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St Andrew's Healthcare - Essex Good

Inspection Summary


Overall summary & rating

Good

Updated 19 May 2020

St Andrew's Essex provides care for both men and women with a personality disorder and/or mental health issues in a low secure and locked environment.

We carried out this inspection in response to concerning information received through our monitoring processes.

We did not rate this service on this inspection. We found the following areas the provider needs to improve:

  • Patients were at risk of avoidable harm. Staff did not always assess and manage patient risks. Multidisciplinary teams were not always reviewing patient observation levels following risk incidents. Staff did not record all risks on one patient’s risk log. Staff did not always report incidents appropriately. We reviewed an incident where a patient had tied a ligature which was reported inappropriately.
  • The service did not have enough registered nursing and support staff to keep patients safe. Managers had not filled a third of registered nurse shifts and 15% of support staff shifts. Shift leads allocated staff to multiple roles, which impacted on staff’s ability to keep patients safe. Both staff and patients told us they didn’t feel safe.
  • Staff did not always follow the provider’s policy and procedures on the use of enhanced support when observing patients assessed as being at higher risk of harm to themselves or others. Staff were not completing intermittent observation records in line with the provider’s policy and procedures.
  • Staff did not always follow the Mental Health Act Code of Practice in relation to seclusion. Staff did not record the levels of observation accurately for a patient who was secluded for a long time. Staff had not completed the section on informing family, carers or advocacy about the seclusion and had not completed the seclusion room checklist prior to seclusion commencing.
  • Staff did not always treat patients with dignity and respect. We were concerned by some of the language used by staff in patient records. Staff recorded information that was judgemental and not a factual account. For example, following an incident involving a staff member being racially abused, it was recorded in the progress notes that the staff told the patient to ‘behave yourself’ and staff recorded that they told another patient to “stop playing up”. In addition, in response to an incident of self harm staff recorded in notes that they had told a patient “you’re an adult, deal with it”. The provider took appropriate action to deal with this incident.

  • The leadership, governance and culture did not always support the delivery of high quality, person centred-care. The provider’s governance processes had not addressed staff failures to follow the provider’s procedures on enhanced observations and allocation of staff tasks. Managers did not have sufficient oversight of key elements of the service that related to patient safety.
  • Managers did not always make notifications to the Care Quality Commission when safeguarding incidents occurred. We reviewed a random sample of six safeguarding incidents, involving physical abuse between patients and managers had failed to notify any to CQC.

However:

  • Staff and patients told us they had been offered support and debriefs following a recent serious incident.
  • Staff reported that learning from incidents was shared through ‘red top alerts’. Managers displayed hard copies in the ward offices.
Inspection areas

Safe

Requires improvement

Updated 19 May 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Patients were at risk of avoidable harm. Staff did not always assess and manage patient risks. Multidisciplinary teams were not always reviewing patient observation levels following risk incidents. Staff did not record all risks on one patient’s risk log. Staff did not always report incidents appropriately. We reviewed an incident where a patient had tied a ligature which staff had not reported appropriately.
  • The service did not have enough nursing and support staff to keep patients safe. Managers had not filled all registered nurse and support staff shifts. Staff were allocated to multiple roles, which impacted on their ability to keep patients safe.
  • Staff did not always follow the provider’s policy and procedures on the use of enhanced support when observing patients assessed as being at higher risk of harm to themselves or others. Staff were not completing intermittent observation records in line with the provider’s policy and procedures on 629 out of 3,364 occasions.
  • Staff did not always follow the Mental Health Act Code of Practice in relation to seclusion. Staff did not record the levels of observation accurately for a patient who was secluded for a long time. We reviewed the records of a patient on Colne ward, who staff secluded for 19 days (425 hours). Staff observation entries recorded no risk issues for 422 hours of the seclusion. Staff had not completed the section on informing family, carers or advocacy about the seclusion and had not completed the seclusion room checklist prior to seclusion commencing.
  • The provider did not manage safeguarding concerns effectively. The local authority safeguarding team reported 22 open safeguarding cases for the Essex location, dating back to May 2019. The safeguarding team requested information from the provider to help investigate, however they had not received the required information. There was a discrepancy between the local authority’s open cases (22) and the provider’s open cases (10). The provider had not notified CQC about nine of the safeguarding cases on the local authority’s list. We reviewed a further six safeguarding incidents on the provider’s incident database, which involved physical abuse between patients. Managers had not reported these incidents to the local authority or to CQC.

