The Care Quality Commission
  • Mental Health
  • Independent mental health service

Archived: Taplow Manor

Overall: Inadequate read more about inspection ratings

Huntercombe Lane South, Taplow, Maidenhead, Berkshire, SL6 0PQ (01628) 667881

Provided and run by:
Active Young People Limited

Important: The provider of this service changed. See old profile

All Inspections

13 December 2022 14 December 2022

During an inspection looking at part of the service

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.

15 - 16 June 2022

During a routine inspection

The ratings for this service were suspended in March 2022 following a focused inspection. The hospital was previously rated requires improvement in July 2021.

Our rating of this service stayed the same. We rated it as requires improvement overall however the safe domain has been rated inadequate. We rated safe inadequate as the provider had failed the meet the conditions of a warning notice that had been issued at the previous inspection. The warning notice was issued under Section 29 of the Health and Social Care Act 2008. The provider was failing to comply with Regulations 12 (1)(2) (c), Safe care and treatment and with Regulation 17 (2) (a)(b) Good governance of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Whilst improvements had been made in some areas, we found the same concerns at this inspection.

We rated the service as requires improvement overall, with the safe domain rated inadequate, because:

  • Staff did not always manage risks posed to young people. There had been a significant number of incidents reported where staff had demonstrated poor practice when completing observations of young people. Incidents included staff falling asleep, leaving young people unattended to complete other tasks and not following young people when they left the member of staff’s direct vision. Young people across all wards told us that staff would not always follow them when they left the room, including those who needed to be directly observed at all times. Young people also told us that at times they would have to point out that their peer had left the room, and no one had followed them.
  • Not all staff were fully trained and competent to keep young people safe. At the time of the inspection, not all staff had completed supportive engagement and observation training or passed the competency assessment. We found that some of these staff had been assigned to complete observation duties prior to being signed off as competent.
  • Not all the child and adolescent mental health wards were environmentally fit for purpose and not all wards were clean. Tamar ward had narrow corridors and the ward was split across different levels. Kennet ward was difficult to navigate. The ward was spread-out and involved going up and down small sets of stairs to reach different areas. Thames ward was not thoroughly clean. We noted that the nursing office’s windows were dirty, smudged and partially obstructed by paper. Some young people and parents commented that Thames and Kennet wards were not always clean, including the bathrooms.
  • The hospital did not have enough specialists required to meet the needs of the young people across all wards. There were gaps in the psychology, occupational therapy, and dietitian teams. There were also not enough youth engagement practitioners or activity co-ordinator teams to ensure that young people always received meaningful activities. Young people told us they did not always receive therapy and were often bored due to the lack of activities. Young people also commented that activities weren’t meaningful for their recovery and often only involved crafts or watching TV. Parents commented that they didn’t know what therapy their loved ones were receiving or due to receive.
  • Young people and parents were not involved in their care and treatment planning and care plans were not always personalised and did not include clear goals. Young people told us they were not involved in developing their care plans and weren’t aware of the content of their care plans. Parents told us that they weren’t involved in their loved one’s care and were often not informed about changes to their care. Parents did not know what their loved one’s treatment plan was and were concerned about the lack of clear goals and structure to care.
  • The hospital’s governance processes did not work effectively at ward level and risks were not managed well. Those who completed the rota were not aware of which staff had completed their observation training and assessment and there was no clear process in place to ensure that only competent staff were assigned this role. When incidents of poor practice occurred, there was no clear plan for managers to follow in terms of performance management. The policy related to observation lacked details of what should happen if staff members fail their observation competency assessment or when staff do not follow the observation protocols correctly. We found that when incidents had occurred with regards to poor practice, actions taken were inconsistent and there was no clear audit trail to show what actions had been taken. We also found that audits, such as the observation audit and infection and prevention control audit, did not clearly identify what actions had been taken when concerns were identified.

However:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
  • Staff minimised the use of restrictive practices.
  • Staff managed medicines safely.
  • The service followed good practice with respect to safeguarding.

01 February

During an inspection looking at part of the service

Following the inspection, we have suspended the rating of the service. We will monitor the hospital closely and will return in due course to see if the required improvements have been made.

On the 1 February 2022 we undertook an unannounced, focused inspection of Huntercombe Hospital Maidenhead to check whether the improvements that we told the hospital to make following our last inspection had been made.

