Penn Hospital

We spent time in the communal areas, chatting with people who used the service and observing the interactions between them and the staff. We saw some people being supported on a one-to-one basis when they were at risk of harm to themselves and possibly to other people. We saw staff being very vigilant, supporting people in a competent and calm way. We saw that the privacy and dignity of some people was not always upheld by the working practices of staff. Some people told us they were comfortable, we saw other people appearing not so.

We looked at a selection of care records including risk assessments and support plans. In the files we looked at we saw that each person had a very detailed plan of care for their mental health care needs. We did not see, and staff could not produce, a similar plan of care for physical health care needs. We saw inconsistencies and omissions of recording a person's consent to their care and treatment. We saw that a mental capacity and best interest assessment had been completed where a person was unable to make decisions for themselves.

We saw that some improvements had been made to the storage of medication. A treatment room on one ward had been re-sited and was now in a much safer area. We saw that action had not been taken when it was identified that the fridge for the cool storage of medication was not at the correct temperature or when the daily temperature was not recorded.

Staff told us the action they would take if they had any suspicions of abuse, this was consistent with their job role. One staff was not quite sure but would report any concerns to the person in charge. Staff told us and we saw that the least restrictive course of action was taken when people were at risk of harm.

We saw that improvements have been made to the environment when issues regarding the safety of people within the wards were identified. We were told of the plans for major works to the building to begin in April 2012 this to improve the facilities. Staff told us there will be additional communal space for people as well as single occupancy bedrooms for all people.

Staff told us that the staffing levels on the wards have improved and that generally there were sufficient numbers of staff to meet the needs of people. They told us that sometimes staff call in sick at short notice and at times it was difficult to arrange cover. They told us that bank staff usually fill in the gaps. One staff member told us the bank staff were 'a regular bunch of people'.

Most staff told us that opportunities for training was 'much better than it was', with the majority of staff spoken with confirming they had received mandatory training. All staff were to be provided with training passports which direct them to the frequency and the subject area required for their job.

We were told of the systems in place for monitoring and assessing the quality and safety of the service. We saw that audits were being completed but found they were not as effective as they should be.

Some people told us that they were aware that they had a written plan of their care needs. Other people were unaware of this. People said they were usually consulted on the treatment that they were to receive, with staff explaining the reasons behind a particular treatment.

Some people commented that the food could be improved and that more fresh fruit would be beneficial. Some people told us they were able to make drinks for themselves when they wished to have a drink. Other people told us they had to ask the staff for refreshments as there was no facility for making drinks on this particular ward.

Some people were aware of the dedicated activity suite within the hospital; others told us they were unaware of this facility. Some people told us that they liked to participate in the various activity sessions that are arranged during the day. Others declined to participate. One person commented that they felt it was important to keep busy and occupied during the day to overcome the monotony of being in hospital.

Some people told us that they were very much at ease in the ward environment. Other people told us that they did not feel safe and that there was not enough staff around to protect them. They commented that there were too many 'blind spots' around the ward which made them feel very vulnerable.

People told us that the staff were very diligent with supporting them to take their medication, and if they asked for their medication the staff would give it to them without much delay.

In some areas around the hospital people told us it was too noisy, too hot or too cold.