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Provider: Coventry and Warwickshire Partnership NHS Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 06 Aug to 04 Oct 2018

During a routine inspection

Our rating of the trust improved. We rated the trust as good because:

  • The trust had made a number of improvements since the previous inspection in June 2017. We rated effective, caring, responsive and well-led as good, and safe as requires improvement. Our rating of effective, responsive and well-led had improved from requires improvement to good from the previous inspection in June 2017.
  • We rated five of the trust’s seven core services as good and two services as requires improvement that we inspected on this occasion. In rating the trust, we took into account the previous ratings of the seven core services not inspected this time.
  • There was improved collective leadership and the trust had worked with and learnt from other NHS trusts to develop a culture of quality improvement. The trust had embedded a number of initiatives since the previous inspection of June 2017 that included; its vision and values, a workforce strategy, an electronic patient records system, and staff recognition and rewards.
  • The trust had worked with NHS Improvement and clinical commissioning groups specifically to reduce the waiting lists for some children and young people with mental health problems and plan the upgrade of wards to reduce risk in acute mental health wards for adults of working age.
  • The trust had identified three empty wards and had worked with NHS partners to design safer adult mental health wards for adults of working age. The work had started and there were clear plans in place for completion. To make patients safer, the trust and staff had robust risk assessments and care plans in place to reduce the risk of patients tying a ligature and in the use of seclusion.
  • For children and young people with mental health problems, the trust had significantly improved triage processes since the previous inspection in June 2017. This meant referrals were reviewed more quickly. The trust was working with partners across local the health and social care economy to reduce the impact on children and families who were waiting for treatment. Systems and processes were in place to monitor assessment and treatment times. However, there was further work to undertake to reduce waiting times for treatment, especially in neurodevelopment services.
  • The trust had good awareness of risk and was working collectively to monitor and address the main risks to the trust. Risks included the recruitment and retention of staff, financial sustainability whilst maintaining quality and safety to patients, and the upgrade of existing buildings and wards.
  • The trust had improved the way it worked with stakeholders across the health and social care economy of Coventry and Warwickshire. The trust continued to work with the public to design and improve services as part of its equal partners strategy. This had supported the Board’s awareness of local priorities to support care to local people. The trust continued to work with neighbouring mental health NHS trusts to develop new models of care to improve quality and safety.
  • The trust had further work to complete to support staff from minority or diverse groups. However, the experience of staff from these groups had shaped the development of specific support groups to black and minatory ethnic staff, LGBT staff and those staff who have a disability.
  • The trust had planned and was making effective use of technology to improve quality and safety to patients. There was outstanding use of medically certified technology in older people’s mental health wards and innovative approaches when working with stakeholders across Coventry. The IT department were leading the drive to make access to patient clinical records timely between the trust and GP services.

However:

  • There were still problems with medicines management across the trust. Not all areas across the trust stored and administered medicines safely. Although the trust had introduced new processes and equipment since the last inspection in June 2017, not all staff or teams adhered to safe medicines management.
  • Some wards did not have enough regular staff to meet the needs of patients. This meant that activities and leave were cancelled and it had an impact on the morale of permanent staff. However, the trust recognised this was a risk and had improved ways to recruit and retain staff.
  • We found that further improvements needed to be made to support managers to access information related to training, supervision, risk and audit.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RYG/reports.


