CQC tells Nottinghamshire Healthcare NHS Foundation Trust improvements are needed to keep people safe

The Care Quality Commission (CQC) has found improvements need to be made by Nottinghamshire Healthcare NHS Foundation Trust following inspections from October to December last year, which sees the ratings of two services drop from requires improvement to inadequate.

Unannounced focused inspections were carried out at the trust’s acute wards for adults of working age and psychiatric intensive care units (PICU) and wards for older people with mental health problems, due to information of concern received about the safety and quality of these services.

Following the inspections, the following ratings were given at each service:

Acute wards for adults of working age and PICU: The overall rating has dropped from requires improvement to inadequate. Safe and well-led have again been rated inadequate. Effective, caring and responsive were not included in this inspection and remain rated requires improvement.

Following this inspection, CQC told the trust they must make improvements to mitigate urgent risks. The trust responded with an action plan to mitigate the risks which gave CQC assurance.

Wards for older people with mental health problems: The overall rating as well as safe and well-led has declined from requires improvement to inadequate. Being effective was again re-rated as requires improvement. Responsive was not included in this inspection and remains rated as requires improvement. Caring was not included and remains rated as good.

Greg Rielly, CQC deputy director of operations in the midlands, said:

“When we inspected acute wards for adults of working age and psychiatric intensive care units (PICU), as well as wards for older people with mental health problems, it was concerning to find a lack of oversight from leaders across the services. We also found staff weren’t always being kind and respectful to the people they were caring for.

“When we visited Cherry ward for older people, there was a significant impact on staffing due to a serious incident which took place last November. That incident resulted in a number of staff being suspended, which heavily impacted on the standard of care people were receiving due to staffing levels.

“A trust investigation of close circuit television (CCTV) found that these staff had falsified care records to show that observations had been done when they hadn’t. Our inspectors also reviewed CCTV footage in the acute wards for adults of working age and PICU and found staff had assaulted people causing physical harm. There had been four occasions where two people had been physically assaulted on Elm ward. The staff involved had been suspended and the trust have investigated the incidents.

“This is totally unacceptable behaviour and must be addressed by the trust as a priority. Leaders must take urgent action to have better oversight of issues, to ensure people are safe and receiving the care they deserve.  

“Since the inspection, we have told the trust where we need to see rapid and widespread improvements and have issued requirement notices, so they know where they need to focus their attention. We will continue to monitor the trust closely whilst these improvements are being made to keep people safe. If we’re not assured improvements have been made and embedded, we will not hesitate to use further enforcement powers to keep people safe.”

Inspectors found at acute wards for adults of working age and PICU:

• There was an inconsistent approach to recording people’s details when they accessed leave from their wards
• There was an inconsistent approach on which documentation to use when recording seclusion observations
• There were ligature risks which had not been identified or acted on to reduce the risk of harm to people
• There was a high use of agency staff due to staff vacancies
• Staff did not always share key information to keep people safe when handing over their care to others
• Staff did not always raise concerns and report incidents and near misses in line with trust policy
• The service did not always learn from incidents.

However:

• All wards were clean well equipped, well furnished.

Inspectors found at wards for older people with mental health problems:

• There were missing signatures on the administration of people’s medicines
• There were examples where sedative medication had been administered against the prescribed dose and against medical advice
• There was an inconsistent approach on which documentation to use when recording people’s risks
• There was an inconsistent approach in the completion of charts that were being completed by staff
• There were wards that did not have single ensuite rooms, and dormitories were still in place on three out of the four wards visited
• There was no assurance that people’s dietary intake was being effectively completed by staff
• There was no assurance that management had timely oversight over data collected by staff regarding people’s risk

However:

• Activities were taking place on two out of four wards visited.