Archived: St Andrews Healthcare Northampton

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At our last inspection we rated this key question as ‘Good.’ This means we looked for evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

At this assessment the rating changed to requires improvement. This meant people were not always supported and treated with dignity and respect; and involved as partners in their care.

Patients gave positive feedback during the night visit. Patients at Berkeley Lodge told us staff were supportive and there was always someone to talk to. We observed a lot of kind and compassionate care. We observed the OT staff (Occupational therapist), completing physical activity in the ward area. 'Patients appeared positive and activities seemed meaningful with positive relationships between OTs and patients'.

Patients were encouraged to have the DBT skills workbook/folder in the lounge and to utilise the techniques and skills.

However, we observed a lack of interaction of staff with patients during observations. There were issues with dignity as patients were sleeping on the floor, patients were refused bedroom access at times. Community meeting minutes showed patients had raised concerns about the food variety and dietary requirements. Improvements had not been made despite actions to feedback via ‘my voice’ and the ‘kitchen diary’.

We have not awarded this service a score for Caring.

Find out about when we will not publish a key question score and what we look at when we assess Caring.

The service mostly treated people with kindness, empathy and compassion and sometimes respected their privacy and dignity. The service mostly treated colleagues from other organisations with kindness and respect.

Most of the staff at the service treated patients with kindness, dignity and respect in their day-to-day care and support. Staff attitudes and behaviours when interacting with patients showed that they were mostly discreet, respectful and responsive, providing patients with help, emotional support and advice at the time they needed it. We received positive feedback from patients during a night visit who felt they were treated with kindness and that the staff really cared.

Staff supported patients to understand and manage their care, treatment or condition. Patients told us regular staff were kind and caring and responded when urgent support was needed.

Patients said regular staff treated them well and behaved appropriately towards them, however it was not always the same with agency staff. One patient told us agency staff didn’t always respect and provide dignified care. For example, during a focus group, one patient said agency staff watched a patient self-harm and didn’t provide any support to the patient.

Staff understood the individual needs of patients, including their personal, cultural, social and religious needs. On Silverstone ward, 1 patient told us ‘staff are caring and it’s the best ward I’ve ever been on.’ Patients told us families were involved in discussions and decisions about their care. Patients told us they had access to an advocate and were aware of their medicines. Patients told us they were provided with information about their care and treatment in a way that they understood, including their rights and consent to treatment. Patients told us their needs were a priority for staff.

We observed lots of activities and positive interactions between occupational therapists and the patients in completing physical activities in ward areas. We observed a one-to-one music group in the activity room with positive interaction between the activity lead and the patients.

During a DBT session we observed confident engagement from patients. OT’s were knowledgeable, caring, and compassionate. Patients appeared to find the groups useful on the ward. Sessions were structured and organised. Staff listened to patients, offered reassurance and encouraged engagement. For example, we observed 3 distressed patients in the communal lounge area during the afternoon. Staff in attendance provided reassurance and reminded and encouraged patients to use the DBT skills.

Staff maintained the confidentiality of information about patients.

The service mostly treated people as individuals and made sure their care, support and treatment met their needs and preferences, taking account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff who were regular, understood and met patients personal, cultural, social and religious needs, however this was not always the case for non-regular staff. Patient needs and preferences were understood and these were reflected in their care, treatment and support. For example, there was a new admission who was catholic, so a chaplaincy referral was sent to respect their cultural and religious needs. We saw evidence of this in care records.

We saw evidence of patients concerns raised in community meeting minutes about the lack of food variety and not meeting dietary requirements. One patient told us there was minimal choice of food for vegans and vegetarians. On 2 occasions orders were not fulfilled, there were 5 concerns around the lack of choice of food to meet dietary requirements and 4 concerns about the temperature of the food. Despite actions to feedback through ‘My Voice’ and ‘Kitchen Diary’ there didn’t seem to be any improvements. Ward monthly menus were available but not in an easy read format.

Most staff treated people as individuals, considering any relevant protected equality characteristics. We reviewed 11 care records which were individualised, detailed, up-to-date and followed with a template to include risks, medicines and physical health. We saw evidence of a pictorial care plan for one patient.

Patients communication needs were met to enable them to engage in their care, treatment and support to maximise their experience and outcomes. This was evidenced in care plans and during patient interviews. We also observed notice boards with detail and information about CQC, advocacy, the complaints process, chaplaincy contact information, healthy eating and BMI and meet the team information. We observed an informal patient notice at the front door.

The service mostly promoted people’s independence, so they knew their rights and had choice and control over their own care, treatment and wellbeing.

Patients were mostly supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. However, during the night visit on Silverstone ward patients were queuing and waiting to access their bedrooms and there were timed restrictions in place.

People were supported to understand their rights by using different ways to communicate. Their understanding was reviewed throughout their care and treatment.

People were supported to maintain relationships and networks that were important to them.

