Arbury Court

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good.

Good: Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Staff from different disciplines worked together as a team to benefit patients. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

We have not awarded this service a score for Effective.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service had a pre-admission assessment form that was completed for all new patients to the service. This was a comprehensive document that allowed the service to ensure that the patient would get the detailed and targeted treatment required to take their journey forward. The form included presenting problems, family history, personal history, schooling, any occupational experience, past psychiatric and forensic history. This was coupled with a pre-admission care plan formulated prior to the patient arriving on the ward. The care plan aimed at covering the first 72 hours on the ward, possibly up to 12 weeks if no amendments were required and looked at short- and medium-term goals for patient care and improvement.

We reviewed care records on all three forensic inpatient or secure wards. It was clear that care plans and risk assessments were taking place and being updated regularly. On Daresbury ward we reviewed 6 sets of care records with no problems noted. All records checked related to patients who had been at the service for a long time, and the records indicated that all actions taken were appropriate and timely. Physical health needs were being considered where practicable: some patients were not willing to maintain agreement to have physical checks completed. If a patient was deemed to have capacity, this limited the physical checks that could be completed if the patient refused to accept them. Physical healthcare was embedded into the service clinical intervention model. There was a physical health nurse employed by the service who helped medical staff to implement physical health checks when required. This included attempts to explain the reasons for the health checks and their benefits to patients. There was a health and wellbeing coach at the service for patients, as well as dietician input into healthy eating from an external health group, provided by an official agreement. The service utilised the National Early Warning Score 2 (NEWS2) to monitor and react to physical deterioration; the application of NEWS2 was better on some wards than others. This was pointed out to the service during the inspection of the completion of NEWS2 being present but not being completed as often as they should. However, the service had a protocol that ensured non-contact physical observations were carried out should a patient refuse to have their contact observations taken. On Oakmere ward the ward manager implemented a training programme aimed at improving physical health care monitoring, with a view to rolling this out to all wards. The service did carry out audits for NEWS2 application, we reviewed an audit for Delamere ward completed in January 2026. The audit showed that NEWS2 was being applied and considered and showed that in November 2025 the problem of patients refusing checks was often present. This would impact on the completion of the NEWS2 documentation. Guidance stated that clinical observation would take place in the event that NEWS2 could not be completed. The service had a service level agreement with a local dentist surgery to ensure any patient dental issues could be dealt with efficiently.

A nationally recognised risk assessment tool was used at the service and was noted to be utilised and updated regularly in the forensic inpatient or secure wards. Care plans were seen to be regularly updated and comprehensive.

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

The clinical governance guidance, which was in review when we conducted the inspection, outlined the need for best practice and evidence-based care, citing relevant guidance for the service.

The service had a clinical model that explained to patients in an easy-read format the rationale behind their treatment. The service had a poster that clearly explained the clinical intervention model. It went through the assessment, treatment and finally the integration into the overall recovery plan for the patient that led to discharge. The psychological aspect of patient treatment also outlined a straightforward rationale using the same model, explaining to patients how their initial risk assessments would lead to relevant treatment, and again lead on to a discharge that included relapse prevention. Psychological interventions included dialectical behavioural therapy (DBT), cognitive behaviour therapy (CBT), and eye movement desensitisation and reprocessing (EMDR) that was used to alleviate distress from traumatic memories. There was access to a psychologist as well as an occupational therapist and occupational therapy assistants. There was no waiting list for psychological therapies at the forensic inpatient or secure wards, we were told.

The service had a multi-disciplinary team approach to treatment that considered each patient as an individual, ensuring each patient had access to the treatment that was most effective for them. This included physical healthcare and access to hospitals and specialists when and if needed. The forensic inpatient or secure wards had access to dieticians through an agreement with an external provider, and a health and wellbeing coach, to support patients to lead healthier lives. The multi-disciplinary team was made up of relevant staff, including the responsible clinician, a psychologist, occupational therapist and nursing staff. Other relevant staff including social workers and advocates would attend as and when requested or required.

