Mill Garth

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection we rated this key question good. At this inspection the rating has remained good. The ward and bespoke therapeutic units were safe, clean well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had not had any serious incidents in the 12 months prior to the inspection.

All staff knew what incidents to report and how to report them.

We reviewed 15 incidents and saw that these were reported in a timely manner and categorised appropriately, with action identified where appropriate. Staff recorded incidents within 24 hours and managers graded each incident in terms of severity. There was also evidence of embedding learning from incidents within staff training.

The incident reporting and learning systems within the service were accessible and responsive. Managers ensured that all staff, including bank and agency staff, were trained and supported to use them. All staff knew what incidents to report and how to report them through a dedicated recording system.

We observed 3 morning meetings: the morning multidisiplinary handover meeting a ‘10@10’ communications meeting and a ward safety huddle. We saw that staff discussed recent incidents that had occurred and provided updates to others about the progress of these including action taken.

Staff shared learning from incidents through several routes. These included staff meetings, dashboard review meetings, and flash meetings which allowed information to be handed over to the wider multidisciplinary team including maintenance, catering and domestic staff.

Staff we spoke with understood the duty of candour. Staff were open and transparent and gave patients and families a full explanation on what had gone wrong.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Patients were at different stages of their treatment with some patients nearly ready for discharge. Patients told us they were involved in discussions about their pathway.

Staff we spoke with told us they arranged for patients to visit prospective placements prior to finalising discharge. They described a clear pathway which ensured a safe transition for patients.

Patients in the 2 bespoke therapeutic placements shared that it had been beneficial to their recovery to have access to a living space off the main ward to support them with their transition for discharge from the service.

All admissions and discharges were thoroughly planned with support from partner organisations with Integrated Care Board involvement to ensure these worked well.

The clinical director, responsible clinician, and hospital director were cited on all potential new admissions and were part of multidisciplinary discussions to evaluate whether patients were suitable for the service. Managers received referral information about patients from the referring provider, and staff completed face-to-face assessments to assess patients’ clinical suitability.

Care records evidenced that patients and staff worked together to identify objectives and goals to prepare them for discharge. There was a focus on developing activities of daily living and independence.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Patients we spoke with told us they felt safe, that staff were supportive, and they felt able to raise concerns.

Staff we spoke with knew the patients, their individual risks and any potential safeguarding concerns. Staff understood the process for making safeguarding referrals and knew the escalation process for what to report and who to report it to. There were good links with the local authority and staff had access to additional local services for support.

There were several morning meetings that different staff groups were able to attend, including nurses, health care workers, psychology, maintenance and catering staff. There was clear evidence of information sharing which staff documented in care records. Managers supported staff in response to recent incidents and checked their wellbeing, ensuring they felt safe.

There was a safeguarding policy in place which was subject to regular review. At the time of inspection, safeguarding adults training compliance was 92% and safeguarding children was 92%. There was a clear process in place for submitting safeguarding alerts. These were reviewed by the ward manager and discussed within the monthly clinical governance meeting. Managers made sure that records adhered to safeguarding requirements through regular audits.

When reviewing all aspects of restrictive interventions within the service we did not identify any concerns and we were assured of the processes used by the service to ensure these were proportionate to the risk.

The service had a blanket restriction register and there were currently 3 blanket restrictions in place. These were; patients limited to two takeaways a week, no vaping inside the hospital, and the occupation therapy kitchen being locked. Each restriction had a clear rationale and was reviewed monthly, and during multidisciplinary meetings, community meetings and clinical governance meetings.

A review of physical restraint incidents for the 12 months prior to inspection evidenced that for between 1 July 2025 to 31 December 2025 there had been no use of physical restraint. Between 1 January and 30 June 2026 there had been 18 incidents where physical restraint was used, with 13 of these incidents relating to the same patient. The service provided evidence to show these incidents were a result of responding to violence and aggression and had been managed appropriately. The 13 incidents were reviewed by the management team who were able to identify that physical restraint had been used due to assault on staff, or to reduce further harm to the patient.

A review of rapid tranquilisation over the 12 months prior to inspection evidenced that this had been used 3 times, all for the same patient. There had been a clear clinical rational and justification provided for each instance. All 3 interventions were documented successfully with no reported complications. Staff had completed post intervention physical health monitoring in line with the organisational policies and guidance.

Mental Capacity Act

Overall, 81% of staff had training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act. They could explain how the this applied to their role and describe the 5 key principles of the Act.

There had been no deprivation of liberty safeguards applications made in the 12 months prior to the inspection.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice from within the provider, regarding the Mental Capacity Act, including deprivations of liberty safeguards.

Staff took all practical steps to support patients to make their own decisions. For patients who may have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions. When patients did lack capacity, staff made decisions in their best interests, recognising the importance of the persons wishes, feelings, culture and history.

The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. The ward staff participated in the provider’s restrictive interventions reduction programme. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew about the risks associated with each patient and acted to prevent or reduce them. Staff could easily access risk information about patients in patient records. Managers also recorded important risk information.

Patients told us they felt safe, and that staff supported them to manage risks. We reviewed 5 risk assessments during this inspection. Staff completed these for each patient on or soon after admission using a tool built into the services’ care records system. Care records evidenced that risk assessments were detailed, personalised, and that staff reviewed these regularly, including after any incident.

Staff shared the range of ways in which risk was understood and managed. Staff discussed incidents regularly at a variety of meetings. These included handovers, team meetings, ward rounds, multidisciplinary team meetings, and clinical governance meetings. Staff escalated concerns to managers when needed.