CQC inspections of services

Service reports published 21 December 2018
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Community end of life care Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Community health services for adults Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
Inspection carried out on 06 Aug to 04 Oct 2018 During an inspection of Community-based mental health services for older people Download report PDF | 577.85 KB (opens in a new tab)Download report PDF | 2.64 MB (opens in a new tab)
See more service reports published 21 December 2018
Service reports published 19 February 2018
Inspection carried out on 21-22 November 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 262.46 KB (opens in a new tab)
Service reports published 8 November 2017
Inspection carried out on 27-29 June 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 409.66 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 376.88 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 413.28 KB (opens in a new tab)
Inspection carried out on 26-29 June 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 421.43 KB (opens in a new tab)
Inspection carried out on 27-30 June 2017 During an inspection of Community dental services Download report PDF | 400.08 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Forensic inpatient or secure wards Download report PDF | 311.78 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 344.27 KB (opens in a new tab)
Inspection carried out on 26 - 30 June 2017 During an inspection of Community-based mental health services for older people Download report PDF | 318.96 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 355.18 KB (opens in a new tab)
Inspection carried out on 26-30 June 2017 During an inspection of Wards for people with a learning disability or autism Download report PDF | 367.83 KB (opens in a new tab)
Inspection carried out on 26 - 30 June 2017 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 355.85 KB (opens in a new tab)
See more service reports published 8 November 2017
Service reports published 12 July 2016
Inspection carried out on 11 - 15 April 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF | 358.79 KB (opens in a new tab)
Inspection carried out on 11 - 15 April 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 288.38 KB (opens in a new tab)
Inspection carried out on 11-15 April 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 314.98 KB (opens in a new tab)
Inspection carried out on 11 - 15 April 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 376.82 KB (opens in a new tab)
Inspection carried out on 11-15 April 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 277.78 KB (opens in a new tab)
Inspection carried out on 11-15 April 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 298.04 KB (opens in a new tab)
Inspection carried out on 11 to 15 April 2016 During an inspection of Community health services for adults Download report PDF | 424.34 KB (opens in a new tab)
Inspection carried out on 11 - 15 April 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 321.44 KB (opens in a new tab)
Inspection carried out on 11 to 15 April 2016 During an inspection of Community health services for children, young people and families Download report PDF | 368.8 KB (opens in a new tab)
Inspection carried out on 11 to 15 April 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 303.91 KB (opens in a new tab)
Inspection carried out on 11-15 April 2016 During an inspection of Community-based mental health services for older people Download report PDF | 291.95 KB (opens in a new tab)
Inspection carried out on 11 to 15 April 2016 During an inspection of Community dental services Download report PDF | 380.2 KB (opens in a new tab)
Inspection carried out on 11 - 15 April 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 337.13 KB (opens in a new tab)
See more service reports published 12 July 2016
Inspection carried out on 26-30 June 2017

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

Following the inspection in June 2017, we have rated Coventry and Warwickshire Partnership NHS Trust as Requires Improvement because:

  • The trust had not made the necessary improvements from the previous inspection to change our rating. The trust had not completed its works programme to reduce ligature risks on acute mental health wards.
  • There was long waiting times for children and young people to access treatment for mental health problems. We also found long waits for children and young people to be assessed for a neurodevelopment disorder, such as autism. There was a backlog of referrals waiting to be triaged in specialist community mental health services for children and young people. We found 600 referrals that required triage in this core service and there was not sufficient staff to complete the task.
  • The trust had not provided staff with specialist training to undertake their role on all wards for older people. Staff were not monitoring patients’ physical and mental health sufficiently to reduce risk. We issued the trust with a warning notice to improve care and treatment. The trust had not challenged the warning notice and had put in immediate plans to address the problems we found.
  • The trust training compliance rate for the Mental Health Act was low. This was similar to the previous CQC inspection.
  • We found temperatures in clinic rooms across the trust were high and this had the potential to affect medicines. The trust had issued advice to vary the shelf life of medicines where safe storage could not be maintained. Not all services monitored clinic temperatures and there was not a consistent approach across the trust to reduce the risk despite standard operating procedures being in place.
  • The workforce race equality scheme required organisations to demonstrate progress against a number of indicators of workforce equality. The trust had reported on the nine indicators, however, specific strategic directions related to action plans and objectives to address the workforce race equality indicators were missing.

However;

  • Staff working across the trust were kind, caring and respectful. We saw some services that went above and beyond to meet patient and carer needs. Patients and carers feedback was positive and highlighted the staff as a caring group.
  • The trust had engaged local communities to develop its equal partners strategy. The trust was involved in new models of care with partner agencies across the West Midlands to improve the quality and safety of care to patients.
  • The trust had developed its approach to how patients were managed when presenting with challenging behaviours. The trust had developed person-centred positive behaviour support plans and had significantly reduced the number of patients who were restrained.
  • The trust had an innovative approach to safeguarding children and adults. The trust had developed a specific team to meet with external stakeholders and support staff across clinical services. Staff were aware of forms of abuse and knew how to raise concerns.

