Arbury Court

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At our last inspection we rated this key question good. At this inspection the rating has remained good. Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. Staff informed and involved families and carers appropriately.

We have not awarded this service a score for Caring.

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

We scored the service as 3. The evidence showed a good standard. The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues from other organisations with kindness and respect.

We spoke with 11 patients across the three forensic inpatient or secure wards.

Some patients were not happy with staffing changes; they felt that their new staff were not as respectful as the previous staff they worked with. Some patients stated they thought staff did not care but could not explain why. One patient told us that they felt the staff were respectful, they knocked on doors before entering their bedroom, and staff were caring.

A patient on Daresbury ward told us that it was difficult to settle on the ward after admission, but that staff were “very encouraging”, pushing the positives of treatment and encouraging engagement with the occupational therapist for the ward. A patient on Oakmere ward told us they felt that staff were too quick to “go hands on” when dealing with patients, too quick to restrain, but stated that it was often for the good of the patient and others. Some patients told us that they did not have care plans, but a check of records showed that patients did have care plans, had been offered copies, and risk assessments were in place.

We observed staff interacting with patients. We watched a dance fitness programme on Daresbury ward, led by an external facilitator, and both staff and patients joined in. It was clear that all participants were enjoying the experience, and the interaction with staff was positive. As the inspection team moved through the service, we saw lots of positive interaction between staff and patients.

Minutes of reviews and meetings did not indicate that patients had any problems with staff attitudes towards care. Community meeting notes reviewed did not show any evidence of problems between staff and patients, one meeting in early February 2026 included a patient suggesting that other patients needed to be more respectful of each other. During observations by the inspection team on Daresbury ward, staff were seen to spend more time out of the nursing office and with patients, with positive interactions displayed.

Visits to the service by other organisations were always welcomed, reports from PROSPECT indicated that staff and the service were helpful and attentive.

We saw from care records that patients were directed to relevant services where appropriate. The service had reached an agreement with the local general hospital A&E department that patients could be seen more efficiently where possible, to lessen the impact of long waiting times outside of the service or for treatment.

Staff we spoke with told us that they did not fear consequences of raising discriminatory or abusive attitudes by other staff against patients. Staff generally felt supported by management.

We saw no breaches of confidentiality by staff about patients.

We scored the service as 3. The evidence showed a good standard. The service treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Every new patient to the forensic inpatient or secure wards received a welcome booklet that explained the service provided, and all patients had the option to visit the service should they so wish prior to admission, or a virtual meeting by computer was offered. Care plans and risk assessments were designed and completed to the specific needs of the patient, and views were considered during the process. Patients attended multi-disciplinary team meetings and ward rounds. They had advocates if they wanted someone to speak for them and carers could attend meetings to support patients if the patient requested attendance. The service would ensure that sign language or interpreters were provided as needed. During the inspection we noted patients being involved in activities that they enjoyed on the wards. Patients with physical disabilities could be cared for at the service, the service being on ground level, and wheelchair access was present.

Community meetings were a regular occurrence across the forensic inpatient or secure wards, giving patients the chance to raise issues or concerns about their treatment or if they thought their protected characteristics were not being considered. The meetings followed an agenda that included feedback from previous meetings, environment on the ward, views on interventions and restrictions that had been in place that week, whether staff and patient relationships were working, planned events and celebrations of success and good news. We reviewed community minutes from each ward in the forensic inpatient or secure wards. The minutes from Delamere ward clearly indicated a shift in the patient staff relationship as the changes to ward staff and ward moves took place. Patients stated that they did not want to move and worried that relationships built would not be the same. This the theme continued after the move. Patients identified that it would take time to build new relationships, they noted that the number of incidents on the wards had increased as patients were unhappy, but the minutes also noted that the patients had recognised the need to change the service.

Patients had input on food choices at the service, these could be and were adapted to fit with cultural needs.

Should language difficulties arise, the service could engage translation services to assist. This was considered during the pre-admission assessment. Information leaflets in languages other than English could be obtained when needed. There was a pastor available for religious support, and other religions were welcome at the service: the diversity, equality and inclusion policy clearly stated that there would be no discrimination with regard to any religion.

We scored the service as 3. The evidence showed a good standard. The service promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

The service placed importance on carer involvement, and the forensic inpatient or secure wards did what they could to facilitate family contact and involvement leading to improved outcomes that were patient and carer led. Patients were allowed to contact their family unless the patient stated they wanted no family contact, or it was deemed that contact would not be in the patient’s best interest. The service tried to be flexible with times for meetings, to ensure that families could fit visiting in with their schedule rather than having to adhere to a strict time structure. There were visiting rooms specifically for meeting families. There were policies in place for visiting children.

The advocacy service was available and was utilised by patients when they felt they needed support or a voice in meetings and to represent them. We saw evidence of advocacy involvement and signage informing patients of their rights and how to access advocacy. Patients we spoke with knew how to access advocacy.

We scored the service as 3. The evidence showed a good standard. The service listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We saw evidence of patient aggression towards staff who were calm and used verbal de-escalation to defuse the situation. On Oakmere ward at the time of the inspection, all patients were on high level observations due to the acuity on the ward. Patients were becoming aggressive and then passive with staff and other patients; staff were seen to be managing situations well and with minimum impact on a tense ward atmosphere.

Care plans showed that there were plans in place to de-escalate each patient in a specific manner, a manner that had been agreed with the patient when compiling the care plan. This included signs of escalation, how to recognise them, how the patient wanted to be treated should this become evident, and the best outcomes for the patient and staff on the ward.

During observations on the wards, we saw staff responding to patients quickly, firmly, and often with a sense of humour that helped to defuse tension. It was clear that some patients were aggravated, upset, and unhappy that they did not get what they felt they needed; they told us this in interview in their comments about staff changes and ward moves.

Care plans and risk assessments showed that staff were confident in their abilities to react quickly should there be any physical ailments or problems with patients on the wards

We scored the service as 3. The evidence showed a good standard. The service cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

Some staff we spoke with were unhappy about the recent changes made to the service. The number of patients across the site was decreased, and the forensic inpatient or secure wards limited to one medium secure unit and two low secure units. Both patients and staff were relocated around the service, and this created some difference of opinions among staff. Some staff told us that the moves were necessary, others felt that they could not understand the rationale for the move.

We saw evidence that staff had been fully informed of the changes that were taking place, and the reasons for the change. We saw an informative email from September 2025 to all staff regarding the closure of a former ward, which informed staff that they would be kept up to date with any further changes or actions across the site. Staff listening forums were set up for all staff to attend and ask questions or raise points of view. Patient communication letters in easy-read format were sent out in October 2025 informing patients of changes and how to seek assistance if required. Information was sent to commissioners outlining the rationale behind changes, we saw an email sent out in October 2025, to a commissioner that clearly stated the reasoning behind the changes to the site and service. Minutes of meetings with commissioners were viewed and it was noted that, since the changes at the service, senior management had introduced a number of initiatives to improve staff wellbeing.

Three staff members on one ward told us that they felt supported and listened to, and if they requested help, they felt managers did their best to facilitate this. One staff member said that they felt the changes to the service could have been more gradual but felt that there were no more ‘cliques’ on the wards and this led to a more helpful atmosphere. The changes to the service prior to the inspection were expected to show different viewpoints from both staff and patients. This was reflected in Daresbury ward staff meeting minutes from December 2026.

Staff supervision and appraisals were regularly scheduled, and staff felt they could raise matters such as career development.