The provider had made the following improvements:

  • The provider had made improvements to the environment by increasing the number of communal spaces available on Kennet ward and refurbished the main dining room. The provider had also started building work on Severn and Thames ward to remodel them into four smaller wards. The provider had made a planning application to build a replacement ward for Tamar ward.
  • The provider had updated their ligature point assessment, and staff would now use observation and CCTV to manage identified risks.
  • The environment of the nasogastric feeding room had been improved. The room now had a wellbeing screen for the young people to watch music videos or television. The room now had air-conditioning to regulate the temperature and a new more comfortable seat was in place.
  • Training in eating disorders was now mandatory on the PICU ward that offered care to young people with eating disorders as well as the specialist eating disorder ward. More staff had completed the full eating disorders training.
  • Staff supporting young people to have nasogastric feeds who needed to be restrained to receive their essential feeds received appropriate supervision and debriefs.
  • The number of therapy staff had been increased. For example, there was now two occupational therapists working across the hospital and each ward had a dedicated occupational assistant.
  • The majority of staff had now received an appraisal.

However:

  • Improvements had not yet been made to the environment on Tamar ward. However, planning permission had been submitted to provide a purpose-built new ward and externally monitored CCTV had been installed.
  • Some young people complained that some staff had a poor attitude towards them. For example, telling the young people that their mental health issues were behavioural.

Following our inspection there was a serious incident at the hospital that resulted in the death of a young person. On the 2 and 3 of March 2022 we undertook an unannounced inspection to ensure young people cared for on the psychiatric intensive care unit (PICU) were safe. We did not look at the events surrounding the serious incident on this inspection as there was an ongoing police investigation. We will follow our usual policies and procedures relating to serious incidents following the police investigation.

At this inspection we found:

  • The observation policy and the assessment of staff competencies were not always completed for all staff and the quality of the competencies assessments varied.
  • All staff we spoke to could not accurately explain what was required of them in carrying out the different levels of observation young people could be placed on to keep them safe.
  • The provider had carried out audits but had not documented any action taken to address any issues identified. Therefore, the provider could not demonstrate that any of the improvements identified by the audits had been made.
  • All staff we spoke to could not explain what other ways they might support young people and manage their risk other than the use of observations.
  • Young people told us staff did not follow the observation policy in line with their care plans.
  • Staff felt the wards were understaffed. However, we found that because managers often moved staff around wards there was confusion as to who was working on what shifts. Staff were unable to access a rota that accurately represented who is working on the ward over the following week.

However:

  • We reviewed CCTV footage and saw that, on all the footage we reviewed, staff followed the observation policy.
  • We reviewed incidents on CCTV and saw that, on all the footage we reviewed, staff used physical interventions appropriately.

Following our inspection, we served a warning notice under Section 29 of the Health and Social Care Act 2008. The provider was failing to comply with Regulations 12 (1)(2) (c), Safe care and treatment and with Regulation 17 (2) (a)(b) Good governance of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We told the provider that they need to ensure staff had the necessary training and competence to follow the observation policy, that staff must be assessed as competent before carrying out observations and that the assessment should be completed inline with the their policy. We also told them that they needed to have appropriate systems in place to ensure staff followed the observation policy correctly to ensure the safety of the young people admitted to the hospital.

We told the provider that they must become compliant with these regulations by 1 April 2022.

14 July 2021, 15 July 2021, 29 July 2021

During a routine inspection

Huntercombe Hospital Maidenhead is a specialist child and adolescent mental health inpatient service (CAMHS).

This is the first time we have rated this service since it was taken over by a new provider, Huntercombe Young People Ltd.

We rated it as requires improvement because:

  • We saw that many improvements had been made at the hospital since it has been taken over by a new provider on 5 March 2021 and at our previous inspection on 18 March 2021.
  • The provider had recruited a new senior leadership team at the hospital. These leaders had the skills and experience needed to drive forward the required improvements at the hospital. Despite only being in post a short amount of time we saw that they had already had a positive impact and begun to move forward with changes in a structured way to ensure the changes made were sustainable.
  • Managers had begun to embed a positive behaviour support (PBS) approach to care at the hospital. This had a positive impact on young people’s care and treatment and we received positive feedback from young people and staff about this improved approach. Young people felt more involved in their care.
  • Staff morale had improved since the previous inspection. Staff were optimistic about the future of the hospital under the direction of the new senior leadership team.
  • The hospital was cleaner and brighter than at our previous inspections.
  • The use of restrictive interventions had reduced on three out of four wards.
  • Young people had up to date risk assessments in place with clear plans for managing identified risks.