Inspection carried out on 11 - 15 April 2016

During a routine inspection

The trust needs to take steps to improve the quality of their services and we find that they were in breach of five regulations. We have issued one warning notice and three requirement notices which outline the breaches and require the trust to take action to address. We will be working with them to agree an action plan to assist them in improving the standards of care and treatment.

We found that the trust was performing at a level which led to a rating of requires improvement because:

  • Some of the wards did not provide a safe environment.

  • The Department of Health guidance and Mental Health Act 1983 Code of Practice in relation to the arrangements for eliminating mixed sex accommodation were not met on six wards, Stanley, Pembleton, Ferndale, Sherbourne, Rowans and Hawkesbury Lodge. On Rowans ward, women were sleeping in the male area of the ward and a young person was not provided with a separate lounge due to the limited space on the ward.

  • Some wards had many potential ligature anchor points with unclear management plans in place. On Larches ward there were multiple ligatures, for example bathroom taps, shower fittings and bedroom windows and handles. Ligature cutters were kept in clinic rooms which were locked. The problem with ligature points was compounded on some wards because of blind spots where staff could not observe patients easily.

  • Anti-barricade doors on Spencer ward could not be opened because staff could not locate the correct key.

  • On Larches ward there were two call bell systems in place. One system was de-activated but buttons still visible. Call bells were ‘disabled’ during original inspection. On a follow-up visit the bells were working, with the exception of one bathroom which remained broken.

  • Medicines were not always stored safely nor disposed of correctly in the learning disabilities service.

  • Record keeping was poor particularly in relation to the Mental Health Act documentation. Patients were not being told of their right to support from an Independent Mental Health Act Advocate (IMHA). Those patients lacking capacity were not referred to advocacy automatically in line with MHA code of practice. Section 17 leave forms did not always record who else had been given a copy other than the patient. Some care records showed no evidence of assessment of mental capacity. No records of Mental Health Act (MHA) paperwork or Ministry of Justice (MoJ) warrants or orders were available in paper or electronic forms at IPU 10-17, Swanswell Point. Ministry of Justice records were not available at the MHA office at the Caludon centre. Medical staff had made errors on consent to treatment documents (T2 and T3 forms) on two wards, relating to three patients. Prescribing did not adhere to the agreed plan, which made the treatment invalid for the detained patients in question. Community treatment order conditions were not included in the care plan for one patient. In the community health service overall, not all services had undertaken robust risk assessments to manage risks in the delivery of care and treatment. Not all records were kept in a secure storage area and some were not maintained in accordance with trust procedures.

  • The trust had identified high levels of restraint and prone restraint used in 2014 and had completed an action plan to reduce this. A review of the action plan in 2015 identified that some recommendations had not been actioned, and some only partially actioned. This included doctors reviewing patients who had been restrained within two hours and for staff to explore alternative restraint methods. However, at the time of inspection we noted that doctor reviews were still not taking place and there had still been a high level of use of prone restraint, in particular on Amber ward.

  • Not all teams achieved the compliance rate for MHA and Mental Capacity Act (MCA) training, the trust’s target was 95%. Staff on adolescent units did not understand the Gillick competence and consequently did not have the knowledge and skills to assess capacity. In the community adult nursing service, we found that there was a poor understanding of the Mental Capacity Act 2005 (MCA) and some teams had poor staff training compliance in this area.

  • There were long waiting times in some of the community services.Data showed 138 young people in the children and adolescent mental health services had waited up to 24 weeks and 117 had waited from 25 to over 49 weeks to access treatment. In the community dental service, we found there was an excessive waiting list for children who had been referred to the service and were waiting for their first assessment appointment. Some patients had been waiting nine to ten months. We saw evidence of increasing demand and acuity in the community health therapy services leading to pressures on staff, which sometimes had an impact on waiting times.

