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

This means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. The provider was previously in breach of the legal Regulations in relation to safe care and treatment, safeguarding, good governance, and staffing. Improvements were not found at this inspection, and the provider remained in breach of these Regulations. The provider was also found to be in breach of the legal Regulation relating to dignity and respect.

At our previous inspection we rated this key question as requires improvement. At this inspection the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

At this inspection the provider was found to be in breach of the legal Regulation relating to dignity and respect (Regulation 10).

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 evidence showed significant shortfalls. The service did not treat people with kindness, empathy, and compassion, or respect their privacy and dignity. Staff did not treat colleagues from other organisations with kindness and respect. The service demonstrated it had a closed culture which directly impacted on the wellbeing of patients.

Staff did not always treat people with kindness, empathy, and compassion, or respect their privacy and dignity. During our inspection, we viewed 26 incidents via CCTV. These incidents included incidents of patient restraint, staff administering intramuscular medicines and staff transferring a patient to seclusion. During the review of CCTV, we saw some positive interactions, however we also observed several examples of unprofessional and abusive staff behaviour to patients. We observed that staff attitudes and behaviours when interacting with patients were not always discreet, respectful, and responsive. This included staff becoming visibly angry or threatening towards a person, staff crowded around a person held in restraint and staff displaying negative body language such as folded arms. We also observed 2 separate incidents via CCTV, where staff were observed to have assaulted a person.

We reviewed one serious incident where staff were restraining a person. Supporting staff did not attempt to protect the person’s dignity. This included the person’s genitals being exposed and staff seen to drag them. Despite there being a high number of staff involved in the incident, no staff members acted to protect the person’s privacy dignity.

Staff did not always raise concerns about disrespectful, discriminatory or abusive behaviours towards people. Staff involved in the incidents we reviewed had not raised concerns about the way staff treated people during incidents.

On Fairbairn ward, deaf patients told us that they had felt “ignored, isolated, and bored”, describing their experience as “worse than prison”. We found this feedback to be similar to our previous inspection and a lack of improvement from the provider. Due to lack of interpreters, patients were not included in forums or equality groups. This excluded the patients from being actively involved in their own care planning. We found that patients were not treated as individuals or supported to express themselves, contrary to the core principles of dignity, inclusion and respect.

Staff informed us that some staff members were regularly found to be talking in languages other than English on the wards. This can have an adverse effect on patients’ mental health and increase feelings of isolation and paranoia. Staff had to be reminded not to talk in their native language on the wards. Minutes of team meetings confirmed that staff have been reminded of this requirement.

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

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

The service had not made suitable adjustments for deaf patients. For example, patients on Fairbairn ward did not always have access to BSL trained staff and interpreters, therefore not meeting patients’ specific communication needs. We reviewed data from the provider relating to the provision of interpreters. Between 1 May and 23 August 2025, the average interpreter fill rate was 51%. On 21 days the fill rate was at 100%, however on 22 days there were no interpreters available. This was raised as a concern on our previous inspection, and we found a lack of improvement at this inspection.

Not all patients said staff treated them well and behaved appropriately towards them. One patient reported that “most staff did not attempt to communicate in BSL”. During our inspection a significant communication breakdown was observed during a staff intervention with a patient. As a result, the patient felt that staff members were observing him without explanation, which led to the patient having feelings of paranoia.

Not all staff members were trained to BSL level 1 or 2, however were working towards completion. The provider informed us that there was an ongoing BSL staff training programme for staff. Managers had recently recruited new staff for the ward, although the recently recruited staff did not have BSL skills. Staff who were trained in BSL were not using BSL routinely. This was adversely impacting on communication between staff and patients. One staff member told us that staff did not engage with deaf patients or use the BSL they were learning. We were also informed that due to staff trained in BSL leaving, available communication skills for patients appeared to have decreased. We were told that consequently the remaining staff on the ward (who were proficient in BSL), were becoming overused and becoming burnt out. This had led to experienced staff leaving.

During our inspection we observed that staff members were largely in the office, therefore patients on the ward appeared isolated and unengaged. We saw patients knocking on the glass of the ward office and at times being ignored by staff. We also noted that consequently (since our previous inspection), there had been a decline in patients’ ability to communicate and use BSL themselves.

Staff told us that people could obtain information on treatments, local services, patients’ rights, how to complain and so on. Staff told us the information was available in a form accessible to the patient group, however this was not observed during our inspection.

The evidence showed some shortfalls. The service 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.

During our inspection we found that each ward had a list of blanket restrictions. These had not been independently risk assessed. Therefore, there was a risk that people may be facing unnecessary restrictions.

The provider shared minutes from the weekly patient community meetings between May and July 2024. During these meetings patients on Sycamore ward raised concerns about the standard of the food. Patients on Seacole ward had told staff that food portions were too small. One patient on Bayley ward had told staff they had not received their meal on 2 occasions; however, staff were able to provide an alternative meal.

Patients were able to access information on their rights and how to complain. During our inspection, we noted information about the Mental Health Act and making complaints was displayed on a notice board.

Patients were able to have access to their mobile telephones unless there was a clinical reason not to. They were able to have regular telephone contact, make video calls, and where possible, arranged to meet up in person. The provider had systems in place (including contracts with patients), to ensure that mobile phones were being used appropriately and safely. The provider had arrangements in place for child visiting off the wards.

The evidence showed significant shortfalls. The service did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern, or distress.

Staff had not always identified and responded to changing risks to, or posed by, people. Staff did not always respond to listen to and understand people’s needs, views and wishes, or act in that moment to minimise any discomfort, concern or distress. We found there were ongoing altercations between patients (including physical and verbal abuse) which were not being effectively managed. Between 11 July 2025 and end of August 2025, the CQC were notified of 7 incidents which related to altercations between people on the wards. On inspection, one person reported they had been subject to racial abuse several times. Some staff told us they had personally witnessed and experienced racism, including from management.

Review of records, incidents and recent cases (reported to the CQC), have shown that on several occasions people told staff they were in pain or discomfort and that was not acted upon. Examples include where a patient informed staff during a restraint their back was hurting, but no action was taken to minimise this pain. A further incident where a patient told staff members they were hurting their arm, but staff members continued with the same restraint techniques.

Staff did not always use de-escalation techniques to reduce the need for physical interventions when peoples’ behaviours became heightened. During our review of CCTV, we reviewed several incidents where staff had immediately responded to incidents by using restraint techniques before trying de-escalation techniques.

The evidence showed some shortfalls. The service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centered care.

Some staff told us the service did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centered care. One nurse told us there had been no care provided to another nurse on the ward after a patient had bitten them. The minutes of the CAMHS and low secure governance meeting for July 2025, referred to ‘current low staff morale relates to uncertainty; the division needs to be transparent with communications.’ However, the provider had systems and processes in place for staff to access support for their own physical and emotional health needs through an occupational health service.

Not all staff felt respected, supported and valued. For example, we were informed that bank staff were often treated differently by staff on the wards. This included the allocation of work, the allocation of activities and breaks and that regular bank staff did not participate in reflective practice. We were also informed that regular staff could be “cliquey” and that bank staff did not always feel valued. One staff member told us “there was no positive feedback, even regarding salaries”. Staff also told us “The work from home arrangement had made leadership inaccessible”. This meant that managers were not always available for face to face support, which had left staff feeling unsupported.

The average percentage sickness across all wards as of June 2025 was 6%, which is slightly higher that the NHS average of 5.6%.

The provider recognised staff success within the service – for example, through staff awards. Staff were in receipt of annual appraisals, which included conversations about career development and how it could be supported.