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 last assessment we rated this key question Inadequate. 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.

The service did not always ensure that people were fully supported and cared for in a timely way. Staff were generally kind and empathetic, and relatives told us they felt their family members were treated with compassion and understanding. However, there were occasions when dignity was not maintained, such as a patient being left soiled for a significant period before receiving assistance. Some care plans lacked sufficient detail to demonstrate a truly person-centred approach. Opportunities to promote independence and choice were sometimes missed, with staff assuming preferences rather than offering options. We observed some positive and compassionate interactions, but these were not consistent across all aspects of care. Staff aimed to respond promptly to people’s needs, but staffing shortages occasionally delayed care and observations, which could have caused discomfort or distress.

Workforce wellbeing was supported and staff felt valued within their teams. However the impending ward closures created uncertainty, and some staff reported anxiety about their future roles. Staff tried to personalise care and engage people in activities they enjoyed, and we saw examples of staff spending quality time with patients.

The provider was previously in breach of the legal Regulations in relation to Person Centred Care (Regulation 9). Improvements had not been found at this inspection, 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 always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

Staff we spoke with enjoyed their work. Many expressed sadness about the upcoming ward closures. Staff appeared caring and compassionate. We spoke with 4 patients across Redwood and Cherry ward. It was not possible to obtain much feedback about their experiences due to the nature of their illness which had impacted upon cognition and communication. We did undertake some observations of interactions on both wards.

On Cherry ward, we saw a staff member engage with a patient for 20 minutes. During this time, they were engaged in talking, listening to music, singing and dancing together. The patient appeared relaxed with the staff member and smiled frequently throughout their interactions. On Redwood ward, we observed 2 staff members with a patient who was on enhanced observations. Interactions between the staff and the patient were positive. Staff engaged with the patient regularly and at a pace which was appropriate. Staff talked to them about subjects they enjoyed, prompting smiles and verbal responses.

We received feedback from 3 relatives of people who were using the service. All the feedback was positive. Staff were described as treating people with compassion and understanding.

While staff wanted to give the best possible care in a timely way, we were aware that there had been occasions when dignity had not always been maintained. For example, on one occasion in September, an incident form had been completed by a staff member after observing a patient who had appeared to be lying in urine and faeces for a significant amount of time. Staff immediately supported the patient to shower.

The service did not always treat people as individuals. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Staff had considered people’s individual preferences and needs in some aspects of their day-to-day care. We observed staff tailoring conversations to topics patients enjoyed (in line with recorded information), such as music and fashion. We saw patients’ bedrooms had more personalised items, such as photographs of significant people or objects related to interests. One relative told us they had spoken with staff about likes and dislikes for the purpose of care planning and tailoring needs, such as activities.

Care plans did not focus on individual strengths, abilities and preferences around day-to-day activities, such as attending to personal care. These could have been more detailed to demonstrate staff were offering truly person-centred care.

On Redwood ward, staff guided a patient from their bedroom to a chair in the day area. The patient was seated safely with staff assistance. One staff member instructed another to help position the chair and bring it up behind the patient. Staff focused on completing the task, with limited interaction directed towards the patient they were assisting. There was a missed opportunity to engage the patient in conversation, assess understanding and encouragement to work with staff to safely sit in the chair.

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 service did not always actively promote choice and independence. While staff generally supported people well, we saw occasions where choices were assumed rather than offered. We saw a staff member on enhanced observations; ask another staff member to get a drink for the patient they were with. The staff member asked what drink, and was told, juice. The patient was not asked what drink they might like. We saw a staff member present a patient with their meal, with no communication around if they might like any condiments.

Staff had recorded within care plans when patients had been unable to engage directly. Staff had engaged with appropriate family members where possible. However, some care plans could have been more detailed during routine reviews to include what staff had noticed a patient liked or disliked when being supported. For example, staff had recorded a patient preferred a shower to a bath. There was no indication if the patient preferred to be assisted with a shower at a specific time of day, or what shower products they preferred to use.

The service 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.

Staff we spoke with were aware of individual patient risks, such as falling, or being at risk of malnutrition and implemented care plans accordingly. Staff did their best to accommodate patients’ needs and respond in a timely way. However, we were told it was not always possible to meet all needs in a timely way due to staffing. This was discussed in team meetings and appeared particularly problematic as and when a patient might require 2 or more staff to assist them to meet their personal care needs. This had been highlighted on an incident form on one occasion, in September.

On another occasion, patient observations had been delayed by 30 minutes, as there had been no staff available at the allocated time to check the patients. If a patient had required something or needed assistance during this time, staff had not been available or aware as they were busy assisting others.

The service cared about and promoted the wellbeing of their staff.

At the time of our inspection, staff had been informed that the older people’s service would be closing. Numerous staff had worked with older people at the hospital for many years and were unsure about the future. However, staff we spoke with confirmed they were being supported by their ward managers, who had answered any queries they could, and escalated those they needed clarity upon.

We spoke with the service director who explained the transfer and movement of staff was something they had considered carefully. It was acknowledged that any transfers to another area might provoke some anxiety and there may be additional training needs. We were assured this was an ongoing piece of work, and all staff would have an opportunity to discuss with their line managers in the coming weeks.

Staff we spoke with generally felt valued and supported within their own ward teams and enjoyed working with this patient group. Staff had access to support for their own physical and emotional health needs through the providers’ occupational health service.