The Care Quality Commission
  • Mental Health
  • Independent mental health service

Kneesworth House

Overall: Good read more about inspection ratings

Bassingbourn cum Kneesworth, Royston, Hertfordshire, SG8 5JP (01763) 255700

Provided and run by:
Partnerships in Care Limited

All Inspections

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

The assessment of acute wards for adults of working age and psychiatric intensive care units took place on 12 August to 14 August 2025. This assessment service group was made up of 1 psychiatric intensive care unit (PICU) and 2 acute wards. The PICU ward was called Wimpole and admitted female patients. It had capacity for up to 10 patients and had 6 patients admitted at the time of the inspection. One of the acute wards was called Bourn. Male and female patients were admitted to Bourn with a split of 10 females and 5 males, giving the ward capacity for 15 patients. The ward was full at the time of the inspection. The other acute ward was called Nightingale and admitted male patients. It had capacity for 14 patients. The ward was full at the time of the inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. Staff now ensured that patients’ access to bedrooms, mobile phone chargers and outdoor space were only restricted where this was required through individual risk assessment. Staff now ensured patients were secluded in line with the Mental Health Act Code of Practice and the provider’s policy. Staff now ensured essential learning and information was passed between the hospital’s senior management team and the ward managers and this was shared with all staff and recorded appropriately.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff and compliance figures across the hospital were 95.5%. Training on the Mental Capacity Act was provided as part of the induction process.

Staff assessed and recorded capacity to consent clearly each time staff had reason to doubt whether a patient had capacity to make a particular decision. Staff completed an assessment of each patient’s capacity to consent to admission and treatment on admission. Further assessments took place during reviews by the multidisciplinary team.

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

The assessment of acute wards for adults of working age and psychiatric intensive care units took place on 12 August to 14 August 2025. This assessment service group was made up of 1 psychiatric intensive care unit (PICU) and 2 acute wards. The PICU ward was called Wimpole and admitted female patients. It had capacity for up to 10 patients and had 6 patients admitted at the time of the inspection. One of the acute wards was called Bourn. Male and female patients were admitted to Bourn with a split of 10 females and 5 males, giving the ward capacity for 15 patients. The ward was full at the time of the inspection. The other acute ward was called Nightingale and admitted male patients. It had capacity for 14 patients. The ward was full at the time of the inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. Staff now ensured that patients’ access to bedrooms, mobile phone chargers and outdoor space were only restricted where this was required through individual risk assessment. Staff now ensured patients were secluded in line with the Mental Health Act Code of Practice and the provider’s policy. Staff now ensured essential learning and information was passed between the hospital’s senior management team and the ward managers and this was shared with all staff and recorded appropriately.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff and compliance figures across the hospital were 95.5%. Training on the Mental Capacity Act was provided as part of the induction process.

Staff assessed and recorded capacity to consent clearly each time staff had reason to doubt whether a patient had capacity to make a particular decision. Staff completed an assessment of each patient’s capacity to consent to admission and treatment on admission. Further assessments took place during reviews by the multidisciplinary team.

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

The assessment of acute wards for adults of working age and psychiatric intensive care units took place on 12 August to 14 August 2025. This assessment service group was made up of 1 psychiatric intensive care unit (PICU) and 2 acute wards. The PICU ward was called Wimpole and admitted female patients. It had capacity for up to 10 patients and had 6 patients admitted at the time of the inspection. One of the acute wards was called Bourn. Male and female patients were admitted to Bourn with a split of 10 females and 5 males, giving the ward capacity for 15 patients. The ward was full at the time of the inspection. The other acute ward was called Nightingale and admitted male patients. It had capacity for 14 patients. The ward was full at the time of the inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. Staff now ensured that patients’ access to bedrooms, mobile phone chargers and outdoor space were only restricted where this was required through individual risk assessment. Staff now ensured patients were secluded in line with the Mental Health Act Code of Practice and the provider’s policy. Staff now ensured essential learning and information was passed between the hospital’s senior management team and the ward managers and this was shared with all staff and recorded appropriately.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act was mandatory for staff and compliance figures across the hospital were 95.5%. Training on the Mental Capacity Act was provided as part of the induction process.

Staff assessed and recorded capacity to consent clearly each time staff had reason to doubt whether a patient had capacity to make a particular decision. Staff completed an assessment of each patient’s capacity to consent to admission and treatment on admission. Further assessments took place during reviews by the multidisciplinary team.

During an assessment of Forensic inpatient or secure wards

The assessment of forensic inpatient or secure wards took place on 12 August to 14 August 2025. This assessment service group was made up of 2 medium secure wards and 1 low secure ward.

Clopton ward was a medium secure ward admitting male patients. It had capacity for 12 patients; the ward was at full occupancy at the time of the inspection.

Ermine ward was a medium secure ward admitting male patients. It had capacity for 18 patients and had 16 patients admitted at the time of inspection.

Orwell ward was a low secure ward, admitting male patients. It had capacity for 16 patients and had 10 patients admitted at the time of inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulation. Staff now ensure patients were secluded in the right environment and seclusion was recorded in line with the Mental Health Act Code of Practice and the provider’s policy.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff, and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act. The training was initially provided as part of the induction process and thereafter staff had regular refreshers.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision. Staff took all practical steps to enable people to make their own decisions. Staff completed an assessment on admission of each person’s capacity to consent to admission and treatment. Further assessments took place during reviews by the multidisciplinary team.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

During an assessment of Forensic inpatient or secure wards

The assessment of forensic inpatient or secure wards took place on 12 August to 14 August 2025. This assessment service group was made up of 2 medium secure wards and 1 low secure ward.