  • In the community dental service, there was no clearly defined strategy for the service in place to drive improvement and innovation. There was not a robust oversight and management of risks within the service.

However:

  • Staff had a good understanding of how to protect patients from abuse. Staff could identify what would constitute a safeguarding referral, how to report, and who to report too. Staff regularly completed safety and security audits of the ward areas. Appropriate arrangements were in place for children visiting. Patients told us that they felt safe on the wards. 100% of staff who required safeguarding children level 3 were trained.

  • For the community health services, we rated two services as being outstanding for caring - end of life care and children and young people and families services.

  • Ward equipment was well maintained and the wards were clean, bright and airy. Interview and waiting areas used by patients were clean, well-maintained and safe.

  • Staffing levels in community health services were appropriate and met patients’ needs at the time of inspection, despite some areas having staffing pressures. Staffing shortages were acted upon appropriately with the use of temporary staff and an effective induction process was in place.

  • Patients’ physical health needs were identified in most services. Medical staff documented physical health examinations and assessments following the patient’s admission to the wards. Ongoing monitoring of physical health care problems was taking place. Patients accessed a range of physical healthcare services including podiatrists, district nurses, tissue viability nurses and opticians. Outcomes for patients using the services were monitored and audited. This included the monitoring of key performance indicators such as length of stay and readmissions within 30 days of discharge. Sherbourne ward had robust system to review physical healthcare needs weekly via implementation of a wellbeing clinic.

  • In the community health services, we found that patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice. These services had effective evidence based care and treatment policies based on national guidance and had introduced an individualised plan for care for the dying person for patients with end of life needs.

  • Nursing staff treated patients with care and respect and communicated in ways patients understood. Staff knew of individual needs and concerns, and spoke respectfully about patients. Staff were positive, experienced, confident, well-motivated and worked together well. They frequently expressed satisfaction in doing a good job in helping people in crisis.

  • Staff helped patients with their personal care, this was done in private and patient dignity was maintained. We observed positive and meaningful interactions between staff and patients. Staff listened to patients and used appropriate forms of communication to ascertain people’s thoughts and feelings when these were not easily expressed.

  • Community health services were planned and delivered to meet the needs of individual patients and of the local community. Effective relationships with key stakeholders and commissioners led to a coordinated approach to service design and delivery.

  • In community health services, most staff and service leads were clear about their priorities and vision and felt involved with the development of services. Staff showed an awareness of the trust strategy for the service. There was good feedback from patient surveys. Leadership within community health services was effective. Most staff felt supported by their immediate managers and senior managers within the community.

  • Staff told us they were aware of the trust vision and values. Ward managers said they had sufficient authority and felt able to carry out their role effectively. Staff knew who the most senior managers in the trust were.

Inspection carried out on 21-24 January and 2 July 2014

During an inspection to make sure that the improvements required had been made

Coventry and Warwickshire Partnership Trust was formed in 2006 and integrated with community services from NHS Coventry in April 2011.

The Trust provides the following services:

Brooklands Solihull (8 Units)

Core service provided:Medium secure forensic unit; Two specialist assessment and treatment units for people aged16 – 25 and 18+ years Three Low secure units; Two Adolescent Specialist Assessment and Treatment units12 – 19 year

Total Bed Capacity:95

St Michael’s Warwick (5 Wards)

Core service provided:Two Acute admission wards, a Psychiatric intensive care ward; health-based place of safety; Long stay/forensic/secure wards, one of which is men only

Total Bed Capacity: 78

Caludon Centre Coventry (8 Wards)

Core service provided:Two older peoples wards; Intensive care unit; Place of safety suite; four acute admission wards (one women only); one ward for people with a learning disability

Total Bed Capacity: 112

Caludon Centre includes the following services:

Community based mental health and community health services

Core service provided:These services are mainly provided in a person’s home.

The Aspen Centre Warwick

Core service provided:Specialist treatment for people aged 16 and over with a severe eating disorder.

Total Bed Capacity: 16

Hawkesbury Lodge in Longford, Coventry.