Regular clinical audits were carried out by ward staff. Each ward had a set of key performance indicators that were audited by staff on the ward. These included fridge temperatures, supervision, primary nurse sessions, care plan audits, and medication prescription checks (five patient prescriptions randomly chosen for checking).

Staff were experienced and qualified, all had fully completed induction and most mandatory training, and appraisals and supervision were up to date. The only outstanding appraisals related to staff on sick leave or maternity leave, however all had dates written in for their appraisal on return.

A pharmacist from an external pharmacy visited the wards every two weeks and did their own checks on medication and prescriptions, preparing a report that included any problems, and would raise an issue immediately if an urgent problem was noted.

Specialist training was available to staff, including HOPE(S) training (a clinical model with a positive approach to supporting people in long term segregation) and acquired brain injury (ABI) training that could be applied to patients in the forensic inpatient or secure wards who had suffered just such trauma. Extra physical health monitoring training was in the process of being introduced in the forensic inpatient or secure wards; the Oakmere ward manager had arranged training to be rolled out on their ward before take up on the other wards.

There were regular team meetings, this was encouraged by service managers. Handovers were seen as a key part of ensuring ward knowledge was passed on. We observed a handover on Daresbury ward which was comprehensive and ensured all aspects of patient treatment and ward protocols were covered. Leadership training was available to staff, but not compulsory.

There was a Mental Health Act administrator at the service, supported by a lead administrator (a national role for the provider) and access to solicitors. The Mental Health Act administrator stated they were always training and learning, and in discussion was aware of the then upcoming changes to conditional discharge and the Deprivation of Liberty Safeguards guidance. Staff could access the Mental Health Act administrator to discuss aspects of the Mental Health Act that needed clarification or advice was needed.

Over 90% of staff on each ward had completed Mental Health Act training at the service. There was access to the Mental health Act Code of Practice, copies were available. Patient rights were given to patients and recorded in records; this was audited. Section 17 leave from the wards was available, and staff ensured that this was taken when requested, both escorted and unescorted.

We reviewed Mental Health Act documentation and noted that it was in order. Capacity checks had been carried out on the wards.

Staff knew how to contact advocacy for patients, should an advocate be requested.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff, teams and services worked together with people to effectively deliver coordinated, consistent person-centred care and treatment. They had regular and effective multidisciplinary meetings, which external professionals were invited to. We attended meetings that showed comprehensive consideration of the views of professionals and patients alike. Care records showed liaison between the forensic inpatient or secure wards and social workers and advocates.

We attended a handover on Daresbury ward and saw that each patient and their recent experience and needs for the upcoming shift were considered.

The service had a discharge checklist that outlined all aspects leading up to a discharge or transfer, including pre-discharge planning for the team, and pre-discharge/transfer planning with the patient. This covered medication, care plans, any equipment, property, any money that was held for the patient, and also a survey questionnaire so the patient could comment on their journey on the wards. Legal documentation was compiled and checked. Capacity assessments and any best interest meeting findings were gathered, and a legally recognised receipt for handover of legal detention documents, known as a H4 document, was prepared. The discharge checklist also covered the actions to be taken should a patient who was not detained decide to self-discharge from a ward at the service. The checklist was comprehensive and ensured that all aspects of a discharge or transfer of care were dealt with and in place.

The introduction of “Board round” meetings meant that there was more effective sharing of patient information and interaction leading to improved treatment outcomes.

The service had good relationships with local authorities and external organisations, as well as agreements with GPs and dentists to ensure treatment for patients.

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

The hospital had an agreement in place with an external provider for dietician input into the service. The hospital maintained a body mass index (BMI) and weight management comparison spreadsheet, documenting the weight gains and losses of all the patients at the hospital, including the forensic inpatient or secure wards. We reviewed the information and saw that weight and BMI fluctuations were monitored. We were told that the information gathered would feed into the dietary and wellbeing promotion for patients. Weight gain or loss can be a side effect of certain medications, and we noted that care records showed that patients on those medications were given direction about weight loss from dieticians. Activity plans for wards were comprehensive and included a lot of physical exercise, including playing football, swimming, pilates, and a walking group.