Clopton ward was a medium secure ward admitting male patients. It had capacity for 12 patients; the ward was at full occupancy at the time of the inspection.

Ermine ward was a medium secure ward admitting male patients. It had capacity for 18 patients and had 16 patients admitted at the time of inspection.

Orwell ward was a low secure ward, admitting male patients. It had capacity for 16 patients and had 10 patients admitted at the time of inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulation. Staff now ensure patients were secluded in the right environment and seclusion was recorded in line with the Mental Health Act Code of Practice and the provider’s policy.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff, and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act. The training was initially provided as part of the induction process and thereafter staff had regular refreshers.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision. Staff took all practical steps to enable people to make their own decisions. Staff completed an assessment on admission of each person’s capacity to consent to admission and treatment. Further assessments took place during reviews by the multidisciplinary team.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

During an assessment of Forensic inpatient or secure wards

The assessment of forensic inpatient or secure wards took place on 12 August to 14 August 2025. This assessment service group was made up of 2 medium secure wards and 1 low secure ward.

Clopton ward was a medium secure ward admitting male patients. It had capacity for 12 patients; the ward was at full occupancy at the time of the inspection.

Ermine ward was a medium secure ward admitting male patients. It had capacity for 18 patients and had 16 patients admitted at the time of inspection.

Orwell ward was a low secure ward, admitting male patients. It had capacity for 16 patients and had 10 patients admitted at the time of inspection.

We rated the service as good. The service had made improvements and is no longer in breach of regulation. Staff now ensure patients were secluded in the right environment and seclusion was recorded in line with the Mental Health Act Code of Practice and the provider’s policy.

Mental Health Act and Mental Capacity Act Compliance Summary

The service admitted patients under the Mental Health Act 1983. Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Training on the Mental Health Act was mandatory for staff, and the compliance rate was 94.7%.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received assistance from designated Mental Health Act staff, based at the hospital.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. For example, there was a process in place to monitor patient’s legal status and renewal dates, which meant staff were able to ensure reviews took place in a timely manner.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s record each time. Discussions in patients’ ward rounds included information about the right to appeal against detention.

Staff made sure patients could take section 17 leave (permission to leave the ward or hospital) when this was agreed with the responsible clinician and ministry of justice where applicable. The use of leave from the ward was agreed by the multidisciplinary team. Arrangements for leave were made at daily planning meetings and nurses carried out an assessment of each patient’s mental state before each occasion of leave was utilised.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed.

Mental Capacity Act

Staff received and kept up to date with training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act. The training was initially provided as part of the induction process and thereafter staff had regular refreshers.

Staff assessed and recorded capacity to consent clearly each time a person needed to make an important decision. Staff took all practical steps to enable people to make their own decisions. Staff completed an assessment on admission of each person’s capacity to consent to admission and treatment. Further assessments took place during reviews by the multidisciplinary team.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

During an assessment of Long stay or rehabilitation mental health wards for working age adults

The assessment of long stay or rehabilitation mental health wards for working age adults took place on 12 August to 14 August 2025. This assessment service group was made up of 1 rehabilitation ward called Wortham and 4 rehabilitation bungalows Pelican, Herron, Falcon and Phoenix wards. Autistic people and people with learning disabilities lived in some of the bungalows, so we assessed the service against ‘Right support, right care, right culture’ guidance. This supports us to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Wortham ward had a capacity of 17 patients and had 11 male patients on the ward at the time of inspection. Each of the bungalows had 1 patient, all patients were male.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. All emergency equipment was properly stored, and easily accessible and all staff knew where to locate it.

Mental Health Act and Mental Capacity Act Compliance Summary

Ninety five percent of staff had received training in the Mental Health Act

Staff were trained and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew their Mental Health Act administrators.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured patients took their Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Staff had had training in the Mental Capacity Act. Training compliance figures across the hospital were 95.5%.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service had arrangements to monitor adherence to the Mental Capacity Act.

During an assessment of Long stay or rehabilitation mental health wards for working age adults

The assessment of long stay or rehabilitation mental health wards for working age adults took place on 12 August to 14 August 2025. This assessment service group was made up of 1 rehabilitation ward called Wortham and 4 rehabilitation bungalows Pelican, Herron, Falcon and Phoenix wards. Autistic people and people with learning disabilities lived in some of the bungalows, so we assessed the service against ‘Right support, right care, right culture’ guidance. This supports us to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Wortham ward had a capacity of 17 patients and had 11 male patients on the ward at the time of inspection. Each of the bungalows had 1 patient, all patients were male.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. All emergency equipment was properly stored, and easily accessible and all staff knew where to locate it.

Mental Health Act and Mental Capacity Act Compliance Summary

Ninety five percent of staff had received training in the Mental Health Act

Staff were trained and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew their Mental Health Act administrators.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured patients took their Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Staff had had training in the Mental Capacity Act. Training compliance figures across the hospital were 95.5%.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service had arrangements to monitor adherence to the Mental Capacity Act.

During an assessment of Long stay or rehabilitation mental health wards for working age adults

The assessment of long stay or rehabilitation mental health wards for working age adults took place on 12 August to 14 August 2025. This assessment service group was made up of 1 rehabilitation ward called Wortham and 4 rehabilitation bungalows Pelican, Herron, Falcon and Phoenix wards. Autistic people and people with learning disabilities lived in some of the bungalows, so we assessed the service against ‘Right support, right care, right culture’ guidance. This supports us to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Wortham ward had a capacity of 17 patients and had 11 male patients on the ward at the time of inspection. Each of the bungalows had 1 patient, all patients were male.

