There were seven people using the service when we conducted an unannounced visit to Tiverton Hospital. We had conversations with two and because of their condition limited conversations with two others. Most of our information on people's experience was gained through our observation. People may remain on the unit for many months. When the unit was closing this was handled with care and with each person's needs carefully considered.Care workers were treating people with patience and respect. There was a good rapport between some care workers and people using services but some demonstrated less skill in the way they engaged with people. Care workers we spoke with about people's specific needs were able to demonstrate good knowledge. People were clearly pleased to see particular care workers but none was able to give an opinion of the staffing arrangements.
People appeared clean and well cared for. Some had exercised their right to refuse some treatment and risk from this was being managed by care workers.
One person held a personal telephone call in clear earshot of many other people. There was an angry exchange between the person and their family, which should have been private. Observation windows into people's bedrooms were left open and any person could look in. Privacy and dignity were not adequately supported.
We saw that people wandered up and down the corridors or congregated at a crossroads of four corridors, next to a nursing station. We saw no meaningful activities on the unit other than one person actively watching the television. The unit environment provided very little stimulation. It contained few items of reference to people with dementia. There was little in place to help maintain people's interest or skills. Due to the shape of the unit care workers needed to pass people regularly as they moved around. There was less contact during these movements and some people just watched them walking by.
The atmosphere in the unit felt mostly stark and essentially clinical in nature, with rooms which echoed, affecting what you hear. D'cor was pale and furnishings sparse, with the exception of a lounge which contained homely furnishings and features. The only smells were cleaning fluids followed by that of overcooked cauliflower at lunch time. Some information on corridor walls reduced the starkness of the unit but it was essentially clinical in nature and did not enhance feelings of warmth or comfort. We were told that one person tries to use a red bin as a lavatory, the other toilet furniture being white and indistinct, and we saw them attempt this.
We saw that the garden space was secure in that people could not wander away from the unit into harm. However, although available for use by people it contained broken plant pots and trip hazards.
We saw a trolley with cleaning fluids left unattended and posing a danger to people using services. The unit was very clean and we saw that care workers followed protocol to maintain hygienic conditions.
Asked about the food people told us: 'Sometimes it's good. Sometimes it's not so good' and 'Food was lovely but it got worse and worse'. The lunch time meal we saw looked very unappetising; the vegetables very overcooked. People were offered choices of food and drink at regular intervals.
Two people told us about their own circumstance and we found that their records substantiated the information they gave. Records provided detailed information for care workers about people's needs.
The modern matron and the manager of Melrose Unit both spent time there during our visit and clearly worked in good cooperation toward good outcomes for people using the service.