However:

  • Staff working with young people with eating disorders had not all received relevant training to equip them sufficiently to care for young people as effectively as needed. Meal support training was offered to staff on Kennet ward but not staff on Thames ward. An eating disorders e-learning course was available however this was not mandatory. This meant that staff who had not undertaken this course lacked an understanding about how to support young people with eating disorders and therefore young people did not always receive adequate support at mealtimes.
  • Several staff involved in assisting young people with nasogastric feeding told us that they did not feel adequately supported to undertake this role effectively.
  • Young people did not always receive the therapeutic intervention required to support them adequately. Young people had to wait a long time to access one to one therapy with appropriately trained therapists. The hospital had struggled to recruit therapy staff, hence there were very few of these available to support the therapeutic interventions required.
  • Tamar ward required modification to ensure it met the needs of young people. It was located over two floors which made observation difficult. There was a lack of communal space and the corridors were very narrow which meant it was difficult for people to pass one another safely. There were also issues with the sound and ventilation on the ward.
  • The room used to undertake nasogastric feeds on Thames ward was hot and unpleasant.
  • The communal space on Kennet ward was too small to accommodate the 20 young people cared for on the ward.
  • The hospital had a high vacancy rate for registered nurses.
  • Staffing across the hospital was inconsistent, with the same number of doctors, administrative staff and youth engagement practitioners allocated to a 20 bedded ward as a 10 bedded ward.
  • Less than half of staff had received an annual appraisal in the last year.
  • Some mandatory training courses had low compliance. These included managing medications (60%) and sepsis awareness (56%).
  • Documentation and incident reports lacked sufficient detail to clearly portray what had happened during an incident. For example, not detailing the actions taken by staff to try and de-escalate a young person prior to restraining them.
  • Although frequency of communication with relatives had improved, there were still inconsistencies in communication and relatives did not always feel listened to by staff.
  • The ligature audit for Severn ward did not include mitigation plans for all identified risks.

Following our inspection we served a warning notice under Section 29 of the Health and Social Care Act 2008. The provider was failing to comply with Regulations 12 (2) (c), Safe care and treatment, 15 (1) Premises and equipment and 18 (1) Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We told the provider that they must become compliant with these regulations by 10 September 2021.

18 March 2021

During an inspection looking at part of the service

Huntercombe Hospital Maidenhead provides specialist child and adolescent mental health inpatient service (CAMHS), including psychiatric intensive care for young people.

Until 5 March 2021 the hospital was run by Huntercombe (No.12) Limited. It was rated inadequate and in special measures.

On 5 March 2021 Huntercombe Young People Ltd took over the running of the hospital. On 18 March 2021 we undertook an unannounced, focused inspection. This was the first inspection of the hospital under the new provider.

Following our inspection, our concerns about the quality of care remained. We therefore served the provider with a notice of decision under Section 31 of the Health and Social Care Act 2008, imposing a condition on their registration from 25 March 2021. The condition means that the provider must seek written permission from the Care Quality Commission before admitting or readmitting young people to Severn or Thames wards psychiatric intensive care wards (PICUs), and must not admit any more than 10 young people on each ward until further notice.

We also served a warning notice under Section 29 of the Health and Social Care Act 2008. The provider was failing to comply with Regulation 17(1) , Good governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider did not have in place:

  • robust governance and oversight of the review of care to ensure it was fit for purpose and any improvements to the quality of care for young people could be made;
  • robust governance and oversight of the management of incidents, including safeguarding incidents;
  • a holistic, proactive and preventative approach to care (such as positive behavioural support (PBS) in line with national best practice and guidelines);
  • a least restrictive approach to care, in line with national best practice and guidelines;
  • an approach to care on the PICUs that was in line with National Minimum Standards for PICUs.

The provider must become compliant with this regulation by 22 April 2021.

We did not rate the hospital following this inspection.

We found that Huntercombe Young People Ltd had made a number of improvements including, brightening up the environment on Severn ward, improving prescribing practices, reducing the use of intramuscular as required medication, carrying out appropriate capacity/competence assessments and regularly inviting parents/guardians to participate in patient review meetings.

Whilst clear progress had been made against some actions that we had identified previously and that were known to Huntercombe Young People Ltd, others had not been progressed.

However, Huntercombe Young People Ltd recognised that significant improvements needed to be made and had put in place a new, strengthened, leadership team, some of whom had started on the day of the inspection. We found that they demonstrated a good understanding of the issues at the hospital and appeared to understand what they needed to do to address these in a timely manner.