We rated the service as good. The service had made improvements and is no longer in breach of regulations. All emergency equipment was properly stored, and easily accessible and all staff knew where to locate it.

Mental Health Act and Mental Capacity Act Compliance Summary

Ninety five percent of staff had received training in the Mental Health Act

Staff were trained and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew their Mental Health Act administrators.

The provider had relevant policies and procedures that reflected the most recent guidance.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.

Patients had easy access to information about independent mental health advocacy.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it.

Staff ensured patients took their Section 17 leave (permission for patients to leave hospital) when this has been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary.

Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and available to all staff that needed access to them.

The service displayed a notice to tell informal patients that they could leave the ward freely.

Care plans referred to identified Section 117 aftercare services to be provided for those who had been subject to section 3 or equivalent Part 3 powers authorising admission to hospital for treatment.

Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Staff had had training in the Mental Capacity Act. Training compliance figures across the hospital were 95.5%.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.
The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.

Staff knew where to get advice regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.

The service had arrangements to monitor adherence to the Mental Capacity Act.

During an assessment of the hospital overall

We assessed Kneesworth Hospital on 12-14 August 2025.

We assessed the service due to emerging risk. The service was last inspected in September 2021 as a focused inspection.

At this assessment we assessed 3 assessment service groups; Long stay or rehabilitation mental health wards for working age adults, Forensic inpatient or secure wards and Acute wards for adults of working age and psychiatric intensive care units. We assessed 33 quality statements in each assessment service group.

We rated the service as good.

29 September 2021

During an inspection looking at part of the service

We carried out this unannounced focused inspection because we received information giving us concerns about the safety and quality of the service.

We inspected specific safe, effective and well-led key questions for the service.

We did not rate this service at this inspection. The previous rating of good overall with requires improvement for safe, good for effective, caring, responsive and well led remains.

The report for the previous inspection can be found here:

https://www.cqc.org.uk/location/1-129389215/reports

We found the following areas of good practice:

  • Staff assessed and managed risks to patients and themselves well. They achieved the right balance between maintaining safety and providing the least restrictive environment possible to support patients’ recovery.
  • The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • Managers ensured staff had the right skills, qualifications and experience to meet the needs of the patients in their care. Managers gave each new member of staff a full induction to the service before they started work.
  • Staff provided a range of treatment and care for patients based on national guidance and best practice.
  • Governance processes operated effectively at team level and performance and risk were managed well.

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

  • Staff did not always update risk assessments following incidents, although they were recorded in the clinical notes and discussed by the multidisciplinary team.
  • The seclusion room environment did not meet the requirements set out in the Mental Health Act Code of Practice.

6-13 & 19 October 2020

During a routine inspection

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.

7-9 & 22 January 2020

During a routine inspection

We rated Kneesworth House as requires improvement because:

  • The hospital did not provide consistently safe care. Emergency equipment and physical health monitoring equipment were not always present, appropriately maintained and easily accessible. The hospital did not consistently manage medicines safely. Staff did not consistently monitor the side effects of medicines or complete care plans for monitoring patients prescribed clozapine. 
  • Patient bedrooms were not en-suite and patients had to share toilets, showers and bathroom facilities. Ward layouts were not always helpful in promoting personalised care planning for patients. The environment on the rehabilitation wards was poor. On Nightingale ward, staff secluded patients in a decommissioned seclusion room which contained potential safety hazards for patients.
  • The acute ward, psychiatric intensive care unit and some rehabilitation wards some rehabilitation wards placed blanket restrictions on patients without assessing and documenting individual risk. These included not having access to keys and mobile phone chargers and restrictions to going outside.
  • Managers and staff did not complete all episodes of seclusion in line with Mental Health Act Code of Practice on rehabilitation and forensic wards and did not complete all seclusion paperwork in line with Mental Health Act Code of Practice.
  • Managers provided training data during the inspection. This showed that mandatory training on the rehabilitation wards, was below 75% in some key areas, such as fire safety, managing challenging behaviour, rapid tranquilisation, safeguarding children and adults and clinical risk assessments. Staff on the rehabilitation wards did not have access to additional rehabilitation-focused training. Not all staff were up to date with Mental Health Act and Mental Capacity Act training. Managers had not ensured action was taken to address this.
  • The clinical records system was slow. Staff could not always locate records when they needed to. In the rehabilitation services, meeting minutes from lessons learned discussions were sparse and poorly recorded. Staff across all wards were unable to give examples of recent lessons learned. Governance systems did not always ensure that essential learning and information passed between the hospital’s senior management team and the nursing team.
  • In the rehabilitation service, staff did not fully assess the physical health needs of patients on admission and did not routinely monitor their health or identify when their condition was deteriorating, including the monitoring of patients on Clozapine.
  • Care plans on the forensic wards did not reflect the patient voice. Community meetings in the forensic service did not document outcomes of concerns raised by patients.

