Arbury Court

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

This means we looked for evidence that the service met people’s needs.

At our last inspection we rated this key question good. At this inspection the rating has remained good. Staff managed beds well. A bed was available when a patient needed one. Patients were not moved between wards except for their benefit. Patients did not have to stay in hospital when they were well enough to leave. The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Staff supported patients with activities outside the service, such as work, education and family relationships. The service met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. The service treated concerns and complaints seriously, investigated them and learned lessons from the result.

We have not awarded this service a score for Responsive.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

Some patients told us that they were involved in their care, however several said they did not feel involved. Care plans and records stated that all patients had been approached and were encouraged to assist in care plans and risk assessments. We observed a multi-disciplinary team meeting and noted that the patient, who consented to us attending the meeting, was fully involved and informed about opinions and the way forward for the patient with their consideration.

Family and carers were invited to be involved, where it was deemed a positive aspect of care and the patient agreed. The service organised carer events to ensure that involvement was encouraged. We saw evidence of social worker involvement in treatment and care plans as well as multi-disciplinary team meetings, as well as advocates who were empowered to speak on the behalf of the patient and their family.

Personalised one to one meeting of patients with staff was encouraged. In the minutes of the January nurse meeting on Oakmere ward, an agenda item was to ensure that primary nurses were updating and monitoring the care dashboard for their patients, this included ensuring staff interaction was maintained.

Staff worked with patients as needs changed and levels of acuity fluctuated; we saw evidence of constant adaptation to things like observations levels as patients improved or declined in their mental or physical health. Occupational therapist involvement, like psychological input, was targeted at the individual patient.

Patient bedrooms were individualised and patients had free access unless risk planning contra-indicated this. The few bedrooms we were allowed to enter (with the permission of individual patients) showed that patients had different approaches to how they wanted their rooms to look. Patients were given keys to their rooms on individual basis following a risk assessment. Patients had secure lockable spaces in their rooms to store items of value.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The care plans reviewed clearly showed the service had an understanding of the needs of the patients in its care. Patients were actively supported to maintain contact with carers and family where permissible, with visiting rooms available for meetings to take place. Patients access to their own mobile telephones were permitted after risk assessment. Patients without access to a personal mobile telephone were given access to the ward telephone if requested.

The service gave opportunities for patients to access work opportunities. The service had a shop that patients could assist staff in running, and work in the community could be facilitated if it was felt that a patient could meet all the requirements to do so; this was led by the occupational therapy team. These were voluntary community placements. Each patient had a care plan that reviewed social, educational, vocational and occupational activities. At the time of the inspection, the service key performance indicators showed that every patient had this completed and up to date.

The occupational therapy team led on a programme of activities that ensured patients had access to a variety of indoor and outdoor pursuits that would lead to improved wellbeing. The team consisted of three occupational therapists and 11 assistants across the site. The team had an occupational therapy review form that patients were encouraged to complete with the team. This allowed patients to outline their recovery goals, what their perceptions were about their progress, what activities they liked to take part in, as well as making suggestions for activities that might be beneficial for their journey. This could be coupled with the occupational therapy team survey form that allowed patients to comment on their overall progress, if any, and their suggestions for improvements or change.

The timetable on Oakmere ward showed a variety of the activities available, including independent living skills, money and budget management, sports such as football or netball, and a choir. These activities were mixed with wellbeing sessions and opportunities to discuss patient progress.

There was a pastor who attended the service for patients who wanted to express their religious nature. Should a patient require a specific religious representative, the service would arrange one if requested.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

We saw evidence from the service of the provision of data to relevant agencies when requested and when required by statutory notification. The service had regular meetings with PROSPECT, the Cheshire and Merseyside Adult Secure Lead Provider Collaborative, in which relevant information about the service was provided as well as mutual agreement to enter premises and inspect should there be concerns raised. This project had been supported from its inception by the provider for the service and recognised as mutually beneficial to all services within the collaborative. The service also had a duty to provide statutory notifications to the Care Quality Commission relating to incidences and occurrences within the service, as well as to make local authority safeguarding referrals should they be required.

The service had a governance policy in place to ensure confidentiality of patient records, both electronic and paper. The service informed patients of their rights if they were detained under the Mental Health Act. The service provided relevant audit data that clearly showed that patients had their rights explained to them within the timings of the Mental Health Act, and we saw evidence of multiple attempts in records when patients struggled to understand these rights due to acuity of illness.

Patients we spoke with told us that they had their rights explained to them, and that they knew how to complain and raise issues if they felt aggrieved.

Information governance systems provided confidentiality of patient records.

