Archived: Jeesal Cawston Park

Updated 28 May 2021

Jeesal Cawston Park was provided by the Jeesal Akman Care Corporation Limited. It was an independent mental health hospital for adults with learning disabilities and/or autistic people.

Jeesal Cawston Park was registered to provide the regulated activities assessment or medical treatment of persons detained under the Mental Health Act 1983 and treatment of disease, disorder or injury. The hospital had a registered manager.

Although the location had 54 beds, this location had a registration condition which the provider agreed via the tribunal process in 2020, to provide regulated activities to a maximum of 12 people.

At the time of our inspection, there were eleven people receiving care and treatment at Jeesal Cawston Park. Although, one person was not staying at the hospital because they were in the process of transitioning to another service as part of their discharge.

At the time of our inspection, people were being cared for in:

A main ward called the Lodge that had 14 beds and accepted both males and females.

Two smaller bungalows called Manor Lodge and Yew Lodge. Both bungalows had three self-contained flats.

There were five patients staying on the Lodge, three patients were staying at Yew Lodge and two patients were staying at Manor Lodge.

The location had other properties which had been de-commissioned, therefore we did not visit these at part of this inspection.

We have inspected this location 15 times since it became registered with the CQC in 2011.

The location has a history of non-compliance to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have inspected this location seven times previously in the last three years. At all those inspections the provider was in breach of the regulations.

Jeesal Cawston Park has been in special measures since 2019. In our previous inspections, we used our civil enforcement powers to take enforcement action against the provider due to failures to meet the regulations.

At this inspection, we found the provider was unable to demonstrate improvements despite caring for a significant reduction in the number of people being cared for by the service.

Due to the concerns we found during this inspection, we used our powers under section 31 of the Health and Social Care Act to take immediate enforcement action and placed conditions on the provider’s registration. We also issued a Notice of Proposal to close the hospital which was not appealed and became a Notice of Decision requiring the hospital to close.

Following our inspection and civil enforcement action, the provider agreed to the closure of the hospital. All people were discharged from the service by 12 May 2021.

What people who use the service say

As part of our inspection we spoke with four people who were staying at the service and eight carers. They gave mostly negative feedback about the service.

All the four people using the service told us that they did not like being around the other people that were also staying at the service. On the Lodge, they said this was because they preferred having their own space. On Manor and Yew Lodges, this was because they felt the people staying there all had different needs. They told us they found it difficult to get along with the other people staying in the same place. One person told us this made them feel very isolated, particularly during the pandemic restrictions where the mixing of people had reduced and opportunities to go out had decreased.

All four people that we spoke to told us that they had been at this hospital for a long time. Two people told us that they were bored at the hospital because there was not much to do.

Two people told us that they were experiencing pain. One of these people had toothache for over three months. We report on this in further detail later in our report.

However, one person told us that staff had provided them with bereavement support and two people told us that they had a positive relationship with some staff.

All carers told us that during the COVID-19 pandemic lockdown restrictions they had to maintain contact with people by telephone, video calls and/or letters. They had not been able to visit people in person due to a blanket restriction on visiting. However, in between the different lockdowns there had been some visits permitted in person.

Four carers told us that activities were limited to things such as: music, colouring, jigsaws and walking.

Four carers raised concerns about staff not providing kind and compassionate care. Two carers of one person raised concerns about incidents that resulted in a person being injured. This was subject to a safeguarding investigation. They felt that staff had provoked the person prior to the incident. One carer told us that their relative felt threatened by larger build male staff that worked at the service and another carer reported an incident where staff were brusque with a person they cared for.

Two carers told us that they had concerns about people gaining weight since their admission to Jeesal Cawston Park. One of these people had developed type two diabetes during their stay.

Two carers told us that people’s belongings had gone missing from the service.

Two carers told us that people had to ask staff for toilet paper. This restriction was not due to their individual risks.

Two carers told us that there was a lack of communication and involvement from staff. One carer told us their views were not listened to.

However, one carer told us that communication was good and they were involved in people’s care plans and two carers told us that on the whole staff were respectful.

Updated 28 May 2021

We expect Health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability or autistic people. 

The paragraph below was added as a revised section of the report following the completion of enforcement action so it clear to the public what action had been taken following this inspection.