Smoking cessation was promoted by the service, as was advice regarding substance misuse and general health issues.

Care records showed that physical health considerations were discussed at multi-disciplinary team meetings and that patient views were noted. National Early Warning Score 2 (NEWS2) was the standard NHS tool for assessing acute clinical deterioration in adult patients, and we saw that this standard was in use at the forensic inpatient or secure wards. We noted that application of the standard was not consistent across the forensic inpatient or secure wards, with better application on one ward than on another Both Daresbury Ward and Oakmere wards showed clear evidence of physical healthcare monitoring, but the NEWS2 scoring was not being consistently applied. However, the service did audit the NEWS2 findings and the Delamere ward ongoing NEWS2 report for January 2026 showed that the ward was at one hundred percent for its adherence to the application of the standard. [JR3] [RO4] The problem of patients refusing checks was often present. This would impact on the completion of the NEWS2 documentation, as all aspects of the 6 physical health monitoring measures must be met for the NEWS2 reading to have any impact. Guidance stated that clinical observation would take place in the event that NEWS2 could not be completed.

The service had a service level agreement with a local dentist surgery to ensure any patient dental issues could be dealt with efficiently.

Patients were asked about side effects of medication and, if raised, these were monitored or medication was changed. There was an Occupational Therapy (OT) patient satisfaction survey that was available for completion by patients, where patients could comment on how their access to OT was impacting on their recovery. Patients told us that they were fully informed during multi-disciplinary meetings of any medication changes.

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The provider had introduced a “Board round” meeting within the wards at the service, designed to be a form of rapid discussion where all aspects of patient care and changes in presentation were discussed, including any barriers to discharge or treatment. We attended one such ‘Board round’ on Daresbury ward and noted that it was an effective way of ensuring that the consultant and ward staff were up to date on ward and patient conditions and treatment.

Staff used recognised rating scales to assess and record severity and outcomes, including the Health of the Nation Outcome Scales (HoNOS).

The occupational therapists had a patient satisfaction survey completed by patients. This discussed whether patients felt more confident in managing self-care tasks such as washing and dressing, self-care activities being independently completed, and other related topics. The survey allowed for patient suggestions as to what might improve the activities and therapies available. The occupational therapy services policy clearly outlined the goals for the department and their service delivery framework.

We scored the service as 3. The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The forensic inpatient or secure wards conducted consent to treatment inspection reports on a regular basis, an audit that ensured consent to treatment was being upheld and monitored. We reviewed 8 of these audit reports across the three forensic inpatient or secure wards, finding that the results ranged from 79% to 100%. The audits were carried out by Mental Health Act administration staff, and any discrepancy was raised and dealt with immediately, resulting in no harm to patients. Audits relating to the reading of rights for patients detained under the Mental Health Act were also carried out and were effective.

We saw evidence in care records that advocates had attended ward reviews with patients to ensure that their considerations were met. The service was acting within national guidance and legislation, both the Mental Health Act and the Mental Capacity Act. Patients told us they had access to advocacy. Should a best interest meeting be needed for a patient, these were organised and comprehensive.

Medication charts were found to have relevant consent forms attached. Care records we reviewed noted that consent was considered constantly and attempts to ensure the patient understood their rights was stressed. We attended a ward round meeting on Daresbury ward, and consent was spoken of during the multi-disciplinary meeting and in the presence of the patients.

The diversity, equality and inclusion policy at the service clearly stated that patients and service-user cultures and histories should be respected and accepted. Whilst recognising that the ‘language of business’ is English, patients and staff languages should also be considered as inclusive in order to reflect the service as a whole. Should a patient have poor English skills, then in order to facilitate considered consent the service would act appropriately.