You are here

St Andrew's Healthcare - Essex Good


Inspection carried out on 10, 17 and 20 February 2020

During an inspection looking at part of the service

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.


  • 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 carried out on 26 to 28 June 2017

During an inspection looking at part of the service

We rated St Andrew’s Essex as good because:

  • All ward areas were clean and well maintained; equipment was well maintained and safety tested, cleaning records were up to date and demonstrated regular cleaning of ward areas.

  • There were designated quiet areas on all wards and there was a visitor’s room near the hospital entrance that could be used for patients to meet with family and friends.
  • There was a phone room on all wards to facilitate patients making calls in private.
  • Patients were given a welcome pack on the psychiatric intensive care wards, which contained essential items for hygiene and enhanced their wellbeing.
  • Shifts were covered by sufficient numbers of staff with the right grades and experience.
  • Staff told us that morale had improved recently and attributed this to new members of the leadership team.
  • Staff told us they felt well supported by managers.
  • There were flexible working arrangements available for staff.
  • Staff and visitors had access to personal alarms. The provider had simplified their staff recording system since the last inspection and for the majority of shifts; staffing numbers matched those on the rota. Shifts were covered by sufficient numbers of staff with the right grades and experience. Staff told us that they were able to maximise their time on direct care activities as opposed to administration duties. There was a full range of mental health professionals available to deliver care.
  • Staff we spoke with knew what incidents to report and used electronic recording system to report incidents. Staff were open and transparent and explained to patients when things went wrong. Staff told us they received feedback from investigation of incidents at team meetings and in managerial supervision. There was evidence that changes had been made as a result of feedback.
  • Patients we spoke with told us staff were kind and treated them with dignity and respect. Carers we spoke with told us that they were pleased with the care their relative received.
  • Care records were up to date, personalised, with holistic recovery-orientated care plans.
  • Prescription charts showed that staff followed National Institute for Health and Care Excellence guidance for prescribing medication. The pharmacist had written the percentage of medication prescribed to help staff remain within British National Formulary limits and reduce the risk of multiple medications being prescribed for the same problem.

However we found the following areas that the provider needs to improve:

  • There were high levels of the use of prone restraint across the hospital, particularly in the psychiatric intensive care services. Whilst the provider had set out measures to reduce levels of seclusion and restraint these measures had not yet had significant effect.
  • The external door to the garden from the extra care suite on Audley ward was clear glass and therefore visible from the garden. This compromised patients’ privacy and dignity. This was raised with the provider who agreed to address the issue.
  • The fridge lock in the clinical room on Audley ward had been broken. The provider had sourced a new lock and was awaiting fitting of the new lock at the time of the inspection.

  • For two of the seclusion records reviewed the front sheets were incomplete. The nurse in charge had not signed them before uploading to the electronic record.
  • For one patient the gap between medical reviews whilst in seclusion was longer than the four hours recommended by the Mental Health Act 1983: Code of Practice.

Inspection carried out on 20-22 September 2016

During a routine inspection

We rated St Andrew’s Essex as ‘requires improvement’ because:

  • The provider had not included all ligature points in their ligature risk assessments.
  • Staff did not always record or manage seclusion and long term segregation in accordance with requirements of the Mental Health Act (MHA) code of practice.
  • The provider had limited rooms or quiet areas on some wards for care and treatment. Staff regularly transferred patients between wards in order to access safe areas to manage disturbed behaviour. Staff transferred patients between wards via lifts or staircases during periods of agitation. This was a risk to patients and staff.
  • Wards had limited space for patients to meet visitors in private.
  • There was a delay in replacing curtain rails and other repairs on wards, affecting patients’ privacy and dignity.
  • Staff had not fully completed an evacuation care plan for a disabled patient and the required evacuation chair, for use in an emergency, was not available.
  • Medication management/prescribing was not always reviewed in a timely manner.
  • Staff were not always aware where to find information in electronic patient records. This meant there may be a delay in finding up to date information.
  • The provider had discrepancies in their staff rotas. Records did not always accurately reflect the staffing on duty.
  • The provider did not have consistent records of management supervision. Management supervision records were inconsistent and poorly documented.
  • Some staff had reported experiencing racial abuse and felt that managers had not responded appropriately to their concerns. However, the provider was able to demonstrate issues of racial abuse were investigated. The provider supplied data that showed from 01 April to 21 September 2016, there were seven recorded accounts of verbal racial abuse. The data also showed that managers addressed incidents at a local level in discussion with staff, with peer support and through reflective meetings. Staff were encouraged to report these incidents to the police. The provider’s workforce race equality standard (WRES) action plan provided showed the provider monitored incidents of verbal abuse of staff through the electronic reporting system.


  • Patients spoke positively about staff and told us they felt safe on the ward and staff were available to support them. We saw good rapport between staff and patients, positive staff and patient interaction and individual support.
  • The provider supplied specific ‘yellow boxes’ for staff use in an emergency, for example, ligature cutters. This ensured staff could respond quickly to patients in an emergency.
  • The provider operated a ‘safewards’ initiative on Hadleigh Ward. We saw this had a positive impact on patient care.
  • Staff were aware of their individual responsibility in identifying safeguarding concerns and reporting these promptly.
  • Staff kept accurate and detailed patient records. Care plans were detailed and showed both patient and multidisciplinary team (MDT) involvement.
  • There was effective MDT working. Patients had opportunities to get involved in hospital governance for example in the monthly patients’ forum.
  • Cleaning records were up to date and we saw evidence that regular cleaning and audits were taking place.

