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St Andrew's Healthcare - Womens Service Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 24 September 2020

We did not rate this service.

We carried out this inspection in response to concerning information received through our monitoring processes.

We found the following areas the provider needs to improve:

  • Managers did not ensure staff had the right skills, knowledge and experience to meet the needs of patients with a diagnosed eating disorder. Staff had not completed full assessments for patients with a diagnosed eating disorder prior to admission. Staff had not completed care plans that met all the needs of patients with a diagnosed eating disorder. Staff did not provide a range of care and treatment options suitable for this patient group.
  • Staff did not manage patient risks effectively. Staff did not always complete observations in line with patient care plans and the provider’s policy and procedures. Staff did not complete care plans for all identified risks. Staff had not met all patients’ physical health needs.
  • Managers did not provide a safe environment for patients. The ward was not resourced with equipment required to support patients with an eating disorder. A patient was in a distressed state for over an hour due to lack of specialist equipment. Staff did not follow correct infection control procedures in relation to coronavirus. We observed staff not wearing personal protective equipment (face masks) appropriately when on the ward.
  • Staff did not always treat patients with kindness, dignity and respect. We observed a senior member of staff dismiss a patient who asked to speak with them about safeguarding concerns. We spoke with a senior member of staff who described patients with an eating disorder as “not a patient group who inspires excitement”. Patients described occasions when they were distressed and staff ignored them.
  • Staff did not always identify and report safeguarding concerns. Managers had not notified CQC about seven out of eight safeguarding incidents and had not referred one to the local authority safeguarding team.
  • Carers reported issues with communication and gave examples of having to ‘battle’ to be listened to and be involved. Patients and carers reported that managers were dismissive of concerns raised.
  • Patients told us that there was not enough food, catering staff did not send meals or sent the wrong meals, food was sometimes "mouldy" and was not always cooked properly. Patients told us there were limited food options, especially if vegetarian. This was raised on numerous occasions in community meetings with no evidence of any action taken. However, we reviewed evidence that staff checked quality and temperature before serving food.

  • Managers had not effectively managed the change to the ward profile. Managers continued with the planned change despite training not being available, due to coronavirus restrictions, and the ward not being sufficiently resourced. Managers had not followed recommendations from an internal investigation into concerns raised.

However:

  • Senior leaders demonstrated learning by acknowledging that a lesson learnt was to ensure new services have the correct capabilities in place prior to opening and reported that they were making changes following concerns being raised.
  • Staff completed annual physical health assessments for all patients and completed standard physical health checks. We saw evidence in progress notes that staff sought support from the provider’s physical health team when required.
  • Staff supported one patient sensitively on the anniversary of a traumatic life event.
  • Patients described the new dietician as ‘amazing’.
  • Two carers told us that the social worker was helpful and another two told us their relative was in the right place for the care and treatment they needed.
Inspection areas

Safe

Inadequate

Updated 24 September 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Managers did not provide a safe environment for patients. The ward was not resourced with equipment required to support patients with an eating disorder. For example, pressure relieving equipment, specialist lifting equipment and appropriate scales. A patient was in a distressed state for over an hour due to lack of specialist equipment.
  • Staff did not follow infection control procedures in relation to coronavirus. We observed staff not wearing personal protective equipment (face masks) appropriately when on the ward. Staff were wearing masks under their chin or they were not covering their nose.
  • Staff did not manage patient risks. Staff did not always complete observations in line with patient care plans and the provider’s policy and procedures. Staff did not complete care plans for all identified risks, for example over exercising, self induced vomiting and laxative abuse.
  • Staff did not always identify and report safeguarding concerns. Patients reported incidents of staff inappropriate behaviour and verbal abuse and of bullying by other patients. Patients advised that they raised these concerns with ward staff, but no action had been taken. CQC and other external agencies referred these concerns to the local authority safeguarding team.
  • We reviewed eight safeguarding incidents reported between 01 April 2020 and 30 June 2020, managers had not notified CQC about seven of the incidents and had not referred one to the local authority safeguarding team.

However:

  • The provider reported a mandatory training compliance for staff on Spencer South ward of 85% as of 01 July 2020.

Effective

Requires improvement

Updated 24 September 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Staff had not completed full assessments for patients with a diagnosed eating disorder prior to admission. Staff had not completed care plans that met all the needs of patients with a diagnosed eating disorder. Staff identified risk behaviours associated with the patient’s eating disorder for four patients but only one patient had care plans in place to manage these risks.
  • Staff did not provide a range of care and treatment options suitable for the patient group. The service offered Dialectical Behaviour Therapy. Whilst, the National Institute of Healthcare Excellence guidance states "there is little evidence on which treatments work best for people with an eating disorder and a comorbidity”, they also state that “preferences of the person with the eating disorder and (if appropriate) those of their family members or carers” should be taken into account. Patients told us they were accessing external websites and helplines for support. Staff had not provided individual therapeutic timetables in line with ward procedures.

  • Staff had not met all patients’ physical health needs. Staff were not always weighing patients with an eating disorder in line with their care plans. The dietician increased one patient’s calorific intake following weight loss. The patient continued to lose weight and staff had not kept clear records of the patient’s calorific intake.
  • Managers had not ensured staff had the right skills, knowledge and experience to meet the needs of patients with a diagnosed eating disorder. There had been no formal eating disorder training provided to staff. Managers facilitated ward based teaching sessions from June 2020. Only four staff attended all sessions and six staff attended none. Staff had not completed training to use specialist lifting equipment required by one patient.
  • Managers advised that specific policies and procedures for the ward were included in the standard operating procedure. The standard operating procedure was dated January 2020 and had not been updated following the change to the ward profile on 01 April 2020.