Staff worked with patients to develop formulations, to understand risks and produce positive behaviour support plans to try and reduce risks and distress, and to enhance patient wellbeing.

Staff described how they used de-escalation techniques wherever possible before using physical restraint.

Following staff concerns around increased violence and aggression from patients within the bespoke therapeutic placements, managers had commissioned and independent threat assessment. This included an analysis of incidents and behaviours and patient interviews with outcomes used to design an interactive staff training programme. The content of the training was focused on developing core practice skills and managers told us the overarching aim was to train staff in how to effectively reduce incidents and respond to these appropriately.

Staff were aware of guidance around restrictive practice and could provide examples of how they used the least restrictive option, for example regarding access to section 17 leave. The service did not have seclusion suite, and seclusion was not used by staff.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Patients told us that they felt safe on the ward and could speak with staff if they had any concerns. Staff were observed completing observations depending on the location and observation level of each person.

Managers completed regular walk rounds of the ward to check the environment and escalated any concerns to the estates team. Ward areas were clean, well maintained, well-furnished and fit for purpose.

All staff carried radios and could respond promptly to alerts. Staff also had access to panic alarms and nurse call alarms were in each room. There were policies, procedures and risk assessments in place for health and safety and business continuity.

We reviewed the environmental risk assessments and found that managers completed and regularly updated these. The assessments clearly highlighted areas of risk and appropriate mitigations that were in place to help reduce the risk level. An environmental risk had been identified with moss on the roof. This was documented on the risk register which set out action taken. Managers had received quotes for the work to be carried out and were aware of the risk of gutters being blocked.

Due to the age of the ensuite bathrooms, managers had identified a risk of mould developing. During the tour of the service, we did not find any mould within the bathrooms.

As a precaution, managers used anti-mould treatment regularly, and work was planned to commence the renovation of 6 ensuite bathrooms during the summer. This risk was also on the risk register and subject to regular review.

Mirrors were in place within the ward to ensure any blind spot risks were reduced as well as having staff regularly present on the ward.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

At the time of inspection there were 10 registered nurses with 2 nurse vacancies (20%). The service had a full health care assistant team of 27 support workers. The service was not currently at full bed capacity with 8 patients on the main ward and 2 patients within bespoke therapeutic placements.

A staffing matrix was in place to calculate staffing numbers based on patient numbers and acuity. Baseline staffing levels were 3 nurses and 5 healthcare assistants during the day and 2 nurses and 5 healthcare assistants on a night. Staff reported “We feel it is workable and safe”.

In the 3 months prior to the inspection, there had been no shifts that were short staffed. Managers told us they used bank and agency staff who were familiar with the service where possible. In the 3 months prior to the inspection, bank staff usage was 4.2% and agency staff usage was 1.5%.

Staff sickness was low. In the 3 months prior to inspection sickness rates were 2.9%. Staff turnover was also low, and the annual staffing turnover was 1.2%.

There was a process in place to ensure all staff had completed corporate and local level inductions and that relevant competencies were signed off.

Staff received and were up to date with appropriate mandatory training. Overall training compliance was 94%. The training provided was appropriate for the patient group using the service. Training included: reducing restrictive intervention training; trauma informed care awareness training, and observations training.

The service also included equality, diversity and inclusion training covering topics on disability inclusion (100% training compliance), inclusion essentials (97% training compliance), neurodiversity (100% training compliance) and supporting trans and non-binary people at work, a guide for managers (100% compliance).

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff had access to personal protective equipment and hand-washing facilities. There were clear roles, responsibilities and procedures around infection prevention and control. The service had an infection prevention and control policy which was up to date.

The service had cleaning schedules and cleaning logs which staff had completed and were up to date. Domestic staff worked 7 days each week to ensure the environment was clean and adhered to infection control measures.

There were health and safety meetings attended by the catering, domestic, estates teams to discuss any issues relating to environment or infection prevention and control concerns.

During a tour of the ward 4 expired items of tinned food were found in the occupational therapy/activities of daily living kitchen. There was a standardised form used by staff when checking the fridges which directed staff to check the food and we saw these checks had been routinely completed. Managers felt this was due to the standardised form not explicitly prompting staff to check expiry dates. They took prompt action in response to this including removing the food items and making amendments to the form.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed good practice in medicines management which was in line with national guidance. Medicines were dispensed by a registered nurse, and we noted the medicines administration and recording was managed well. The service made sure that medicines and treatments were safe and met patient’s needs, capacities and preferences by enabling them to be involved in planning, and ongoing discussions about their medicine.

We reviewed prescription charts for all 9 patients. Medicines administration records were clearly completed and where needed the appropriate Mental Health Act authorities for prescribing were in place.

Staff reviewed the effects of medicines on patients' physical health regularly and in line with National Institute for Health and Care Excellence (NICE) guidance. Staff had access to tools for monitoring side effects and had support through the pharmacy team. Patients with physical health conditions, including diabetes, received appropriate monitoring, with clear involvement from external healthcare professionals. Care plans were in place to support patients with long-term physical health conditions and their mental health medicines.

Care records and staff interviews confirmed that patients had regular multidisciplinary team meetings where side effects of medicine were discussed and acted upon where appropriate. Staff documented patients’ preferences about medicines and prescribing decisions.

Staff were required to complete and document a weekly check of emergency equipment contained within the emergency bag. We reviewed the weekly checks for the 5 months period prior to inspection and saw this was completed on all occasions apart from the first two weeks in June 2026. We raised this with managers who provided evidence that these checks had been completed. Staff had completed the appropriate checks but had not completed the form until midnight on the required day, which flagged as not completed on the electronic system. Managers told us they would revisit this process with staff to prevent this from reoccurring.