Arbury Court

Our rating of this service stayed the same. We rated it as require improvement:

The service had not maintained the environment with mould and badly maintained fixtures and fittings.

Staff supervision and appraisal compliance rates were low in the months prior to the assessment. Staff mandatory training compliance was also below 75% for some of their training courses, including therapeutic observations and engagement, which was a concern as patients that we spoke to described that staff undertaking enhanced observations did not often engage or interact with them.

Some observation sheets had not been completed so we could not assure ourselves observation checks had been completed.

Senior managers within the hospital did not always use governance process to effectively monitor, manage and take action to address identified issues in a timely manner.

However;
Ligature risk assessments were up to date and security checks were carried out regularly. The ward had enough nurses and doctors. Staff assessed and managed risk well, patients all had up to date, relevant risk assessments.
Staff followed good practice with respect to safeguarding. Staff had received appropriate safeguarding training and there were systems in place to support staff make safeguarding referrals when required.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.

Dates of onsite assessment: 22 to 26 July 2024; with additional offsite interviews taking place on 29 to 31 July 2024.

We carried out an unannounced assessment of the forensic inpatient or secure wards. We visited all 4 forensic inpatient or secure wards which included 2 medium secure wards, Delamere and Oakmere, and 2 low secure wards, Daresbury and Hartford.

We assessed 18 quality statements across the safe, effective, caring, responsive and well led key questions. We have combined the scores for these areas with scores from the last inspection. Our overall rating for this core service is requires improvement. We identified 4 breaches of the legal regulations in relation to person-centred care, premises and equipment, staffing and governance.

At this assessment, we found that physical health monitoring was not always recorded appropriately and there were inconsistencies between what staff told us they should be doing with what the records indicated. This also included inconsistencies across physical health care plans and staff not always following care plans in relation to this.

We identified environmental issues on some of the wards, in particular on Delamere, where there were some large refurbishment projects still awaiting progression, such as the ensuite bathrooms and the Delamere kitchen and laundry. There were also some smaller maintenance projects and issues with damaged furniture and environments on some of the wards.

Staff supervision and appraisal compliance rates were low in the months prior to the assessment. Staff mandatory training compliance was also below 75% for some of their training courses, including therapeutic observations and engagement. This was a concern as patients that we spoke to described that staff undertaking enhanced observations did not often engage or interact with them.

Senior managers within the hospital did not always use governance process to effectively monitor, manage and take action to address identified issues in a timely manner.

However, patient risk assessments were detailed and indicated positive, joined up working across the MDTs on the wards. Staff described feeling supported by their colleagues and ward management. There were systems in place for monitoring and managing risk.