Inspection carried out on 31 March 2016

During an inspection looking at part of the service

We carried out an unannounced focused inspection of St Andrews Healthcare, Maldon Ward, on 31 March 2015 due to concerns that were raised with the Care Quality Commission. During the inspection we found that:

  • The provider had high levels of staff vacancies. This meant the provider used a high rate of bank and agency staff. The provider did not employ regular bank and agency staff to ensure continuity of care for patients. A patient told us the permanent staff treated them with kindness, consideration, and compassion. However, the agency staff did not always treat them with dignity and respect

  • The provider did not keep accurate or accessible duty rotas. Duty rotas were duplicated in three different records, some of which were not accessible to ward staff. This meant staff could not be sure who was expected on duty or whether shifts had sufficient staff for safe care and treatment for patients.
  • Staff cancelled patient’s section 17 community leave due to staffing shortages. Section 17 leave is a controlled, discretionary period of leave given to a person detained in hospital under the MHA. Medical staff granted leave to patients to allow them to access activities, and appointments, and to support their recovery.
  • Staff did not always update risk assessments following incidents. Staff recorded incidents on the electronic record system but did not update risk assessments and care plans when risk changed. This meant that staff did not have up to date information to provide safe care for patients. The provider had carried out an environmental risk assessment. However, this did not fully address risks presented by blind spots where staff could not observe patients

  • The seclusion room was located on the first floor, which meant that staff have difficulty safely accessing this facility in an emergency.


  • Patients had access to an advocacy service. There was information about the advocacy service displayed on posters in the ward area.
  • Staff managed seclusions in line with The Mental Health Act code of practice. Doctors were attending within an hour to review patients.
  • Patients were involved in developing their care plans. A patient told us they attended regular review meetings where their care plan was reviewed. They had received a copy of their care plan.
  • The ward environment was clean and tidy and the furnishings were in good condition. Staff completed cleaning audits that were up to date.

Inspection carried out on 9 and 10 September 2014

During a routine inspection

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.

Easton Lodge


Core service provided: Long Stay/forensic/secure services

Male/female/mixed: Female

Capacity: Six bed


Core service provided: Long Stay/forensic/secure services

Male/female/mixed: Male

Capacity: 18 bed


Core service provided: Long Stay/forensic/secure services

Male/female/mixed: Male

Capacity: 17 bed


Core service provided: Long Stay/forensic/secure services

Male/female/mixed: Female

Capacity: 18 bed

Easton Lodge

Core service provided: Long Stay/forensic/secure services

Male/female/mixed: Male

Capacity: Four bed


Core service provided: Psychiatric intensive care unit

Male/female/mixed: Female

Capacity: 14 bed

Inspection carried out on 27, 28 May 2014

During an inspection looking at part of the service

At our last inspection of St Andrew�s Healthcare Essex on 04, 18 and 19 December 2013, we had major concerns about whether the provider had taken proper steps to ensure that people were protected against the risks of receiving care or treatment that was inappropriate or unsafe. We also had major concerns relating to records and the provider�s quality assurance systems.

The provider sent us actions plans setting out how they would ensure compliance. This inspection was to check on this and we visited Hadleigh, Colne and Frinton wards. We found that the provider had taken the steps outlined in their action plan to address the areas of non-compliance.

We found however that staff were not consistently following the provider�s policy relating to systems for the seclusion and long term segregation. We considered that there was a risk that reviews of seclusion and segregation episodes were not consistently taking place.

Inspection carried out on 4, 18, 19 December 2013

During a routine inspection

During the inspection we received several positive comments from people who use the service, such as, �Staff are okay.� Another person told us, �Nurses are professional and they also have a laugh with you�. However, six people told us they did not always feel safe on Frinton and Colne wards.

We found from talking with people who use the service, staff, reviewing records and observing care that people did not always experience care, treatment and support that met their needs and protected their rights. We raised concerns with the senior management team during the inspection about safeguarding practices, medicine management practices and that staff were not always enabled to take part in learning and development that is relevant and appropriate so that they can carry out their role effectively.

We saw that there was a lack of communication and reporting frameworks to ensure incidents were reported in line with the hospital�s policy and that lessons were learnt from incidents being reported. We also noted that people using the service could not be assured that records were sufficiently complete and accurate to demonstrate accurate person centred care practices.

Inspection carried out on 30 October 2012

During a routine inspection

We saw that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and the provider had an effective system to regularly assess and monitor the quality of service that people received.

People were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that the staff were knowledgeable and that they generally felt safe in their hands.

A Mental Health Act (MHA) commissioner met with seven patients during the inspection and found no significant care issues of concern. We could see that people experienced care, treatment and support that met their needs and protected their rights.

Inspection carried out on 14, 15 June 2011

During a routine inspection

People with whom we spoke told us that key workers are nice and helpful. One person with whom we spoke said �I think it is the best hospital I have been in. They don�t give up on you. There are strict boundaries, but staff are good.�

People told us that the new risk and incentive scheme was good as it provided more things to do but should include rehabilitation visits and more activities off the ward. Also that not everyone understands the risk level practices and incentive plan and that losing privileges such as going to the gym or caf� is sometimes unfair.

We were told that there is not always a choice of male or female carers, and that some people are not always aware when advocates are around or how to contact them. Some people felt there are not enough occupational therapists and external trips are not always happening.

People with whom we spoke told us they feel safe in the units. They said that staff would not tolerate abusive behaviour and would deal with incidences appropriately. They told us that most areas are clean although the toilets on Milne unit are not always hygienic and are very close to the sink and some of the communal areas are dull and dirty, also some of the furniture needs replacement as it is damp and not all surfaces are wipe able.

People said that there were adequate numbers of staff most of the time although sometimes they had to wait for escorts to get their cigarette breaks. They said that the staff work hard and know what they are doing.

People were positive about the service user�s forum and told us that it helps get things sorted out.

Reports under our old system of regulation (including those from before CQC was created)

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.