Core service provided:Secure rehabilitation unit for men and women

Total Bed Capacity: 20

Highfield House Nuneaton

Core service provided:Community-based rehabilitation unit for men and women.

Total Bed Capacity: 8

The Manor Hospital Nuneaton

Core service provided:Secure assessment and treatment service for over 65 years

Total Bed Capacity: 12

Woodloes Avenue Warwick

Core service provided:Acute assessment and treatment to people over 65 years

Total Bed Capacity: 25

Lyndon House in Solihull

Core service provided:Respite service for children with learning disabilities, behaviours that can challenge and additional physical health needs.

Total Bed Capacity: 7

Gramer House and Holly House North Warwickshire

Core service provided:Respite service for children with learning disabilities, behaviours that can challenge and additional physical health needs.

Total Bed Capacity: 4 and 3

Bradbury House in Coventry

Core service provided:Respite care for children with learning disabilities and behaviours that may challenge.

Total Bed Capacity: 7

The Birches in Coventry

Core service provided:Respite care for children with learning disabilities and additional physical health needs.

Total Bed Capacity: 7

The provider headquarters is based at Wayside House in Coventry. Coventry and Warwickshire Partnership NHS Trust serves a population of 1,053.000, of which 850,000 live within Coventry and Warwickshire, with delivery of very specialist services to a wider geographical area. It provides integrated services such as all age mental health, specialist services, primary care and prevention, integrated children’s services and all age community services. The trust has a total of 80 sites spread over 870 square miles. The trust has a budget of £200 million, employing 4000 whole time equivalent staff.

The trust has a bed occupancy rate of 93.3% compared to the England average of 85.2%. We found the high bed occupancy rate sometimes had a negative impact on the use of beds held for people on leave and the ability to properly segregate accommodation for men and women.

The Board was working hard at leading the trust through a transformation agenda supported by core values. However, this was unsettling for staff who expressed these concerns to us during the inspection. Some staff reported feeling well informed; however, others told us they felt unsupported by the trust and were afraid to raise concerns.

We found from the sites we visited that there were inconsistencies across the trust in staff practice and this had an impact on the Board’s ability to be aware of the risks within the organisation regarding quality and safety. There was inconsistency in safe storage and administration of medication and practices, and some inconsistency in adhering to the Mental Health and Mental Capacity Acts.

There was not enough overview of the Board’s groups and subgroups to bring issues together from the CQC Mental Health Act monitoring visits.

There were examples of very good practice in one service that was not mirrored at another and good practice was not shared even within the same hospital site. Where an experienced ward-based manager offered good leadership, there were positive outcomes for patients and staff; these included access to information, staff supervision and development, following the safeguarding process and addressing concerns promptly.

Staff employed by the trust were caring and committed, made good patient care and safety central to their work, and interacted well with patients. People told us about individuals who gave excellent care and support. We also saw some examples of good physical healthcare in a mental health setting.

We found where wards were poorly staffed and where they frequently used agency workers or non-permanent staff, the ability of staff to provide consistent and compassionate care was reduced. We found a lack of age appropriate activities and access to facilities. This was partly due to a lack of consistent support.

Some teams were without a manager for long periods. Others reported that where they had a manager, they had not had team meetings and therefore were unaware of changes and other messages from the trust.

We saw some good evidence of multi-disciplinary team working, particularly from inpatient to community teams and in planning people’s discharge from hospital. We also saw some very good specialist areas. These included the specialist inpatient eating disorder service, the children’s respite services, Electro Convulsive Therapy (ECT) unit, community services and some specialist wards at the Brooklands site.

In children’s services there were waiting lists of up to 15 months to access a service.

We saw some positive examples of staff balancing and managing caseloads to ensure that they had the right amount of time to undertake their work well, particularly in the community services. Some good processes were in place to monitor and respond to serious incidents and identify early warnings of issues.

We had some concerns about the safety of patients and staff, particularly the medium secure unit at Brooklands. This was due to difficulties in repairingexternal gateand the fact that the lone working policy was not being consistently followed throughout the trust. Learning from incidents across the organisation required some improvement to give consistent messages to staff.

