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 service involved people and treated them with compassion, kindness, dignity and respect.

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

The service did not always provide care that consistently upheld kindness, compassion and dignity. Many patients and carers spoke positively about staff and described them as kind, respectful and supportive. Staff often engaged warmly with patients, and we observed examples of compassionate, person-centred interactions. However, these experiences were not consistent across all wards or times of day. During some observations, staff engagement was limited, particularly during one-to-one observation periods and mealtimes, and opportunities to reassure, communicate with or meaningfully interact with patients were missed. In some cases, the way care was delivered did not promote dignity, which resulted in mixed experiences for patients.

Staff understood the importance of supporting people to be involved in their care and treatment, and patients’ views were reflected in some care plans and community meeting discussions. Carers told us they were generally able to maintain contact with their relatives and felt staff cared about patients’ wellbeing. However, care records did not always clearly show how individual preferences, communication needs or capacity considerations were applied in day-to-day care. Some carers raised concerns about staff attitudes and the way care was delivered during periods of staffing pressure, and patient feedback also reflected inconsistency in how supported and listened to they felt.

At the previous assessment, the provider was found to be in breach of legal Regulations in relation to person cantered care (Regulation 9). This inspection did not identify sufficient improvement, and the provider remained in breach of this regulation.

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 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 did not ensure that people were consistently treated with kindness, compassion and dignity, although there were examples of positive and person-centred care. Patients often spoke positively about staff support and social contact, and some described staff as kind, supportive or “amazing”. We observed respectful and calm interactions during parts of the inspection, and staff explained how they supported people to understand their care and access other services. We saw positive practice on one ward, where staff supported a patient to celebrate their birthday by taking them out into the community. Staff adjusted the support they provided so the person could take part in the outing in a way that mattered to them. Staff told us they wanted the person to have a meaningful and enjoyable experience, and the person said they enjoyed the visit. There were examples of positive practice. For example, on Tavener ward staff involved patients in community meetings, care planning, garden management, and decoration of the gym area. On Walton ward, staff had adapted smoking routines based on patient feedback. Progress had continued creating the ward ‘pub’, providing non-alcoholic beverages.

However, people’s experiences were not consistent. Complaints and ward meeting minutes highlighted concerns about staff attitude and behaviour, and some patients and carers told us that staff were not always respectful or engaging. For example, one ward meeting minutes noted “staff can be rude”. Complaints data corroborated this trend, with staff attitude and behaviour present in some complaints reviewed. During periods of observation, particularly on Allitsen and Walton wards, we observed limited interaction between staff and patients. At times, staff remained present but did not speak with people, offer reassurance or engage therapeutically. We observed poor mealtime support, including minimal communication, inappropriate handling and the use of a broken beaker, which did not promote dignity. At the time of the assessment, the provider was investigating an allegation about staff behaviour on 1 ward. This related to an allegation that a member of staff had asked a patient to use derogatory language to describe themselves. Although this incident had been escalated appropriately and was subject to investigation, and the staff member no longer working on the ward, it however raised concerns about staff conduct, professional boundaries and the culture on the ward.

We also reviewed another incident under investigation where a patient reported an inappropriate comment about their body image by a staff member, raising concerns about professional boundaries.

One carer described poor staff engagement, limited support during visits, and a lack of compassion, including an inability to support a simple walk during a family visit, despite advance planning. They also reported witnessing rude staff behaviour and raised concerns about personal care, describing a strong smell of urine in the patient’s bedroom which they believed indicated neglect. The carer said these experiences caused distress and led them to escalate concerns externally, as they did not feel reassured that dignity, respect and compassionate care were being consistently upheld.

Environmental and practice issues also affected people’s privacy and dignity. On one ward, staff were unable to lock a window hatch during observations and bedroom doors were left open adjacent to communal areas, meaning others could see into people’s rooms. There was no clear documentation or consent recorded to explain or authorise this practice, and staff could not explain how patients’ dignity was being protected during these periods. Incident reviews and safeguarding records also highlighted occasions where dignity was not maintained, including during restraint and the prolonged management of distressed patients in communal areas.

Feedback from community meetings also reflected that some patients felt listened to and supported by staff on their wards.

Staff described signposting patients to other services, including physical healthcare, therapy input and advocacy, and supporting access where required. Care records showed evidence of referrals and multidisciplinary involvement.

Staff told us they understood patients’ individual needs, including personal, cultural, social and religious needs, and we saw some evidence of this reflected in care records. However, documentation did not always demonstrate how these needs were actively considered in day-to-day interactions or reviewed following incidents.

Staff maintained the confidentiality of patient information, and records were stored securely. However, environmental practices, such as open doors and unlocked observation hatches, reduced assurance that privacy and dignity were always protected in practice.

The service 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.

The service made some adjustments to support disabled patients. Ward environments were accessible, and staff used aids and equipment to support people with mobility needs. We saw examples of staff adapting their approach to individual communication needs, including the use of communication passports. On Allitsen ward, we reviewed communication passports for 3 patients. These followed a similar structure but included patient-specific information to guide staff on how best to communicate and reduce distress. However, staff told us that understanding of patients’ communication needs often developed informally over time rather than through structured training or competency assessment, which reduced assurance that all staff could consistently meet complex communication needs. Although staff told us they avoided allocating non-regular staff to patients with known communication triggers, we observed on the day of inspection that a member of staff on general observations appeared unfamiliar with the ward layout and attempted to leave the lounge area via the wrong exit. This did not provide assurance that systems were effective in ensuring all staff, including non-regular staff, were sufficiently familiar with the ward environment or able to communicate safely and appropriately with patients.