However:

  • The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm. The provider had addressed the issues found at the focused inspection in June 2019. The environments on Wimpole ward and the forensic/secure wards had improved and staffing numbers had increased on the forensic/secure wards.
  • Staff assessed and managed risk on admission, and reviewed this regularly, including after incidents. Staff followed best practice in anticipating, de-escalating and managing behaviours that challenged and used restraint and seclusion only after attempts at de-escalation had failed. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • On the acute ward and psychiatric intensive care unit, the service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications patients’ physical health on these wards.
  • Staff assessed the physical and mental health of all patients on admission. They developed care plans, which they reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the assessed needs, were holistic and recovery-oriented. Care plans in the rehabilitation and acute services were personalised.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance. Ward teams included or had access to the full range of specialists required to meet the needs of patients. Staff from different disciplines worked together as a team and held daily multidisciplinary meetings to benefit patients, attended by members of the senior management team, doctors and nursing staff.
  • Managers made sure staff had a range of skills needed to provide high quality care. They provided an induction programme for new staff, supported staff with appraisals and supervision, identified training needs and gave staff the time and opportunity to develop their skills and knowledge.
  • Most staff treated patients with compassion and kindness and respected patients’ privacy and dignity. Staff gave patients help, emotional support and advice when they needed it. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning and risk assessments. They had a good understanding of patients’ needs, supported them to understand and manage their treatment and ensured they had easy access to independent advocates. Staff informed and involved families and carers appropriately. Staff invited carers to multidisciplinary meetings and monthly ward reviews.
  • Managers were visible in the service and approachable for patients and staff. Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. Staff felt able to raise concerns without fear of retribution.

3, 22 and 23 October 2019

During an inspection looking at part of the service

We did not rate forensic/secure wards or psychiatric intensive care units at this focused inspection. We carried out this inspection to look at what improvements the provider had made after the concerns raised by the focused inspection on 23-25 June 2019, after which the CQC imposed urgent conditions on the provider. This inspection focused solely on the progress made against the conditions imposed by the Care Quality Commission across two core services. The report reflects what we found in the three wards we inspected. These were:

  • Ermine ward, a 19-bed medium secure service for men with a mental illness
  • Orwell ward, a 18-bed low secure service for men with a mental illness
  • Wimpole ward, a 12-bed psychiatric intensive care unit for women with a mental illness

We found the following issues that the provider needs to improve:

  • Managers had not transferred the learning from problems identified on the PICU to the rest of the hospital site. There were significant environmental issues on Ermine and Orwell wards, including dirty toilets, damage to the environment and a dirty kitchen area.
  • The service had not ensured they had met all the conditions imposed by the CQC. Staff in the forensic/secure wards had not reviewed all patients’ risk assessments weekly as required and there had been considerable delays in completing some of the actions identified in their own action plan.
  • In the forensic service, staff undertook constant and intermittent observations for more than two hours without a break, which was not in line with their own policy and best practice. Managers had not maintained oversight of this.
  • Staff on the PICU did not always categorise the severity of incidents appropriately on the provider’s electronic incident recording system. Staff had classified some incidents of self-harming behaviour, including head banging, tying ligatures and assaults against staff, as having no harm or impact.
  • Managers had not provided clarity about how staffing levels on the PICU should increase in response to patient numbers.
  • The Priory’s mandatory ligature risk audit document did not allow staff to specify the nature of the risk effectively.

However, we found the following areas of good practice:

  • The service had addressed the environmental issues on the PICU and had systems in place to ensure the ward remained clean and safe.
  • Senior managers and ward managers had ensured staff on Wimpole ward had PICU specific training, including risk assessment and risk management, and were adequately prepared to work with patients within the service.
  • Senior managers had increased staffing levels on Ermine and Orwell wards to ensure there were enough staff to maintain the safety of patients and facilitate patient leave consistently.
  • Ward managers had ensured up-to-date ligature risk assessments were easily available to staff.

23-25 June 2019

During an inspection looking at part of the service

We did not rate forensic/secure wards or psychiatric intensive care units (PICU) at this focused inspection.

We found the following issues that the provider needs to improve:

  • Wimpole Ward, the psychiatric intensive care unit (PICU), was unsafe. Staff reported high levels of aggression between patients and on staff. Some incidents involved several patients joining together to attack their peers. Managers had failed to provide staff with appropriate guidance on how to deal with these incidents or to learn lessons from them. Managers had not ensured staff working on the PICU had specific training to equip them for this and so were not adequately prepared to work with the specific patient group.
  • Staff did not effectively manage patient risk. Staff had failed to identify individual patient risks or strategies to manage the risks on Orwell Ward or on Wimpole ward (the PICU). Staff on the PICU had not fully completed risk formulation for patients and staff had not updated risk assessments after incidents.
  • Managers had not described or identified potential ligature points in the wards’ ligature risk audits or how staff should mitigate the risk. Staff did not have access to the most up-to-date printed ligature risk audits.
  • The PICU was dirty and poorly maintained. Sink wastes needed replacing in toilets and bathrooms and a toilet door was missing. The kitchen and dining room areas had loose and engrained dirt in the floors, under tables and in drawers.
  • Managers had not ensured there were enough staff to maintain the safety of patients and facilitate patient leave consistently. This was more evident on wards designed over two floors.
  • Seclusion practices, including the recording of seclusion and the storage of records were not in line with the requirements of the Mental Health Act Code of Practice.
  • Staff kept food at high temperatures in the kitchen on Wimpole ward which could pose a risk to patients.

However, we found the following areas of good practice:

  • Staff offered practical and emotional support where needed. Seven of the 12 patients we spoke with told us staff were understanding, helpful and polite and cared about their wellbeing.

1 August 2019

During an inspection looking at part of the service

We did not rate psychiatric intensive care units (PICU) at this focused inspection.