However:

  • Staff and patients told us they had been offered support and debriefs following a recent serious incident.
  • Staff reported that learning from incidents was shared via ‘red top alerts’. Managers displayed hard copies in the ward offices.

Effective

Good

Updated 19 May 2020

Caring

Good

Updated 19 May 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • Staff did not always treat patients with dignity and respect. We were concerned by some of the language used by staff in patient records. Staff recorded information that was judgemental and not a factual account. For example, following an incident involving a staff member being racially abused, it was recorded in the progress notes that the staff told the patient to ‘behave yourself’ and staff recorded that they told another patient to “stop playing up”. In addition, in response to an incident of self harm staff recorded in notes that they had told a patient “you’re an adult, deal with it”. The provider took appropriate action to deal with this incident.

Responsive

Good

Updated 19 May 2020

Well-led

Good

Updated 19 May 2020

We did not rate this key question.

We found the following areas the provider needs to improve:

  • The leadership, governance and culture did not always support the delivery of high quality, person centred-care. The provider’s governance processes had not addressed staff failures to follow the provider’s procedures on enhanced observations and allocation of staff tasks. There was no evidence that the provider undertook regular and effective audits of these issues.
  • Managers did not have sufficient oversight of key elements of the service that related to patient safety. We found issues with the quality and timeliness of incident reports. Managers did not ensure shift tasks and patient observations were allocated in line with policy. Managers had not ensured the service provided suitable numbers of staff to meet patients’ needs.
  • Managers did not always make notifications to the Care Quality Commission when safeguarding incidents occurred. We reviewed a random sample of six safeguarding incidents, involving physical abuse between patients and managers had failed to notify any to CQC.
  • Managers did not always engage with external agencies. We were provided with examples of managers being obstructive towards the police, local authority safeguarding teams and advocacy staff.
Checks on specific services

Forensic inpatient or secure wards

Good

Updated 10 February 2015

Overall we found that improvements were required as the services provided were not always safe. Actions from ligature audits were not followed through on one ward and care and treatment records were incomplete in respect of one person’s physical healthcare needs. This meant that people may be at risk of unsafe care and treatment.

There were systems in place to ensure an effective service. Surveys and audits measured the quality and effectiveness of systems.

The services provided were caring. This was confirmed by our observations of the care and treatment being provided and subsequent discussions with staff.

The services provided were responsive. Evidence was seen that demonstrated to us that the provider encouraged feedback from people and staff to influence the running of the service.

The services provided were well led. Most staff told us that they felt supported. Staff across all of the wards inspected told us that there were difficulties with the recruitment and retention of staff. We found that there was widespread use of bureau (St Andrews healthcare staff) and agency staff on the wards inspected.

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 10 February 2015

Overall we found that PICU services provided safe, effective, caring, responsive and well led services.

We found that risk assessments were carried out to keep people, staff and the environment safe.

There were systems in place to ensure an effective service. Surveys and audits measured the quality and effectiveness of systems.

The services provided were caring. This was confirmed by our observations of the care and treatment being provided and subsequent discussions with staff.

The services provided were responsive. Evidence was seen that demonstrated to us that the provider encouraged feedback from people and staff to influence the running of the service.

The services provided were well led. Most staff told us that they felt supported. Staff across both wards told us that there were difficulties with recruitment and retention of staff. We found that both units used a number of bureau (St Andrew’s healthcare staff) and agency staff to support people.

Forensic inpatient or secure wards

Good

Updated 19 May 2020

Wards for older people with mental health problems

Updated 19 May 2020

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 19 May 2020