However:

  • Staff completed annual physical health assessments for all patients and completed standard physical health checks. We saw evidence in progress notes that staff sought support from the provider’s physical health team when required.

Caring

Inadequate

Updated 24 September 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Staff did not always treat patients with kindness, dignity and respect. Staff demonstrated a lack of enthusiasm for the patient group they were supporting. We observed a senior member of staff dismiss a patient who asked to speak with them about safeguarding concerns. We spoke with a senior member of staff who described patients with an eating disorder as “not a patient group who inspires excitement”. Patients described occasions when they were distressed and staff ignored them.
  • Patients reported that staff “had a go” at them for making complaints. We found examples of inappropriate language being used by staff in patient records, for example reference to patients “bragging about talking to CQC”, “x and some of her peers have engaged in unhelpful conversations regarding CQC and the complaints they have made about staff”.
  • Patients facilitated and attended weekly community meetings. Staff did not respond to all concerns raised in these meetings including numerous complaints made about the quality and quantity of food.
  • Carers reported issues with communication and gave examples of having to battle to be listened to and be involved. Two carers advised that they thought the quality of care and treatment on the ward deteriorated since they complained. Two carers did not think the ward was prepared and equipped to support their relative.

However:

  • Staff supported one patient sensitively on the anniversary of a traumatic life event.
  • Two carers told us that the social worker was helpful. Two carers told us their relative was in the right place for the care and treatment they needed.

Responsive

Good

Updated 24 September 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Facilities did not always promote dignity and confidentiality. Staff used the quiet room to administer nasogastric feeds. This room was not sound proofed and therefore other patients could hear if a patient was distressed. The CQC reported this as a concern during the comprehensive inspection in March 2020.
  • Patients told us that there was not enough food, catering staff did not send meals or sent the wrong meals, food was sometimes "mouldy" and was not always cooked properly. Patients told us there were limited food options, especially if vegetarian. This was raised on numerous occasions in community meetings with no evidence of any action taken. However, we reviewed evidence that staff checked quality and temperature before serving food.
  • Patients and carers reported that managers had been dismissive of their complaints. The inspection team found that a senior leader was also dismissive of the complaints.

Well-led

Requires improvement

Updated 24 September 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Managers had not effectively managed the change to the ward profile. Managers continued with the planned change despite training not being available and the ward not being sufficiently resourced. Managers had not followed recommendations from an internal investigation into concerns raised.
  • Frontline staff spoken with reported that morale was low and that they did not feel equipped to support patients with an eating disorder effectively.
  • Managers reported internal and external pressures to admit new patients to the ward. This resulted in staff admitting patients without a full assessment and this placed pressure on ward based staff.

However:

  • Senior leaders demonstrated learning by acknowledging that a lesson learnt was to ensure new services have the correct capabilities in place prior to opening and reported that they were making changes following concerns being raised.
Checks on specific services

Child and adolescent mental health wards

Requires improvement

Updated 10 February 2015

  • There was a need to assess and treat patients based on individual risk and identified needs, rather than placing emphasis on generic, restrictive risk management processes.
  • Agency and bank staff did not have adequate information about individual patient care and any safeguarding protection plans on the wards where they are working.
  • The complaints process was not always clearly displayed on the wards in formats people can understand.
  • Feedback from the outcome of complaints was not shared with the complainant on all occasions. 
  • Seclusion facilities were being used for de-escalation and time out.

Long stay or rehabilitation mental health wards for working age adults

Updated 24 September 2020

Wards for people with a learning disability or autism

Requires improvement

Updated 10 June 2020

Safe- requires improvement

Effective – requires improvement

Caring- inadequate

Responsive- good

Well led- requires improvement

Forensic inpatient or secure wards

Inadequate

Updated 10 June 2020

Safe- inadequate

Effective - requires improvement

Caring- inadequate

Responsive- good

Well led- inadequate

Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 10 June 2020

Safe- inadequate

Effective - good

Caring- requires improvement

Responsive- good

Well led- requires improvement

Child and adolescent mental health wards

Good

Updated 16 September 2016

  • Bayley ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning+ disabilities / autistic spectrum disorder.

  • Heygate ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning disabilities / autistic spectrum disorder.

  • Fenwick ward is a low secure inpatient ward that can accommodate up to 10 children and adolescents females with neuro-disability / autistic spectrum disorder.

  • Richmond Watson ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent males with complex mental health needs.

  • Church ward is a low secure inpatient ward that can accommodate up to 10 children and adolescent males with neuro-disability / autistic spectrum disorder.

  • Boardman ward is a low secure inpatient ward that can accommodate up to 11 children and adolescent females with complex mental health needs.

  • Heritage ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent females with complex mental health needs.

  • John Clare ward is a low secure inpatient ward that can accommodate up to nine children and adolescent females with complex mental health needs.

Services for people with acquired brain injury

Good

Updated 16 September 2016

  • Rose ward is a medium secure male ward.

  • Tallis, Tavener, Althorp, Berkeley Close (1st floor) are male locked wards.

  • Berkeley Close (ground floor) is a female locked ward.

  • Berkeley Lodge, 37 and 38 Berkeley Close and 19 The Avenue are locked units

  • Walton is for male patients with Huntingdon’s disease.

  • Harper – specialist ward for male and female patients with Huntingdon’s disease.

Wards for older people with mental health problems

Good

Updated 16 September 2016

  • O’Connell ward is a locked ward for male older adults.

  • Compton is a locked ward for male and female older adult patients.

  • Foster is a locked ward for male older adults.

  • Cranford is a medium secure ward for male older adult patients.