We found the following issues that the provider needs to improve:

  • While risk assessments had improved, staff did not manage patient risk consistently. Staff did not always update risk assessments after incidents. Managers were not assured that patients’ risks were always managed safely and effectively.
  • Managers had not ensured staff had PICU specific training and were adequately prepared to work with patients within the service.
  • Managers had not described or identified all potential ligature points in the wards’ ligature risk audits or how staff should mitigate the risk. Staff did not have access to the most up-to-date printed ligature risk audits.
  • The provider had not addressed all environmental concerns in their action plan and some actions were overdue. Sink wastes needed replacing in toilets, bathrooms and bedrooms. The kitchen had loose and ingrained dirt in the floor and under the fridge.
  • The chilled food cabinet was not working correctly and recording high temperatures. Staff had not checked the temperature of this equipment.

However, we found the following areas of good practice:

  • The ward was visibly cleaner than at the last inspection visit.
  • Risk assessments on the PICU were of a higher quality and contained more detail than at the last inspection.
  • Managers had overseen some improvements to the PICU’s environment. We noted that the ward was cleaner, staff had replaced the toilet door and put up signs for toilets and bathrooms and had ordered new floors and sink wastes.

19-21 March and 4 April 2019

During a routine inspection

We rated Kneesworth House as inadequate because:

  • We had serious concerns about the forensic service, which consisted of Clopton, Ermine, Icknield and Orwell wards.

  • The provider had not addressed all the breaches identified at the last inspection. When staff secluded patients, they did not do or record this in line with the provider’s policy and the Mental Health Act Code of Practice. The provider had not prevented contraband items from entering some of the ward environments and had not resolved the ligature risks in the seclusion rooms. The provider had not fully addressed issues in relation to staff approaches towards patients.

  • The provider had not kept patients safe from improper treatment and some staff were uncaring and disrespectful. Two patients told us some staff on Icknield ward used a key to prod their feet if they did not get up in the morning. Some patients altered their sleeping position or wore trainers in bed to prevent this happening. Seven patients we spoke with commented that a few staff were rude, unfriendly, did not listen to them or antagonised patients.

  • Staff did not always complete risk assessments in a timely manner and did not manage patient risk robustly. Staff did not routinely update risk assessments after incidents. The provider did not have a consistent approach to physical health checks in line with guidance, including patients on high dose antipsychotics.

  • Staff sometimes had to cancel patient leave and activities. Staff we spoke with told us that if there was an incident on the forensic wards, this could adversely affect plans for activities or leave. Four patients and one carer also told us there was insufficient staff to enable patients to take planned leave as planned and that staff regularly cancelled patient leave. On rehabilitation wards, six patients we spoke with told us that their regular permanent and bank staff were often moved to cover gaps in staffing on other wards, leading to a high use of agency staff.

  • Staff did not consistently store, record or administer medicines in line with guidance. On forensic wards, staff did not always administer medication safely. Staff left syringes in pots of water with patient initials written on kitchen paper underneath. Staff had not recorded information about allergies on individual care records. Staff identified allergies to medicines on prescription charts, but these did not include full details of food allergies. On Clopton and Icknield wards, records did not contain a review for as-required medication in the previous 14 days. Staff audits did not ensure these issues were addressed.

  • The clinic room on Clopton ward was dirty and disorganised. The clinic room on Orwell was disorganised and the medicine cupboard on Icknield ward was broken. Some ward areas were dirty, and many areas were in need of repair and redecoration. This included stained and dirty toilets and unpleasant odours. Furniture was ripped and the system for ensuring maintenance jobs were completed was ineffective. The system to highlight, action and monitor maintenance issues across the wards was not robust.

  • Staff did not consistently involve patients in care plans and risk assessments in the forensic service. Patient records did not document how patients were involved in care planning or risk assessments.

  • Managers had not ensured that there were effective processes to inform them of poor practices in different parts of the service and could not therefore take immediate steps to address them.

  • The provider had not addressed the challenges posed by the wards which were on two levels. In the forensic service, staffing levels were not sufficient to ensure that patients had access to the whole ward. Staff used restrictive practices to manage the ward environments on Ermine, Icknield and Orwell wards. Staff confined patients to upstairs or downstairs areas at certain times. On Icknield ward, patients had to be downstairs by 8.30am and in bed by 10.30pm.

  • Electronic recording systems were slow, and staff experienced difficulties in accessing information quickly.

However:

  • We did not have similar concerns about the acute ward and rehabilitation wards.

  • The acute and rehabilitation services had sufficient nursing staff, who knew the patients and received basic training to maintain safe staffing levels. There were sufficient medical staff, including out-of-hours cover across the hospital.

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it. The provider supported staff with induction, appraisals, supervision and opportunities to update and further develop their skills. Managers monitored the performance of the team to ensure staff received appraisals, supervision and training.

  • Staff completed comprehensive mental health assessments and assessed most patients’ physical health fully on admission with a full medical assessment. Staff ensured that most patients had good access to physical healthcare and supported patients to live healthier lives, particularly on Bourn ward and in the rehabilitation wards.

  • Staff held regular and effective multidisciplinary meetings. In the acute and rehabilitation services, staff treated patients with respect and put them at the heart of the discussion. They ensured that patients had access to independent advocates. Across the hospital, staff involved patients in their care through ward rounds and other multidisciplinary meetings.

  • The rehabilitation and acute wards used systems and processes to safely prescribe, administer, record and store medicines in line with national guidance.

  • The provider had emphasised the use of de-escalation in managing challenging behaviour. As a result, staff use of restraint had reduced since the last inspection.

  • Staff provided a range of care and treatment interventions suitable for the patient group. This included medication, psychological therapies, ward activities and employment opportunities, such as the educational and vocational skill centre, which included a patient-run café.

