CQC calls on Castlebeck to make root and branch improvements

2 August 2011

The Care Quality Commission has told the Castlebeck Care Group that it has serious concerns about four of the services run by the group, and that a further seven do not fully comply with essential standards of quality and safety.

Where we have immediate concerns about people’s safety, we have taken action and are working closely with both the provider itself and commissioners to ensure the safety and welfare of people using these services as a first priority.

In the four cases where we have serious concerns we are taking enforcement action, but for legal reasons we cannot go into details at this time. We will report fully on these actions later.

We have reviewed and inspected all the services provided by Castlebeck at its 24 locations in England. One of these, Winterbourne View, has already been closed following our regulatory action.

These inspections have revealed a number of concerns across Castlebeck’s services for people with learning disabilities. We have discussed these with Castlebeck and we are taking a range of actions to address these problems.

Of the 23 Castlebeck services which were reviewed:

• Inspectors found serious concerns at four services; CQC is taking further action.
• A further seven services were failing to comply with one or more essential standards; CQC inspectors have told Castlebeck to show how it will make improvements to meet these standards.
• 12 services were compliant with the essential standards which were reviewed.

As well as finding a range of failings in individual services, CQC has looked across those services to identify company-wide themes. These include:

• Lack of training for staff.
• Inadequate staffing levels.
• Poor care planning.
• Failure to notify relevant authorities of safeguarding incidents.
• Failure to involve people in decisions about their own care.

Our inspectors visited two homes as part of our routine programme of inspections early in 2011. The full review of all Castlebeck services began after we were informed that the BBC television programme Panorama had gathered evidence over several months to show serious abuse of patients at Winterbourne View.

The inspections focused on safeguarding the care and welfare of the people who use the services provided. Where inspectors identified concerns, measures were put in place to address the problems and to ensure the safety of people using services. Where we had any immediate concerns for people’s safety we took action to safeguard those people.

A CQC team made unannounced sites visit to all locations. Our staff were supported by people with specialist expertise where specific issues were identified, for example in relation to the management of medicines and, in the cases of detained patients, Mental Health Act Commissioners.

Examples of the poor practice our inspectors saw included:

• locking bedroom and other doors within the independent hospitals without explanation.
• patients staying in rehabilitation services for long periods.
• in some services staffing levels dictated the activities that could be offered, so that for some only group activities could take place rather than activities based on an individual’s assessed needs.

We set up a national panel to consider the outcomes of each of the reviews and to identify any common elements which would require further examination of the provider’s overall performance. Issues that emerged included inadequate quality assurance systems and lack of clarity about how local systems feed into the corporate and governance systems. There was no evidence that any evaluation took place corporately of any changes that had been implemented.

Our Chief Executive Cynthia Bower said: “We need to be clear: we have not found problems on the same scale as were found at Winterbourne View.

“However – we do have serious concerns at four locations in particular. In these cases we are taking action, although for legal reasons we cannot go into detail at this time. We will report fully later.

Our inspections have found a range of problems, many of which are found in a number of different services. This clearly suggests that there are problems that Castlebeck needs to address at a corporate level – the company needs to make root and branch improvements to its services and processes.

“Where necessary, we have demanded improvements. Where we have had immediate concerns about people’s safety we have taken action. In the case of Winterbourne View we took action which led to its closure.

“Although our reports set out what Castlebeck and individual services need to do, there is a lesson here for all professionals who have contact with these services and those who commission care from them. You have a clear responsibility to stay alert for the signs of problems; take action if you can, and tell us if you have doubts about the safety and quality of care.

“I would like to put on record thanks to the BBC’s Panorama programme and Terry Bryan, whose concerns about Winterbourne View led to the documentary. Their exposure of abuse at Winterbourne View has led to this close examination of services for people with learning disabilities.

“We are following up our inspections of Castlebeck’s services with a major review of learning disability services. We will carry out unannounced inspections of 150 of these services.”

This review of Castlebeck services represents our first systematic review of services for people with learning disabilities. These services have only been registered with us since October 2010; before that time, under previous legislation independent hospitals may only have been subject to an inspection every five years. Under our latest proposals, every service will be inspected at least once a year.

We have a number of enforcement powers which range from issuing a statutory warning notice, to issuing a financial penalty notice in lieu of prosecution and, in the most serious cases, to prosecute or suspend registration. Where required, our compliance reports set out compliance actions and/or improvement actions for providers.

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

The Castlebeck Group comprises Castlebeck Care (Teesdale) Ltd, Mental Health Care UK Ltd (MHC) and Young Foundations & Fostering. The group has 11 independent mental health hospitals and 12 adult social care facilities registered with the Care Quality Commission.

The company is a subsidiary of Castle Holdings Limited.

The list of services with most serious concerns are:

• Arden Vale (Meriden, Solihull)
• Cedar Vale (Nottingham)
• Croxton Lodge (Melton Mowbray)
• Rose Villa (Bristol)

The other services which are non compliant are:

• Acrefield House (Wirral)
• Briar Court Nursing Home (Hartlepool)
• Chesterholme (Hexham)
• The East Midlands Centre for Neurobehavioural Rehabilitation (Melton Mowbray)
• Hollyhurst (Darlington)
• Oaklands (Hexham)
• Willow House (Edgbaston)

CQC's response to the abuse at Winterbourne View hospital includes:

• A review of all Castlebeck services.
• A review of learning disability services involving the inspection of 150 services for people with learning disabilities which have the same or similar characteristics as Winterbourne View.
• An internal management review. The first stage of CQC’s internal management review of our actions in relation to Winterbourne View is complete. The final report will make recommendations relating to how CQC ensures that safeguarding alerts and whistle blowing information are handled.
• A serious case review: CQC's internal report will feed into a serious case review being led by an independent chair, Margaret Flynn, which will examine the role of all the responsible agencies.