St Ann's Hospital

During this inspection, we spoke with people who were on the ward receiving care and treatment. We also spoke with nursing, medical and therapy staff. We also spoke with the Executive Director of Nursing, Quality and Governance and the Chief Operating Officer. We received information from the trust which we reviewed. We found that the provider was only using the seclusion rooms and the designated place of safety (known as the "s136 suite") when it was clinically appropriate to do so.

One person who was receiving care and treatment on the ward told us "It has been pretty good [on the ward]" and another person told us "If I could have a checklist for here, I would give it ten ticks out of ten". Most of the feedback we received from people on the ward was positive. We observed staff responding with kindness and consideration to people who were receiving care and treatment on the ward.

We checked seven records of people on the ward and found that they were up to date. Everyone had an initial care plan and risk assessment. We saw that sometimes capacity and consent was not explicitly referenced in the electronic notes.

Staff told us that there had been positive changes on the ward since our last inspection and they felt supported to do their jobs.

We spoke with seven members of nursing and medical staff on Haringey Assessment Ward, one member of staff on duty on the s136 suite, we checked the records of six patients on the ward at the time of the inspection and spoke with seven patients. We also requested further information from the Trust after the inspection.

We found that some care was provided in an environment that did not meet the needs of individual patients. We found that people were cared for by staff who knew and understood their responsibilities. We found that most patients had care plans which were recorded and had up to date risk assessments although some patients told us they were not aware that they had care plans.

People told us that they did not have enough activities on the ward and staff told us that the activities which were timetabled to take place did not always take place. Some people also told us that they did not always know their rights and whether they were detained under the Mental Health Act (1983) or whether they had been admitted to the ward informally.

We checked the two seclusion rooms on the ward and looked at the general ward environment. We found that the two seclusion rooms on Haringey Assessment Ward and the s136 suite had been used to admit patients when there were not enough bedrooms in the Trust. This meant that the provider had not made the changes which were indicated in the action plan which was sent to us following the inspection in June 2013 and continued to be non-compliant.

Most people we spoke with told us they received care which they found helpful. We spoke with two relatives of people on Downhills Ward who told us they had not been told when their family members had moved wards or hospitals. One person told us they had been given no advance warning about moving between hospitals in the Trust. Three members of staff raised concerns with us about the Trust's use of seclusion rooms to admit patients to when there were no beds available. We found one patient who was admitted informally had been told that "a section would be activated" if they tried to leave. We found that people who were not detained may be at risk of experiencing the same restrictions as detained patients without any legal protection.

We found that most people told us they felt safe on the wards and that staff had a good understanding of safeguarding and the procedures which they needed to take when there were concerns raised.

We found that the Trust had adopted improved recording and auditing systems when restraint and seclusion was used. We found people and staff were able to feedback information to improve the running of the service.