  • Staff informed and involved families and carers appropriately and enabled them to give feedback on the service they received. Carers we spoke with felt their relatives were safe and well cared for.

  • Staff helped patients with communication, advocacy and cultural and spiritual support.

  • In the acute and rehabilitation services, staff treated patients with compassion and kindness. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.

  • The service treated concerns and complaints seriously and investigated them promptly. Lessons learnt were shared with the whole team and the wider service.

27 November to 1 December 2017

During a routine inspection

We rated Kneesworth House Hospital as good because:

  • Staff completed detailed risk assessments using recognised tools that included comprehensive risk management plans. Staff updated individual risk assessments following incidents. Staff knew what incidents should be reported, incidents were reviewed and feedback distributed to staff via a ‘lessons learnt’ bulletin and discussion in meetings. We identified positive reductions in restrictive practices linked to individualised risk assessments on the medium secure wards. Rehabilitation wards reported low levels of restraint and seclusion over the past nine months.
  • Overall mandatory training compliance for staff was 84%. Safeguarding adult training compliance was 98% and for safeguarding children was 96%. They received supervision in line with the provider’s policy, attending both 1:1 supervision and group reflective practice sessions. Compliance ranged between 72% and 100%. Staff received a thorough induction programme with support workers training to care certificate standards. Staff accessed regular reflective practice sessions.
  • The provider had estimated staffing levels on the wards and numbers and mix of staff was adjusted to take into account of patient need and safety. Ward managers block booked agency staff to provide continuity of care for patients.
  • On the rehabilitation and acute wards the provider had mitigated risks posed by obstructed lines of sight by the use of convex mirrors and closed circuit television. The provider had refurbished the bathrooms and wash hand basins in bedrooms on the acute ward with anti-ligature fixtures and fittings. The provider had improved infection control by removing carpeting from the majority of the wards and replacing with laminate flooring in line with the 2016 inspection report action plan. Housekeeping staff kept most ward areas visibly clean.
  • Patients accessed regular physical health care monitoring; a GP visited the site twice a week, with practice nurses based on site. Care records showed that staff monitored patients’ physical health needs throughout their admission.
  • Psychology staff delivered specialist treatment programmes, working with models recognised for use in secure and rehabilitation services. Occupational therapists provided vocational rehabilitation programmes and encouraged patients to access opportunities to aid reintegration with the local community.
  • Secure wards held regular multi-disciplinary team meetings and encouraged patient attendance to contribute to their care and treatment programmes. Patient records contained detailed information relating to leave entitlement and outcomes. Where patients did not have authorised leave, staff tailored therapeutic activities for the ward environment. Staff regularly discussed discharge planning as part of multi-disciplinary and professionals meetings. Discharge planning commenced at the point of admission on to rehabilitation wards and staff on all wards focussed on treatment, recovery and reintegration back into the community.
  • We observed many caring and compassionate interactions between staff and patients. Patients told us that staff were caring and approachable, and most said they felt safe on the wards. Patients gave examples of where staff had gone above and beyond to offer them support for example staying late to facilitate family visits. Patients were involved in developing care plan goals, and completed a document that included their goals, strengths and how they liked staff to support them.
  • The wards ran a variety of activities including at weekends for patients to attend. Patients had regular visits to community services and could access local shops and gym with authorised leave.
  • The provider had a clear complaints policy and this included sending update letters to complainants. Patients felt their complaints were answered and action taken as a result.

However:

  • All secure wards contained blind spots and poor lines of sight. Environmental ligature risks were present on all secure and rehabilitation wards; the corresponding audit tool was cumbersome and did not assist staff to link environmental risks to patient’s individual risk assessments and care plans. The quality of patient care plans varied across the secure wards. Agency staff told inspectors they could not access electronic patient records relating to risk information.
  • Shift handover meetings on secure wards did not discuss patient observation levels or associated clinical risks in detail. Mirrors above the wash hand basin in two bathrooms on the acute ward had sharp corners. We identified safety concerns in seclusion rooms. Seclusion paperwork on secure wards contained gaps in recording and non-compliance with the provider’s seclusion policy and the Mental Health Act Code of Practice. Provider supplied data showed 410 episodes of restraint across the wards for the six months prior to the inspection.
  • Staff did not consistently complete ward security checks, and took personal belongings including contraband items through the secure reception areas and onto the wards. Staff reported delays in serious incident investigation outcomes and implementation of associated action plans for the acute and secure wards.
  • Some treatment environments were tired and in need of refurbishment. Housekeeping staff did not consistently adhere to infection control practices, and staff did not consistently adhere to the provider’s dress code.
  • On wards without emergency grab bags, staff stored emergency medicines in clinic room cupboards, this could result in staff confusion in an emergency. Some medication cards examined had authorisation signatures missing and examples of incorrect medication administration. National early warning score assessment paperwork did not include the corresponding chart to check scores against. There were episodes of missed nasogastric feeding on a secure ward.
  • Wards had between eight percent and 35% staff vacancy rate, and a high use of agency staff. Patients reported cancellation in 1:1 sessions and activities due to staffing pressures. Some acute ward staff told us they regularly moved between wards to cover staffing shortages.Inspectors identified concerns in the management of staff breaks. Frequency of staff meetings varied across the wards.
  • Inspectors identified some examples of punitive approaches used on the secure wards particularly in relation to Section 17 leave entitlement. Carers and family members of secure ward patients reported concerns about patient safety and the quality of communication with ward staff. Some patients on secure wards reported feeling unsafe, with a bullying culture between patients.Patients on the acute ward told us that the community meeting was being held too early in the morning and that it was often cancelled. Patients told us that actions arising from these community meetings were not carried out. The quality of patient community meeting minutes varied between wards. The provider did not have a staff or patient lead for equality and diversity. Their policy did not include how to manage staff receiving abuse due to protected characteristics such as race or gender. Some staff reported having been racially abused by patients and that the provider had not addressed this.

