Dorset Healthcare University NHS Foundation Trust

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed the learning culture, safe systems and pathways, involving people to manage risks, safe environments, safe and effective staffing, medicines optimisation and infection prevention, and control (IPC), quality statements for the safe key question.



We found that staff provided treatment and care for patients in a safe way. The ward environment and equipment were appropriate and the ward felt welcoming. Staff and patients told us there was a good environment which helped patients get better and provided a good place to work.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patients were positive about staff training and learning. Patients felt staff had the skills and experience to do their job well. Patients said staff gave them time and space when needed and listened to them.

Staff said a comprehensive learning and training package had been put in place after previous incidents. Staff described additional training they had undertaken in response to previous incidents. Staff said they knew patients well and made good use of de-escalation skills and recognising people’s triggers. All staff professions had led a programme of bitesize emergency training scenarios, including responding to a person choking and caring for the deteriorating patient.

We saw learning embedded in staff training and development plans. Following incidents staff reflected on their practice and appropriate training packages were put in place to address any learning needs identified. Staff completed training and attended supervision to update their learning and maintain professional knowledge.

People felt happy about their care and treatment at Waterston Ward and felt staff had helped them.

Staff said there was a positive staff culture and morale. Staff felt they had support from each other and were valued by their leaders.

Local Community Mental Health Teams (CMHT) and the Crisis Team worked collaboratively with the ward in planning and managing admission and the safe discharge of patients.

Staff completed a risk assessment on a patient's admission to the ward and this was shared with the multi-disciplinary team. The ward worked closely with community services. Each patient had a goal for their admission and how they were to meet it and care plans were individualised and built to achieve these goals. Patients had clear goals which were regularly reviewed and discharge plans recorded as they continued in their recovery.

People said they felt safe on the ward and were assured staff were there for them.

Staff knew how and when to report safeguarding issues appropriately and could give examples of when they had done this. Staff told us had completed safeguarding training appropriate for their roles.

The ward was settled and relaxed. Staff completed observations discreetly. Activities were taking place on the ward . There was also access to a garden and outside space including an area to care for pets.

There was a clear safeguarding reporting system in place and staff at all levels knew how to report incidents, review and act on them.



The service described a good relationship with local authority safeguarding team.

People we spoke with told us they felt involved in their own care planning and knew why they were in hospital and what they needed to do to go home. People said they felt staff knew them well and could anticipate any triggers that may impact their mental health.

Staff reported good communication about sharing risks and that these were managed appropriately. Staff said people and the carer voice were central to all decisions. The team worked well together and said they used hands on restraint and restrictive practice rarely as they had good de-escalation planning and skills to manage complex situations.

Staff completed a risk assessment of every patient on admission and updated it regularly, including after any incident. Information about risk was easily accessible to staff as it was recorded in care plans and risk assessments which were regularly updated. There were completed people and carer voice sections in care plans. Staff followed relevant policies and procedures for use of observation including to minimise risk from potential ligature points and for searching patients or their bedrooms.

Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained patients only when these failed and when necessary to keep the patients or others safe. They had received training in restraint techniques and recorded when they used it.

People told us they felt the environment was homely and welcoming with good amount of space for people. There were dedicated therapy rooms and garden space for people to use.

Staff said they felt safe at work and that they and colleagues had skills needed to manage any risks appropriately. There was no dedicated seclusion room on the ward, however, staff told us they used quiet de-escalation areas with good effect to calm people when distressed.

The ward was settled and relaxed. Staff completed observations discreetly. Activities were taking place on the ward . There was also access to a garden and outside space including an area to care for pets.

The ward environment was suitable for the needs of the patients. There was designated quiet zones and de-escalation space for patients. The environment was clean and free from clutter. There was appropriate storage for hazardous materials which were locked away.

People reported staff were kind, approachable and calm. There were a range of staff on the ward including activities and peer support workers.

Staff reported good morale. Staff felt training met their needs and equipped them well to perform their roles. However, they told us there were some issues with temporary staff turning down shifts at short notice due to the isolated, rural location of the service. This risk was mitigated by regular staff, including qualified senior leaders covering shifts as needed.

There was evidence of a multi-disciplinary team working well across the ward to meet the needs of patients. The psychological therapies team was well integrated within the team.

The service had enough nursing and support staff to keep patients safe. The staffing for the ward was 7 staff on early and late shifts and 5 on nights, the numbers included qualified nurses and healthcare support workers. This was based on clinical judgement and data for a stand-alone acute ward of this size. In addition, the service was actively recruiting and had new staff starting in autumn 2024. Regular bank and agency staff were used to fill temporary shortages. This included agency staff nurses being block booked to work regularly on the ward and provide better continuity of care for patients.

People said the wards were kept clean and tidy and told us they could access cleaning material for their own room if they wanted to be independent.

Staff said the wards were cleaned regularly with a domestic team. Leaders said these staff were integral part of the team.

We saw domestic staff cleaning the ward. Staff were following infection prevention and control guidance by being bare below the elbow and washing their hands. There were signs up about hand washing and stickers were put onto equipment to demonstrate that they had been cleaned.

There was a cleaning rota in place and all equipment was cleaned and maintained regularly. Regulars cleaning audits were completed and review by senior staff and actions taken to make improvement as required.

People were receiving a variety of medicine for mental health problems. Some people told us that staff regularly monitored their blood levels which was a requirement of some of the medicines they were taking. People reported having medicines reviewed regularly and being able to ask staff questions about their medicines. Relatives told us they felt staff had sufficient knowledge about medicines.

Staff told us they felt the had the necessary skills and experience to administer medicines safely.

In the records we reviewed, nurses had completed electronic medication charts fully. When required we saw doctors had completed specific legal documents authorising medicines under the Mental Health Act (1983).

We saw the multi-disciplinary team had completed patient group directions (PGDs) to guide nurses in administering as required medicines and these were completed correctly and in date.

The service used systems and processes to safely prescribe, administer, record and store medicines. Staff stored and managed all medicines and prescribing documents safely. Staff completed medicines competencies and also in dispensing medication via an electronic system.

Patients had regular monitoring in place for medicines and staff knew how to respond if there were any problems. Physical health monitoring was also in place for people including electro-cardiograms (ECGs) and National Early Warning Scores (NEWS) physical observation levels monitoring.

Emergency drugs and equipment were available on the ward and were in date and checked regularly by trained staff. We saw healthcare pathways including emergency treatment scenarios in flowcharts clearly displayed for staff. There were patient information leaflets about medication available for people to read and take away to keep them involved and informed about their medicines.

One patient was waiting for a Second Opinion Appointed Doctor (SOAD) to review medication, and this formed part of their care plan. Staff completed legal documentation for administering medication for people detained under the Mental Health Act (1983).