improve services. We saw that when staff where able to, these ideas were taken on board and implemented.

• Staff monitored patients’ physical healthcare and they could access specialist physical health services when needed. A GP provided regular physical health monitoring. Patients attended a well-man clinic.

• We observed many positive engagement and interaction between staff and patients. Staff demonstrated a clear understanding of individual patient’s needs.

However:

• Staff were not always available to facilitate section 17 leave on the forensic wards and leave was often cancelled.

• The number of staff having access to regular supervision was below the provider’s target of 90%.

• Not all patients were always reminded of their rights when their circumstances changed, such as on renewal of detention.

• The seclusion room did not have a two-way intercom to ease communication between staff and patients.  Gym equipment was worn . All of these facility issues had been identified for refurbishment and upgrade in 2018

• The recording of seclusion was documented differently across the wards. Staff made the required checks however, some was recorded electronically and some in paper form.