We took enforcement action against the registered provider to remove the services registration - this meant they would not be allowed to continue to provide a service after a specified date. This decision was made due to continued serious concerns about the quality of service provision. In response to this action the provider decided not to appeal the notice and agreed to close the hospital. Irrespective of the hospitals decision, we served the Notice of Decision to close the hospital using our civil powers to ensure that the closure took place without delay.

The enforcement action undertaken limited our overall rating of this location to inadequate.

Our rating of this location went down. We rated it as inadequate because:

• The service could not show how they met the principles of Right support, right care, right culture. People were not being kept safe from avoidable harm because there was not enough suitably trained staff to keep people safe and incidents continued to recur.
• People continued to receive care that did not meet their needs and was not always compassionate or kind. The service did not have a clear model of care, and did not have the required specialists and therapies suitable to meet the needs of people with learning disabilities and/or autistic people to ensure they did not spend longer than necessary in hospital. However, the provider told us that activities had been limited by the COVID-19 pandemic.
• Leaders had failed to ensure the service improved and governance systems and processes were ineffective in identifying, managing and mitigating risks and improving the quality of the care provided. There was insufficient oversight of restrictive practice.
• We also identified issues with the monitoring of the effect of medicines on people’s physical health, issues with long term segregation and policies that were not in line with national guidance.

However:

• The care environments were clean and well maintained, people’s views were recorded in their care plans and information was available in accessible formats.

Updated 28 May 2021

Our rating of this service went down. We rated it as inadequate because:

• We took enforcement action against the registered provider in relation to the concerns that we identified during this inspection. This limits our rating of the service and all the five key questions to inadequate.
• The provider failed to submit data in relation to several of our requests. The lack of assurance increased concerns about the providers ability to provide safe care and treatment and it was necessary to liaise with other stakeholders to gain the necessary assurances.
• We served a Notice of Proposal to close the service. The hospital decided not to appeal the notice and this then became a Notice of Decision to close the hospital. Following our inspection and enforcement action, the provider agreed to close the hospital. All people in this service were discharged or transferred to an alternative hospital and closed on 12 May 2021.
• People were not being kept safe from avoidable harm, abuse and poor care. The service did not have sufficient, appropriately skilled staff to meet people’s needs and keep them safe. There were also issues with ligature risk assessments containing inaccurate information.
• Staff did not always monitor the effect of medicines on people’s physical health, medicines records were incomplete, and staff did not always follow prescribing instructions. People were not always supported to lead healthy lifestyles.
• Staff did not support people through recognised models of care and treatment for people with a learning disability or autistic people. People’s length of stay was high.
• People did not receive care, support and treatment that met their needs and aspirations. Care lacked a focus on people’s quality of life and did not follow best practice.
• The service did not have all the specialists required to be able to provide effective care and treatment and meet people’s needs.
• People only had access to a limited range of activities that were mostly self-directed and were not part of planned therapy or care to support them to achieve their goals or discharge.
• People did not always receive kind and compassionate care from staff. Staff did not always protect and respect people’s privacy and dignity or understand each person’s individual needs. People’s human rights were not always upheld.
• Although people’s care, treatment and support plans reflected their needs, these were not always followed by staff in practice.
• Although people’s risks were assessed regularly, staff were not proactive in preventing further incidents and people were not involved in managing their own risks.
• The provider did not have a restrictive practice reduction programme or sufficient oversight of restrictive practice and the use of physical restraint was increasing.
• Clinical and quality audits were not effective in identifying risks or evaluating the quality of care and did not lead to improvements in the service.
• Carers were not always actively involved in planning people’s care and did not always receive communication.
• Independent external reviews of long term segregation did not take place every three months and one person’s long term segregation was not in line with the Mental Heath Act code of practice. There were also delays in requesting second opinion appointed doctors.
• People were not receiving active, goal oriented treatment. Although people had clear care plans in place, there were issues with the effectiveness of discharge planning to support people to return home or move to a community setting.
• Leadership and governance processes were not effective and did not ensure the service kept people safe, protect their human rights or provide good care, support and treatment. The service was not effectively working to develop and improve the service. The provider had not ensured its policies followed national guidance in relation to infection prevention and control, observation and visiting.

However:

• People’s care and support was provided in a well equipped, furnished and well maintained environment which met people's sensory and physical needs.
• People’s views were recorded in their care plans and information was shared in a way that could be understood through easy read formats.
• Apart from the issues identified around long term segregation, staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.