If a patient requested information that was not displayed on notice boards around the service (the notice boards included how to complain, advocacy contact and other pertinent details), the service was able to deal with the request.

Patient progress was reported regularly to commissioners, families and carers (with patient permission) to keep them as informed as possible. Carers were invited to attend multi-disciplinary team meetings for the relatives on the wards.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

The service had access to the provider complaints policy. This comprehensive document outlined the channels and procedures for the handling of complaints from patients, carers and staff. Community meetings were regularly held on forensic inpatient or secure wards, giving patients the opportunity to raise any issues they felt should be addressed.

The service had very few formal complaints, and key performance indicators showed that, for the three months prior to the inspection, all complaints had been resolved. The service did allow for informal complaints, and these were dealt with through discussion with patients or complainants generally.

The hospital completed patient surveys to gather their feedback on their care and treatment and offered family, friends and carers experience surveys.

Patients told us that they knew how to complain, as did staff at the forensic inpatient or secure wards. All complaints were discussed in governance meetings, with results given either personally to complainants or shared with the staff through forums or use of the email system. Staff were aware of the importance of protecting patients from discrimination, harassment or disadvantage. Staff were informed of outcomes of complaints, if relevant.

From April 2025 to December 2026 the key performance indicators relating to complaints showed there had been 7 complaints made about the service in total. 2 were still being investigated, 4 had been resolved.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

New referrals to the forensic inpatient or secure wards would be assessed within 72 hours of referral, often well within that time frame. Patients who were on leave from the ward had their beds kept for them so there was immediate access on return. The service used a pre-admission assessment template to comprehensively review the patient across different subjects, including presenting problems, family history, school history, psychiatric history, forensic history, risk and personality. Patients were reviewed holistically and with a view to whether they would be suitable for the service, and whether the service was suitable for them. Review of care records showed pre-admission assessments were completed.

The forensic inpatient or secure wards were situated on one floor, allowing access to people with wheelchair requirements, if necessary, and the doors were wide enough to allow said access. People who spoke different languages could be considered by the use of interpreters and sign language for people with hearing difficulties. Food menus were varied and could accommodate choice and religious, vegetarian or vegan tastes. The service also gave consideration to hygiene, with vegan soaps on offer for patients who chose that particular lifestyle.

Medical cover during out of office hours was in place, and the local general hospital was a short distance away. Mental Health Act Section 117 aftercare was considered when appropriate, allowing for patients to have ongoing care in the community after discharge. Care records showed consideration of post-discharge assistance for patients. Patient movement from ward to ward only occurred during appropriate times, and only for the benefit of either a stepdown from medium secure or for movement from low secure to medium secure.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

Each ward in the forensic inpatient or secure wards had community meetings that involved patients, with a wide agenda giving opportunity for different issues to be raised. We reviewed minutes of community meetings, and the follow-up actions attributed to the suggestions of patients. Community meetings featured in the weekly key performance indicator for the ward managers across the service, ensuring that they had taken place. There was clear evidence of consideration for each point raised and discussed. Advocates were available to patients, and we saw evidence in care records of involvement of advocacy when requested by patients and carers.

Patients with physical, as well as mental health problems were given due consideration by the service. On Oakmere ward, the ward bathroom was adapted for use by patients who might require more space or equipment to access the facility.

Patients had access to one-to-one time with care staff, we saw that this was regularly utilised in care records. The service could produce information for patients in a variety of languages if required, as well as access to an interpreter if needed.

Staff on the three wards in the forensic inpatient or secure wards had to complete diversity, equity and inclusion training as part of the mandatory training programme, and at the time of the inspection the wards were all at 100% completion.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The service had introduced a programme called Board Round, which was a weekly ward-specific multi-disciplinary meeting that considered all of the patients on the ward in a short format discussion. This included multi-disciplinary team members such as the psychiatrist, occupational therapist, as well as the ward manager. As it was a new addition to the service, the meetings were initially led by the Hospital Director. Each patient was discussed with a view to monitoring and updating their journey should any changes be considered, and included discharge planning, physical health and observation levels. We observed a Board Round meeting on Daresbury ward and saw that it was an efficient and re-assuring addition to patient care and monitoring.

Multi-disciplinary team meeting notes were seen to be comprehensive and considerate, giving not just the staff viewpoint but that of the patient, and indicated the path that the ward was following in relation to the patient journey, right up to discharge. Patient viewpoint was always considered, recorded and acted upon where applicable.

Care plans were individualised, taking into account patient history, diagnosis, likes and dislikes, as well as other factors. Should a patient have required assistance in planning for advanced decisions or whether to implement a Do Not Attempt Cardiopulmonary Resuscitation order, the service would have given due consideration and assisted to implement this.