St Andrews Healthcare Northampton

Ratings - Long stay or rehabilitation mental health wards for working age adults

• Overall

  Requires improvement

• Safe

  Requires improvement

• Effective

  Requires improvement

• Caring

  Requires improvement

• Responsive

  Requires improvement

• Well-led

  Requires improvement

Our view of the service

We completed an assessment and inspection of St Andrews Healthcare Northampton on 12 and 13 March 2025.

This assessment was carried out following the CQC's new approach to assessment; Single Assessment Framework (SAF). We inspected the long stay rehabilitation mental health wards for adults of working age. We looked at all quality statements under each key question. We carried out a mix of onsite and offsite inspection and assessment activity between 12 March 2025 and 22 April 2025. This was an unannounced assessment, which means the provider was not told an assessment was going to be starting beforehand.

St Andrews Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities and behaviours of distress.

The long stay or rehabilitation mental health wards for working age adults ASG (assessment service group) is made up of 5 wards/lodges. We assessed Silverstone, Watkins House and 37 Berkeley Close. We also assessed Berkeley Lodge and Sitwell Ward. At the time of the inspection there were 24 patients at the service in long-stay or rehabilitation mental health wards for working age adults.

We rated the service as Requires Improvement as we identified 6 breaches of the Health and Social Care Act 2012 regulations. Staff did not always record capacity and consent in relation to the clinical treatment model and support level framework on Silverstone ward. The service did not ensure to keep the clinic room clean and tidy and assess the risks to people's health and safety for safe care and treatment. Staff did not always use the least restrictive interventions. We found there were also blanket restrictions applied to patients on all wards.

The service did not ensure to manage and mitigate maintenance risks on premises in a timely manner. Governance systems and audits were not effective in identifying or addressing areas for improvement. The service did not always ensure that staff had the necessary specialist skills to support patients' needs and implement the proposed clinical treatment models.

However, the rehabilitative model was evident and there was good multi-disciplinary input into it. Care records including risk management were detailed and up to date. Many staff were compassionate caring and skilled.

During this assessment and inspection, we found 6 breaches of regulations.

The provider did not always:

• Ensure to obtain and record capacity and consent for care and treatment on Silverstone Ward
• Ensure care and treatment was provided in a safe way and to adhere to infection prevention and control processes.
• Ensure patients are safeguarded from abuse and improper treatment such as the application of blanket restrictions
• Ensure premises and equipment including maintenance risks are recorded and mitigated within a timely manner.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure there were sufficient, suitably competent, and experienced staff trained to apply and provide care within the clinical treatment model and dialectical behavioural approach for service users accessing specialist rehabilitation services

We have asked the provider for an action plan in response to the concerns found at this assessment.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• Staff had received training in the Mental Health Act with a compliance of 95% and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy.
• There was a lack of information relating to the care of informal patients within the clinical treatment model and consent policies. The leave section of the clinical treatment model and support framework did not include guidance or information around rights of informal patients. Staff and patients did not have sufficient understanding of informal patient's rights and management of risks in relation to time away from the ward, as there was a serious incident reported where one patient accessed leave without it being agreed.
• Staff did not always ensure patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted due to lack of staff.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

• Staff had had training in the Mental Capacity Act with a compliance of 95%.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles, however not on Silverstone Ward.
• The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.
• Staff took all practical steps to enable patients to make their own decisions
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions, however not on Silverstone Ward.
• The service had arrangements to monitor adherence to the Mental Capacity Act.
• Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

People's experience of this service

We spoke with 9 patients and 1 carer during the inspection. While most of the patients we spoke with said they were happy with their care, our assessment found, there were elements of care that did not meet the expected standards. Five out of 9 patients on Silverstone ward told us the ward was very restrictive and punitive in its model. Patients told us, the courtyard was always locked and most patients could not access their rooms in the day. However, during the inspection the courtyard door was unlocked with a door sign stating, courtyard access supervised unless this has been agreed in the ward round and that the door maybe locked to manage risks. Patients could not lie down in their rooms or go to their bedrooms and ensuites to attend to their personal hygiene due to the restrictions to go after the nighttime medicines were administered. Patients could not freely access the side rooms of the ward, including the dining area. There were also no hot or cold drinks freely available for patients as they would need to ask staff first. One patient said, ‘There have been delays with fixing the plumbing,’ ‘We are short staffed at times,’ and ‘Permanent staff are skilled and supportive, whereas agency staff are not always kind and caring.’ Another patient told us ‘It’s the best ward I’ve ever been on and they feel safe on the ward. The DBT (Dialectical Behavioural Therapy) is useful and the OT (Occupational Therapist) is amazing.’ However, during a focus group with 5 patients they told us the ward didn’t feel safe due to there not being enough staff, especially at night. A further patient told us that ‘newer staff didn’t appear to have the necessary skills to care for them.’

The service uses My Voice data (an online and confidential survey) across all of their wards. The provider told us patients prefer to use the community meetings to share their voice. We observed 9 out of 12 community meeting minutes across the wards for long stay rehabilitation and found concerns had been raised about dietary need options, the temperature of food on Silverstone ward and maintenance concerns. Despite feedback via patient surveys and the kitchen diary, these had not been improved.

Patients told us the therapists were knowledgeable, caring and compassionate. Patients were observed to be open and trusting of staff. DBT sessions were structured and organised. Staff listened, offered reassurance, and encouraged engagement. We observed the therapist comforting a distressed patient. Patients told us they found the groups useful on the ward.