Kneesworth House

Updated 5 January 2022

Kneesworth House is operated by Partnerships in Care which is part of the Priory Group of companies and is situated in Cambridgeshire, close to the Hertfordshire border. It provides inpatient care for people with acute mental health problems, a psychiatric intensive care unit, locked and open rehabilitation services, and medium and low secure forensic services for people with enduring mental health problems.

The service is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983
• Treatment of disease, disorder or injury
• Diagnostic and screening procedures

We inspected the following service:

Forensic inpatient/secure wards

• Clopton - 12 bed medium secure service for men with a personality disorder.
• Ermine - 19 bed medium secure service for men with a mental illness.

Updated 5 January 2022

Kneesworth House provides inpatient care for people with acute mental health problems, a psychiatric intensive care unit, locked and open rehabilitation services, and medium and low secure forensic services for people with enduring mental health problems.

Following inspections in March and June 2019, the Care Quality Commission placed the hospital in special measures and took enforcement action. Services are placed in special measures when we judge care is inadequate and are inspected again within six months.

When we inspected in March 2019, we found serious issues in the forensic wards and placed the service in special measures. These included safeguarding incidents, environmental breaches, poor quality seclusion practices and paperwork, institutional practices to manage wards over two floors, adequate staffing numbers and the quality and timeliness of risk assessments.

We made a further inspection in June 2019 and placed conditions on the provider's registration in relation to the forensic wards and newly opened psychiatric intensive care unit.We found the quality of the environment was poor, staffing levels were low, risk assessments were missing or of poor quality and incidents were not dealt with safely. On the forensic wards, there were not enough staff to manage the high levels of risk displayed by patients. We required the provider to rectify these issues and monitored that they had done so. 

We undertook a comprehensive inspection in January 2020 and removed the conditions placed on the provider in June 2019. However, we found that although the provider had made some significant improvements, some aspects of care remained inadequate. The service overall was re-rated as requires improvement but kept in special measures.

At this inspection, we noted further significant improvements and decided to take the service out of special measures. We will continue to monitor and review their improvement through continued engagement with the service.

We rated Kneesworth House as good because:

• Generally, the ward environments were clean and well maintained. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• The hospital managed the supply of personal protective equipment well during the COVID-19 pandemic and had robust policies in place regarding the wearing of facemasks and other protective equipment where appropriate. Staff received training and used equipment effectively in line with the provider’s policy.
• Staff developed holistic, recovery-orientated care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The services were well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Seclusion care plans did not always meet the recommendations of the Mental Health Act code of practice. Most plans did not specify what interventions patients needed to maintain their food and fluids intake. Staff did not always update nursing care plans as the patient’s presentation and needs changed.
• Emergency equipment on the bungalows was not located where it was signposted or easily accessible. Staff had not clearly labelled two patient-specific medicines in the rehabilitation service, which meant there was a risk patients could receive the wrong medication. On the secure wards, staff had not consistently recorded clozapine prescriptions as an alert on the front record page of the patient’s record so staff could identify this easily.
• Staff did not isolate patients newly admitted to the secure wards who had declined a COVID-19 test and were not displaying symptoms. This was in line with the provider’s policy but increased the risk of an asymptomatic COVID-19 positive patient transmitting the virus to other patients.
• The rehabilitation service did not provide a structured, recovery-based rehabilitation pathway for some patients. However, most patients had holistic personal goals identified.
• Carers of patients on the secure wards told us the hospital did not always provide regular updates about their relative or gave them information about the service, including how to complain.

Updated 24 December 2020

We inspected all three wards in this service and changed our ratings. Our overall rating of the service is Good.

Updated 24 December 2020

We inspected seven of the eight wards in this service and changed our ratings. Our overall rating of the service is Good.

Updated 27 April 2020

Bourn ward

Wimpole ward - psychiatric intensive care unit