- Independent mental health service
Arbury Court
Assessment report published 5 June 2025
Contents
Ratings - Forensic inpatient or secure wards
Our view of the service
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.
People's experience of this service
Patients on the forensic inpatient or secure wards gave mixed feedback about their experiences of the service overall.
Patients stated that staff were generally caring and were positive about the permanent staff on the wards. Some patients raised concerns that certain staff were not always respectful to them or spoke in their own languages, particularly on nights. Patients also noted that staff did not always interact with them or were just on observations, which impacted on the patient experience on the wards.
Patients that we spoke to did not raise a concern about staff being visible on the wards, but did note that staff were often busy or in demand on the wards.
Patients described mixed levels of involvement in their care and treatment, with some patients feeling appropriately involved whilst others did not feel that they were always listened to or given appropriate information.
We spoke to two patients who had been restrained whilst on the wards who gave very positive feedback about how staff had managed the restraint and supported them afterwards.