Patients told us they had access to their friends and family while they were using the service. On Berkeley Close one patient told us they could see their family whenever they liked, they couldn’t come in but could pick them up. Feedback from patients was positive around access to the community and seeing friends and family.

Patients had access to a range of activities and the local community to promote and support their independence, health and wellbeing. Patients had community access to both the gym and swimming pool on site.

Patients were supported into work such as a chef or grounds maintenance, volunteering, cooking and using transport. There was a café/restaurant with patient workers on site and there were education and recovery college facilities on site.

The service did not always listen to and understand people’s needs, views and wishes. They did not always respond to these in that moment and act to minimise any discomfort, concern or distress.

On Silverstone ward we observed that staff did not always respond to people’s immediate needs to minimise any discomfort or distress. We observed staff completing therapeutic observations without engaging with patients and standing or sitting on the outside of communal areas without interacting with patients.

We also observed a staff member not interacting with a patient while carrying out their one-to-one enhanced therapeutic observations. Following this lack of interaction and engagement the patient became distressed and staff only engaged with the patient at this point to attempt to de-escalate the situation. However, attempts at de-escalation failed and further staff were required to support the patient, resulting in the use of restrictive intervention.

A patient who had received intramuscular medication that could lead to drowsiness was denied access to their bedroom when requested. The patient had a one-to-one nurse carrying out their enhanced observations but was informed that they could not go upstairs while handover was taking place. Following this refusal the patient attempted to go upstairs as staff entered the ward and restrictive interventions were utilised to prevent the patient leaving the downstairs corridor.

Due to a plumbing issue only one toilet was in use downstairs, we observed patients queuing for the one downstairs communal toilet that was working and being denied access to their bedroom ensuites.

We also observed and were told of examples across all wards of staff listening to, understanding and supporting patients with their needs and views. Three patients told us that staff were supportive and responsive to their immediate needs. Patients also told us that staff supported them when they were distressed. Some patients on Silverstone ward told us that the permanent and experienced staff were responsive to their needs and supported them when they were distressed.

Patients at Berkeley Lodge and Watkins House told us they had open access to the communal garden and could go for a walk without restrictions. Patients felt happy and could do cooking and play bingo. On Berkeley Lodge one patient told us staff are caring and friendly.

We observed a DBT session on Silverstone ward and noted that staff were responsive to patient’s becoming distressed during and following the session and offering immediate support and techniques to manage their emotions.

The service did not always care about and promote the wellbeing of their staff, and support and enable them to deliver person centred care.

Staff didn't always feel respected, supported and valued. Managers and members of the MDT raised concerns with communication and support from senior managers within the organisation. Where managers and staff had raised concerns to senior managers, they did not always feel that managers listened and took action to support them to deliver person centred, quality care.

Some staff raised concerns about being asked to carry out further roles or take on new responsibilities on a short-term basis without clear timeframes for this work or acknowledgement of the impact on patient care.

The Silverstone MDT and managers expressed significant concerns regarding patients being admitted against their advice. Staff had assessed the patients and identified that they were not appropriate or ready to engage in the DBT programme. The team told us that their assessments were overruled. The patients were admitted due to concerns about the low occupancy level for the wards. Following the patients' admission to the ward staff felt invalidated and described significant impact on the wellbeing and safety of staff and patients due to increased incidents, including violence and aggression. Some staff had escalated their concerns with this to the senior leadership team but did not receive a response to their concerns. Following the admissions and an increase in incidents, the ward was identified as a `ward or concern' and subject to a safeguarding review. The team did not feel there had been any reflection from the senior leadership team or learning to ensure this would not happen again if occupancy reduced. It was also noted that these shared concerns were not reflected in the division risk register.

The multidisciplinary and management team for Silverstone ward also raised concerns that vacancies and maternity leave had not been filled due to financial constraints. While all deputy ward managers were on maternity leave these vacancies were not filled despite a request from the ward manager. The DBT assistant vacancies were not filled due to the division having no more senior healthcare worker level vacancies. When medical team members had left these vacancies were not filled in a timely manner and impacted on the medical leadership for the ward and continuity of patient care.

Most staff told us they felt positive and proud about working within their ward and with their direct managers and team. This view was reflective of the providers 2024 staff survey which showed that the top scores for staff were around being valued by their line managers and satisfaction with support from their colleagues.

The 2024 `your voice' staff survey (June 2024) evidenced shared concerns across all wards in the division with the communication from senior management, belief that senior managers would act on staff feedback and feeling valued by St Andrews Healthcare, within the lowest scoring areas. Scores for health and wellbeing, and pride were also low, with the favourable percentage between 25 -50% for pride and between 50 -58% for health and wellbeing.

The division did have an action plan in place to address the outcome of the staff survey and staff described these areas as improving during the inspection.

Staff appraisals included conversations about career development and how it could be supported.