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

Caring - this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

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 provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Relatives and patients, we spoke with were generally positive about staff treating them with kindness and compassion. However, while people expressed general satisfaction, we found elements of care did not meet the expected standards.

Staff we spoke with were kind and compassionate in their approach and were motivated to improve outcomes for patients, However, we observed a staff member on Elm ward remove a patients top clothing in full view of other patients, staff members and visitors, leaving them without a top on until they returned with a new clean top. This was not respectful and did not respect their privacy and dignity. We saw a staff member standing over a patient when supporting them with their meal. This practice is discouraged and known to create an atmosphere of coercion, pressure and discomfort. Staff should be positioned at eye level to support communication and a relaxed atmosphere.

Review of close circuit television on Cherry ward showed a staff member did not appear to act with empathy and compassion when a patient had a fall.

The provider did not provide sufficient time for staff to develop trusting relationships with patients because there was a high usage of bank and agency staff who did not know to the patients or the wards. This meant permanent staff were very busy providing personal care and meeting people's needs and other patients were cared for on a one to one or two to one staffing ratio by staff they did not know.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Patients’ strengths abilities, aspirations and unique backgrounds were recorded within care records. However, for some patients this information was limited. For example, 1 patient had only 1 strength listed, and this was their ability to feed themselves. For another patient their cultural background was recorded as important to them but there was no direction for staff about what they should do to meet their cultural needs. There was limited evidence of culturally appropriate care being provided within care records. Some patients had religious needs and a desire to attend their chosen place of worship but opportunities for this were limited. Patient’s likes and dislikes were recorded in the ‘all about me’ document but there was no indication in care records of how staff used this information to plan and deliver care, treatment and support.

Staff told us how important knowing patients’ needs and building a therapeutic relationship was and gave examples of how they delivered care, treatment and support to meet patients’ individual needs. However, they told us the high use of bank and agency staff made this difficult and how this had a negative impact on patient’s experience.

Care coordinator meetings and community meetings took place, however there was limited evidence patient’s preferences had been discussed or changes to personal, cultural, social or religious needs been considered.

Some patient’s rooms did not reflect their individuality with meaningful decoration or photographs and were bare and stark in appearance. However, we saw 2 patient’s rooms on Cherry ward had been personalised and contained photographs and items that were significant to their individual preferences.

Equality, diversity and human rights training was mandatory for all staff and compliance with this training was high (above 96%) across all 3 wards.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Patients could not access leave as much as they wanted. Staff told us they did not always have time to support patients to go for a walk or visit the café because there were not enough staff. In particular, where patients required one to one or two to one support in order to keep them safe. There was also limited access for patients in outside space in the courtyard areas. These areas where unkempt on Aspen and Cherry Wards. Records we reviewed showed many patients had very limited access to leave and we did not see this being utilised during our inspection. Ward governance meeting minutes (February 2025) for Elm ward recorded; ‘Last year an establishment review meeting was held. It was acknowledged that more staff are needed but this has not yet happened. Patients who are dependent on staffing are not receiving sessions due to this.’

Many patients were from out of the local area and lived a long way from their friends and family. Relatives we spoke with told us they were provided with an appropriate space for visiting and were involved and consulted about their family members, care treatment and support. Two patients told us they attended meetings and were consulted and involved in their care and treatment plans. Many patients had cognitive impairment and difficulty with communication so were unable to participate in these meetings. Family views were sought were possible. However, it was not clear from some records how staff had attempted to involve patients and carers as much as possible, to ensure their views were taken into account and recorded in their care records.

The provider told us they used an anonymous survey known as ‘my voice’ to collect patient feedback. However it is not clear how patients with advanced dementia could participate in this survey.

Staff told us they valued family involvement. An initiative known as ‘Johns campaign’ was being implemented to promote and support relatives’ involvement. ‘Johns campaign’ core principle is that family members and carers should be welcome and supported to assist with care, decision making.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

Patients, needs views, wishes and comfort were not always a priority and staff were not always able to respond in a timely way. A patient told us they frequently had to wait for pain relief medication because there was not a nurse available. They also told us they asked staff to support them to lie down to relieve their abdominal pain but there were no staff available, so they had to wait.

We observed a patient walking around the ward and standing facing a wall. Staff had not been alert to this patient’s needs and possible disorientation. Another patient was communicating their distress to staff, but staff were not providing comfort or reassurance. Another patient was walking around the ward and appeared disoriented but there was some delay in staff offering support. Many staff were not permanent to the ward so did not understand patients’ needs or the best way to communicate with them. A relative told us their family member could be aggressive towards staff if the staff were not familiar to them.

There was also delay in escalation when a patient’s physical health was declining due to ongoing insufficient intake of food and fluids. There were no records of escalation when another patient did not meet their daily fluid target for 7 out of 13 days.

Patients physical, cognitive and communication needs were recorded in their PBS plan. However, information was limited and there was a lack of clear guidance and care plans for staff to support a structured routine that met patients’ individual needs and effective communication.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff told us they valued their team and all worked well together. However, some regular staff were frustrated because of the high use of agency and bank staff resulting in all of the responsibility for providing care and support fell to them. Staff acknowledged staffing numbers had increased but remained frustrated about the lack of permanent staff. This meant they did not always have time to provide effective person-centred care. On the night shift on Elm and Aspen wards there was only one qualified nurse on duty so it was difficult for them to take a break away from the ward.

Staff meetings were held monthly. Minutes of these meetings showed staff had been raising concerns about the high use of agency staff since at least December 2024. Staff also raised concerns about ongoing aggression from patients. Leaders were aware of these concerns. In the clinical governance meeting for Aspen ward in December 2024 and January 2025 it was stated ‘Mostly agency staff covering who have little or no knowledge of service user needs.’ However, these concerns were ongoing at the time of our inspection visits in March and April 2025.