St Charles Mental Health Centre

We also received information about serious incidents in the service. We reviewed information from stakeholders prior to the inspection to ensure we inspected against concerns that had been raised since the last inspection.

We visited four wards including an older people's ward (Redwood ward), one acute admission ward (Thames ward) and the two psychiatric intensive care units (PICU - Nile and Shannon wards). From the compliance actions submitted from the last inspection in September 2013 the provider took the decision to implement an Accelerated Service Improvement Programme (ASIP) across both of the PICUs to implement and ensure sustainability of improvements on the wards. We were assured that the trust's board had sight of the developments and challenges inherent to the PICUs. We were informed by senior management in the service that the ASIP process would be signed off by the board once they were satisfied the required improvements had been made.

At our inspection we found improvements had been made against the previously identified non-compliant areas. Although systems had been embedded across the service the pace of change since the last inspection had been slower than expected against the action plan and this was confirmed by senior management staff we spoke with in the service and findings on the day of the inspection. For example there were continuing issues in relation the development of care plans and appropriate risk assessments and staff documenting the relevant detail around a person's ability to consent to specific decisions.

We observed positive interactions between staff and people across the wards.

The centre had policies on consent procedures. Staff had been trained in how to assess mental capacity and were aware of their responsibilities however, we did not see records of capacity assessments. We were told that by staff that patients had their rights explained to them. Patients confirmed that they had their rights explained to them, but we did not see records of this.

Care plans and risk assessments were completed. However, the level of detail was not consistent in all wards visited. There were examples of practices which was not conducive to the care and welfare of patients.

The Trust had appropriate policies in Safeguarding Adults and staff had received training in safeguarding. Staff in different wards gave explanations of the signs of abuse and provided examples of the various forms of abuse. However, we were given examples of incidents which had not been reported in line with the Trust policy in one ward.

There were systems in place to monitor the quality of service people received. People were asked for their feedback through patient surveys and service user meetings. We saw evidence that feedback was acted upon.