Archived: Taplow Manor

Updated 24 March 2023

Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS). It provides specialist mental health services for adolescents and young people from 12 to 18 years of age. The hospital delivers specialised clinical care for young people requiring inpatient CAMHS, including psychiatric intensive care (PICU) and eating disorders. The hospital and its surrounding grounds are within a rural setting and are situated near a town with easy access to transport links and shops. Young people are supported in their education via the hospital school which is rated good by Ofsted. Where appropriate the young people have access to the hospital grounds and local community facilities.

When all the wards are fully open, the hospital has 59 beds. The PICU wards have a cap on admissions and are only able to admit a maximum of 22 young people due to conditions imposed on its registration by CQC at a previous inspection in July 2021. At the time of this inspection, the cap was still in place.

The hospital consists of five wards:

• Kennet ward provides eating disorder services and has 20 beds
• Tamar ward provides tier four CAMHS general adolescent services and has 10 beds
• Juniper ward provides PICU services and has 7 beds
• Holly ward provides PICU services and has 8 beds
• Maple ward provides PICU services and has 7 beds.

There was a registered manager in post at the time of the inspection.

The hospital is registered to provide the following regulated activities:

• Treatment of disease, disorder or injury
• Assessment or medical treatment for persons detained under the 1983 Act
• Diagnostic and screening procedures.

Following the previous inspection in July 2022, we issued a letter of intent under section 31 of the Health and Social Care Act 2008. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. A letter of intent sets out our intention to take urgent action if the provider does not assure us that it will make the required improvements urgently. The provider submitted an action plan to us and assured us they were taking immediate actions to improve the safety of the hospital. As such we did not take further action at that time. As a result of the July 2022 inspection we rated the hospital as requires improvement overall, with a rating of inadequate in the safe domain, requires improvement in the effective, caring and well led domain and good in the responsive domain.

Following the inspection in July 2022 we issued the provider with requirement notices. We told the provider to make the following improvements:

• The service must ensure that all relevant staff are appropriately trained and assessed as competent to carry out observation checks of young people. (Regulation 12)
• The service must ensure that all ward environments are fit for purpose. (Regulation 15: Premises and equipment, (1)(c) and (e))
• The service must ensure that staff receive a debrief and/or reflective practice session following serious incident, including after incidents that involve restraints. (Regulation 12)
• The service must ensure that staff have completed managing medications and immediate life support training. (Regulation 12)
• The service must ensure that young people and the relevant family/carers are involved in care and treatment planning. (Regulation 9)
• The service must ensure that young people have access to the recommended psychological therapy as outlined in best practice guidance and that young people have access to meaningful activities seven days a week. (Regulation 9)
• The service must ensure that there are effective and robust governance procedures in place to ensure that young people always receive safe care and treatment. (Regulation 17)
• The service must ensure that they complete the actions of the action plan following the issue of the letter of intent and embed the improvements to the service. (Regulation 17)

During this inspection we saw that the provider had made improvements in the areas of concerns we had found in July 2022, but had not met all of the requirement notices. We also found new concerns during this inspection relating to governance, the cleanliness of Tamar ward, maintenance issues on Tamar and Kennet wards, the physical observations of young people following the use of rapid tranquilisation and the recording of nasogastric tube insertion and administration of feed lacked detail.

The hospital had improved the process around observations of young people. There was now a daily checklist in place to ensure staff on shift were trained and competent to undertake observations of young people. There were also processes in place to ensure young people’s observations were undertaken as prescribed. The hospital was monitoring observations through regular audits and a standard operating procedure had been implemented to ensure all staff followed the Supportive Engagement and Observation Policy and were competent to use it.

Training compliance rates among staff had improved for managing medications. However, the training rate for Immediate Life Support training was still low. Staff requiring this training had dates booked to complete it by January 2023.

We found some of the ward environments were still unfit for purpose. A feasibility study had been developed and planning permission was being sought to replace Tamar ward with a purpose built ward. Refurbishment of the psychiatric intensive care units had now been completed.

The hospital recognised there were still actions that needed to be completed and work was required to embed the improvements to ensure they would be sustained permanently. The provider had introduced a new governance system and developed a comprehensive site improvement plan to monitor progress against each of the actions contained within it and had detailed oversite of progress.

Updated 24 March 2023

Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS). It provides specialist mental health services for adolescents and young people from 12 to 18 years of age.

Our rating of this location went down. This inspection rated Taplow Manor as inadequate and placed them into special measures.

We rated it as inadequate because:

• Tamar ward remained unfit for purpose. This had been a concern in the last 3 inspections. The provider had developed a feasibility study and were submitting a planning application so a new purpose built ward could replace it. However, there had been little progress to mitigate the immediate concerns about the ward environment and it was not well maintained.
• Tamar ward was unclean. Floors and carpets were heavily stained and there was dirt throughout the ward. Bathroom areas and the clinic room were unclean.
• Not all of the wards at the hospital were well maintained. Ward furniture was in a state of disrepair, there was graffiti on the walls and peeling paint.
• Staff training compliance with immediate life support training was still low.
• Physical health observations after the use of rapid tranquilisation were not always being undertaken.
• The recording of nasogastric tube insertion and administration of feed lacked detail and was not in line with guidance.
• Treatment programmes and activities for young people across the hospital were starting to improve. However, this work required further embedding across the hospital.
• Care plans did not demonstrate that children and young people had been involved in their development and represented their voice and views. There was little evidence that young people had been offered a copy of their care plans.
• Supervision rates for staff across the hospital were variable.
• We saw evidence the hospital had better oversight of governance processes and were progressing with the site improvement plan. However, some of the improvements were still in their infancy and further work was required to embed and sustain changes. There were also concerns found during the inspection which the hospital’s governance processes had not identified or mitigated against.

However:

• Vacancy rates were reducing, and the provider was actively recruiting international staff.
• Observation procedures had significantly improved across the hospital. Staff were trained in observations and processes were in place to establish competency with the observation policy.
• Staff understood how to safeguard patients and were compliant with safeguarding training.
• The investigation of incidents had improved since the last inspection. Incidents were investigated thoroughly and staff were provided with a debrief. The hospital learned lessons from incidents and shared these.
• Positive Behaviour Support plans were in place for all young people. Young people had been involved in their development and staff had received training.
• Managers used audits to make improvements. The hospital had recently implemented a new audit schedule across the hospital.
• Staff treated young people with kindness and respect. Staff supported young people and involved their families or carers.
• Young people and their relatives and carers knew how to complain or raise concerns.
• Staff morale was improving and the senior management team had implemented a number of initiatives to improve engagement with staff and improve well-being and morale.
• Leaders at the hospital had shown a commitment to making the improvements required following the last inspection. A site wide improvement plan was in place to measure progress and the actions required.

What people who use the service say

We received mixed feedback from young people across the hospital.

Young people said staff treated them with respect and dignity and ensured that their needs were met.

They were sometimes bored outside of school hours or if not in school as there were no other activity programmes during this time. Mobile phones and television programmes on streaming services were not available during school hours, even if they were not at school.

Young people told us they weren’t always involved in their care plans or received copies of their care plan.

Some young people said that the food was good, while others said it could be better.

Young people on Kennet ward said new staff or staff who cover from other wards as well as agency staff will sometimes say and do inappropriate things as they don’t understand eating disorders.

Some young people said it could take time for staff to respond to requests when the wards were busy.

Updated 24 March 2023

Our rating of this service went down. We rated it as inadequate. See summary above for details.