Enhanced support audits showed gaps in care planning, and we saw patient documentation which had appeared to have been copied and pasted from other patient's records, with errors and missing details.

Community meeting records show patients shared specific requests such as trips out to places of interest, and specific request for preferred activities, but many remained unfulfilled over several months. While some activities were delivered, the service did not consistently deliver the specific request, despite it being requested more than once. Complaints and PALS concerns further highlighted failures to consider individual needs, such as not involving carers in decisions about dental treatment and not consulting relatives in care planning. These gaps suggest that while forums exist for patient voice, systems to act on feedback are inconsistent.

Staff told us they supported patients to access information about their care and treatment and explained daily routines and ward processes. We saw information displayed on wards about patients’ rights, advocacy services and how to raise concerns. However, documentation did not always evidence how information was adapted to individual communication needs or how staff checked patients’ understanding, particularly for people with cognitive impairment or communication difficulties.

Information leaflets were available on wards, and staff told us these could be provided in different formats or languages if required. Managers said interpreters could be accessed when needed.

Patients’ dietary needs were generally met. Staff told us patients had choices at mealtimes and that dietary requirements relating to health needs were considered. However, observations during mealtimes showed that individual preferences and dignity were not always promoted in practice. On Walton and Allitsen wards, we observed task-focused feeding with limited engagement, which did not always reflect a person-centred approach to mealtimes.

Staff told us patients could access spiritual support if they wished, and managers described how chaplaincy or faith support could be arranged.

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.

The provider did not always promote independence, choice and control. Patients were encouraged to share views in structured meetings and surveys, and some choices, such as vaping arrangements, were adjusted following feedback. One patient said and staff agreed to discuss this in a huddle. However, restrictive practices such as the use of smoking jacket and patients’ preference of how they wanted to be supported to manage their risk were poorly documented.

Staff told us they aimed to promote people’s independence and support them to understand their rights. Patients had access to information about their care, treatment and advocacy services, and community meeting minutes showed that patients were encouraged to share feedback and raise concerns about ward life. Some patients told us they felt able to express their views and said staff listened to them.

However, this was not consistent. Five care records of the 24 care records reviewed did not always demonstrate how patients’ choices and preferences were reflected in care planning or reviewed over time. We found limited evidence that people were actively involved in decisions about restrictions, and changes to their care. In some cases, restrictions were applied without clear documentation of how patients’ preferences for specific physical intervention support methods were considered, as this was not reflected in patients care record.

Observations on Walton and Allitsen wards showed that patients’ independence and choice were sometimes limited by task-focused care and reduced engagement. During mealtimes and periods of observation, staff did not always explain what they were doing or offer patients choices, which reduced opportunities for people to be actively involved in their care. This meant people were not always supported to maintain control over day-to-day decisions that affected their wellbeing.

Although staff told us they avoided allocating unfamiliar staff to patients with known triggers to reduce distress, reliance on informal knowledge rather than structured systems reduced assurance that patients’ individual needs and choices were consistently recognised and respected.

The service did not listen to and 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.

Across multiple wards, basic issues such as broken lights, TVs, and environmental discomfort, were raised repeatedly over weeks without evidence of resolution. For example, Tavener ward minutes show a patient’s TV remained broken from early September through October 2025 despite being logged as an outstanding action. Similarly, requests for vape shelters and improved food quality persisted across meetings before they were actioned. Some progress was noted, such as fitting curtains and delivering an exercise bike on Tallis ward. Documentation seen did not demonstrate staff consistently responded to people’s needs in a timely way.

Staff were aware of specific risks, including falls and physical health needs, and care records showed that risks were identified and monitored. Staff told us they reviewed risks during handovers and multidisciplinary meetings, and incident records showed that staff responded when risks escalated. However, risk management was inconsistent. On Allitsen ward, decisions such as keeping bedroom doors ajar were not documented in care plans or supported by MCA assessments.

Our observations indicated that staff did not always respond promptly or appropriately to people’s immediate needs. On Walton and Allitsen wards, we observed patients on enhanced and general observations for prolonged periods where staff did not engage, offer reassurance or respond to non-verbal expressions.

We observed where staff provided physical support without speaking to patients or explaining what they were doing. This did not minimise discomfort or distress and did not reflect responsive care in the moment. Staff told us they used de-escalation techniques to reduce distress, including stepping away and returning at set intervals, and in some cases this approach helped to reduce agitation. However, observations and incident reviews showed that opportunities to de-escalate through communication and engagement were sometimes missed, and this practice was not always clearly documented, reviewed or adapted to reflect people’s individual needs at the time.

The service cared about and promoted the wellbeing of their staff, and supported and enabled staff to always deliver person-centred care

Most staff we spoke with said they felt respected, supported and valued by their immediate managers. Staff told us they were proud of their teams and enjoyed working with patients. Ward managers described regular supervision and appraisal processes, and staff said appraisals included discussions about development and career progression. Two staff members told us that the service actively supported career development and progression. They described how the service had sponsored them through an apprenticeship programme, enabling them to train as registered nurses. One member of staff told us they had progressed through the apprenticeship route and had achieved a deputy ward manager post. Staff spoke positively about this support and said it made them feel valued and invested in by the organisation.

Staff also told us they had access to occupational health services and support for their physical and emotional wellbeing. Sickness absence data reviewed showed variation across wards, with some wards experiencing higher levels of sickness as previously referenced, which increased pressure on remaining staff and reliance on bank staff.