17 August 2017

During an inspection looking at part of the service

Ratings are not given for this type of inspection.

At this inspection, we found that:

  • Ward managers for Wortham (locked rehab) and Wimpole (low secure) and the senior management team were unable to access figures for mandatory training, supervision or appraisal completion. It was unclear how staff performance was being monitored and any issues addressed.
  • Senior management and the ward managers across the hospital met each morning to review incidents and staffing levels for the previous 24 hours. Minutes from these meetings lacked detail and did not reflect the discussion regarding the two serious incidents that led to the CQC unannounced inspection.
  • Environmental ligature risk audits for Wimpole and Wortham wards did not contain details of all ligature risks present within the ward and treatment environments.
  • Patient’s care plans and risk assessments were not linked to the environmental ligature risk audits to mitigate and manage individual risks.
  • Blind spots and poor lines of sight for monitoring patients remained on the wards. This issue was identified in the 2016 inspection, but had not been resolved in its entirety.
  • We identified poor cleanliness on both wards, particularly in toilets, bathrooms and the rehabilitation kitchen on Wortham ward. This increased infection control risks for patients and staff.
  • We found examples of contraband and restricted items on Wortham ward such as cigarettes butts. It was unclear how regularly staff completed patient and property searches in line with the provider’s prohibited items policy and environmental ligature risk audits action points.
  • Staff and ward managers reported concerns in relation to the varying quality and level of detail given at shift handovers, particularly where shifts contained agency staff and staff unfamiliar with the patients and ward environment.
  • Records for patients on enhanced levels of observation contained gaps and inconsistencies. Staff were not adhering to the provider’s observation policy.
  • We identified a lack of appropriate professional boundaries between staff and patients on Wimpole ward.

29 November- 1 December 2016

During a routine inspection

We rated Kneesworth House as requires improvement because:

  • Some seclusion rooms were not fit for purpose. Urinals and bedpans were used at times during seclusion episodes on Orwell and Nightingale wards. There was an unpleasant smell in the seclusion area on Bourn ward. Mattresses used in seclusion rooms looked like gym mats. They were thin and laid directly on the floor and not on a bed base as recommended by the revised Mental Health Act code of practice (2015). For a patient in seclusion this would be both cold and uncomfortable. CCTV in Nightingale’s seclusion area was not operational. This was repaired once reported to senior managers during the inspection. However, the room was used before this had been addressed.
  • Most wards had ligature points and not all of these had been identified by the hospital or the associated risks mitigated.
  • Some wards had ‘blind spots’, in particular near bathrooms on Bourn and poor lines of sight on landing areas on Swift and Nightingale, which were not mitigated by the use of mirrors.
  • There was evidence of routine prescribing of ‘as required’ medication on Bourn ward. Many of these prescriptions were unused.
  • Throughout the hospital, infection control concerns were identified. For example, there were carpets in many communal areas floors on Bourn ward. Wimpole ward had beanbags in side-rooms, which were not clean. Water from the shower area in Bungalow 67 had been flooding under the door causing damage in the hallway. Patients on Bungalow 67 were using the shower on 69 on a temporary basis. Some of the bedrooms on Wortham and Nightingale wards smelt.
  • Progress with reducing blanket restrictive practices across the hospital remained slow. For example, open bedroom access for most was not individually risk assessed.
  • There was limited evidence of patient involvement in some care plans across the hospital.
  • Regular ward team meetings were not held. This did not ensure good communication between staff.
  • Some patients reported there were not enough ward-based activities.
  • Staff did not have a working knowledge of safeguarding practices on the rehabilitation wards as the social work team dealt with referrals.
  • Some staff identified a need for further training in the Mental Capacity Act, particularly across the rehabilitation services and reported that they felt unclear of their role and responsibilities within the capacity assessment process.
  • Patients had access to psychologists but due to recent difficulties in recruiting, patients were on waiting lists for several months.
  • Some patients reported not feeling safe on Wimpole ward.
  • There had been a lack of governance in identifying and managing concerns about the hospital’s environment.
  • Management systems had not addressed identified safety and infection control issues. Contingency arrangements to mitigate these risks were not in place.

However:

  • The hospital and the corporate provider changed senior operational management teams on the final day of our inspection.
  • A staff recruitment and retention action plan dated October 2016 was in place and this covered areas such as recruitment open days, staff mentorship programmes and flexible working patterns.
  • Wards had identified nursing staff levels. Ward managers were able to increase staffing in response to patient increased observation levels.
  • A hospital refurbishment programme had started.
  • There was good medication management in place around patients’ self- medicating.
  • Environmental risk assessments were completed daily.
  • Documented ligature risk assessments and some mitigating actions were in place throughout the hospital.
  • Staff knew how to report incidents; there were lessons learnt from these, and action plans in place.
  • Physical health care monitoring was taking place. Well person clinics were in place on most wards to monitor this.
  • Senior managers held a daily morning meeting to discuss recent incidents, staffing concerns and work issues.
  • Staff were respectful and caring of patients and there was good interaction.
  • Daily planning and weekly community meetings were in place.
  • Patients were able to give feedback on the service they received via community meetings and surveys.
  • The provider had introduced a restrictive intervention reduction plan based on a Commissioning for Quality and Innovation (CQUIN) agreement with commissioners. This included an active least restrictive working party in place consisting of staff and patients.
  • Most staff said senior managers were approachable and visited the wards on a regular basis.
  • Clopton, Ermine, Icknield, Wimpole and Orwell wards were part of the external accreditation scheme from the Royal College of Psychiatrists’ quality network for forensic mental health services. The provider had an action plan to address any identified concerns.

21 to 24 July 2015

During a routine inspection

We rated this location overall as ‘requires improvement’ because:

  • Some of the wards did not provide a safe environment. High level ligature points were across the hospital including secure wards which posed a risk for patients with self-harming behaviours. Not all staff had easy access to ligature risk assessments and management plans or were aware of the actions needed to minimise the risk.
  • Nightingale, Wimpole and Orwell seclusion rooms were not suitable for purpose. For example, relating to ‘blind spots’ where staff could not observe patients who might be at risk of self-harm. Ward environments on Icknield, Ermine and Bourn were not conducive to patient’s recovery and refurbishment was required.
  • Cleanliness and infection control procedures were not robust for Wortham, Nightingale and Bourn wards. Staff and patients on Nightingale ward reported to the maintenance team that they had no hot water for ten days and staff had not escalated this further to senior managers for action.
  • There were staffing shortages across each ward with some staff and patients reporting consistency of care was affected.
  • On some wards we found improvements were needed regarding medication and equipment monitoring records
  • Seven risk assessments across the hospital out of 70 reviewed were not updated, which could mean that patients’ risks were not being managed appropriately on those wards.
  • Staff’s knowledge of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards varied across wards.
  • Some frontline staff across wards did not have access to the hospital’s clinical governance processes which posed a risk that they would not have information for their role.
  • Staff supervision compliance overall was 49% since April 2015. There was 23% overall compliance with staff appraisals. This was below the provider’s target and posed a risk that staff were not getting adequate support.

However:

  • Risk assessments took into account historic risks and identified where additional support was required. Assessments took place using nationally recognised assessment tools including the model of human occupation screening tool.
  • Ninety-five percent of staff had management of violence and aggression training. Staff said they were trained to use prone restraint only when absolutely necessary, for the shortest possible period and were working towards reducing the use of restraint as recommended in the guidelines, ‘Positive and proactive care’ produced by the Department of Health in 2014. The records we examined supported this.
  • Managers had systems for tracking and monitoring safeguarding referrals and ensuring protection plans were in place for patients.
  • Staff provided a range of therapeutic interventions in line with national institute for health and care excellence guidance.
  • Most patients were positive about the support which they received on the ward. Where they had concerns we found that staff had investigated or were investigating these.
  • Patients were involved in their care and treatment, and in governance of the hospital in various ways such as chairing their care programme approach meetings or ward community meetings. Patients had opportunities to get involved in hospital governance.
  • Staff were passionate and enthusiastic about providing care to patients with complex needs.
  • Secure wards were members of the quality network for forensic mental health services and had received peer led reviews to compare themselves with other similar units and against national standards.

9 July 2013

During a routine inspection

Patient that we spoke with during our inspection on 09 July 2013 were generally positive about the care and support they received. They made comments such as; 'The staff are helpful and help me plan my week.' Patients that we met told us that they were able to discuss their concerns with members of the care staff.

Care and support was being regularly reviewed to ensure that patients' needs were being met. There was evidence of patient's involvement in the planning of their care and support.

Dietary and nutritional needs were being met and patients chose from menus through the hospital catering services. Some patients were involved in self-catering and they were able to make individual choices and shop at local supermarkets with staff assistance.

There were regular ongoing training sessions in place to ensure that staff could safely deliver care and support to patients. However, improvements were needed to staff supervision arrangements to ensure that they received it at regular intervals

There had been concerns raised regarding staffing levels. Patients that we spoke with told us that staff shortages had meant that some trips to the local community had been cancelled. Staff we spoke with told us that staff shortages had prevented them from taking breaks and impacted on support that patients received.

There were quality assurance processes in place and patients were able to raise concerns and issues via the regular 'Patients Council' meetings.

30 August 2012

During a routine inspection

During our inspection on 30 August 2012 we visited Wimpole Ward, one of the bungalows where people lived and The Skills Centre. People told us that they felt involved with the planning and reviewing of their care. One person told us that, "Staff will always talk with me when I need to talk'. Two people told us they were 'Patient Representatives' and attended meetings with managers of the service to represent patients' views. There were regular ward meetings where people could discuss day to day issues and concerns. Staff spoken with during our visit informed us that people were fully involved in making decisions and that where possible, their concerns were acted upon. People using the service told us that there were activities available and that they particularly enjoyed going to the gym with staff.

Staff spoken with confirmed that they have received training in safeguarding people from harm or abuse. They were aware of the different types of abuse that would constitute a safeguarding referral having to be made and were aware of whom to report safeguarding concerns to.

The provider had robust recruitment and selection policies and procedures to ensure that staff they employed were fit to work with vulnerable people. Staff received ongoing training, appraisal and supervision throughout the year to ensure their safe practice

1 November 2011

During an inspection in response to concerns

We spoke with eight people using the services on both Clopton and Wimpole wards. They told us that much of their day was spent, 'Just hanging around with little in the way of positive, constructive activities'. Some people told us they were bored and felt under- stimulated. People said that they did not feel they were being consulted about service changes that would affect their care and treatment.

Some people who use services were involved in a peaceful protest about their care as they felt they were not being listened to and changes were not taking place. They felt the actions taken by the hospital after the protest were, "Unfair."