Training for some teams was excellent. However in some areas staff had limited knowledge of safeguarding and deprivation of liberty procedures and staff were not always following the trust’s procedures in reporting incidents and risks.

We had sufficient serious concerns regarding Quinton Ward in the Caludon Centre to issue a Warning Notice regarding this ward. The trust sent us an action plan following the inspection to detail how they were planning to implement improvements. We undertook a follow up inspection in July 2014 and found the trust had taken action to improve the outcomes for people on this ward. We found that the trust had responded and that the ward was much improved with sufficient improvement to remove the warning notice. Details of this visit and our findings can be found within the report on the Caludon Centre.

Inspection carried out on 21-24 January 2014

During a routine inspection

Coventry and Warwickshire Partnership Trust was formed in 2006 and integrated with community services from NHS Coventry in April 2011.

The Trust provides the following services:

Brooklands Solihull (8 Units)

Core service provided: 

Medium secure forensic unit; Two specialist assessment and treatment units for people aged16 – 25 and 18+ years Three Low secure units; Two Adolescent Specialist Assessment and Treatment units12 – 19 year

Total Bed Capacity: 95

St Michael’s Warwick (5 Wards)

Core service provided: Two Acute admission wards, a Psychiatric intensive care ward;  health-based place of safety; Long stay/forensic/secure wards, one of which is men only

Total Bed Capacity: 78

Caludon Centre Coventry (8 Wards)

Core service provided: Two older peoples wards; Intensive care unit; Place of safety suite; four acute admission wards (one women only); one ward for people with a learning disability

Total Bed Capacity: 112

Caludon Centre includes the following services: 

Community based mental health and community health services

Core service provided: These services are mainly provided in a person’s home.

The Aspen Centre Warwick

Core service provided: Specialist treatment for people aged 16 and over with a severe eating disorder.

Total Bed Capacity: 16

Hawkesbury Lodge in Longford, Coventry. 

Core service provided: Secure rehabilitation unit for men and women

Total Bed Capacity: 20

Highfield House Nuneaton

Core service provided: Community-based rehabilitation unit for men and women.

Total Bed Capacity: 8

The Manor Hospital Nuneaton

Core service provided: Secure assessment and treatment service for over 65 years

Total Bed Capacity: 12

Woodloes Avenue Warwick

Core service provided: Acute assessment and treatment to people over 65 years

Total Bed Capacity: 25

Lyndon House in Solihull

Core service provided: Respite service for children with learning disabilities, behaviours that can challenge and additional physical health needs.

Total Bed Capacity: 7

Gramer House and Holly House North Warwickshire

Core service provided: Respite service for children with learning disabilities, behaviours that can challenge and additional physical health needs.

Total Bed Capacity: 4 and 3

Bradbury House in Coventry

Core service provided: Respite care for children with learning disabilities and behaviours that may challenge.

Total Bed Capacity: 7

The Birches in Coventry

Core service provided: Respite care for children with learning disabilities and additional physical health needs.

Total Bed Capacity: 7

The provider headquarters is based at Wayside House in Coventry.  Coventry and Warwickshire Partnership NHS Trust serves a population of 1,053.000, of which 850,000 live within Coventry and Warwickshire, with delivery of very specialist services to a wider geographical area. It provides integrated services such as all age mental health, specialist services, primary care and prevention, integrated children’s services and all age community services. The trust has a total of 80 sites spread over 870 square miles. The trust has a budget of £200 million, employing 4000 whole time equivalent staff.

The trust has a bed occupancy rate of 93.3% compared to the England average of 85.2%. We found the high bed occupancy rate sometimes had a negative impact on the use of beds held for people on leave and the ability to properly segregate accommodation for men and women.

The Board was working hard at leading the trust through a transformation agenda supported by core values. However, this was unsettling for staff who expressed these concerns to us during the inspection. Some staff reported feeling well informed; however, others told us they felt unsupported by the trust and were afraid to raise concerns.

We found from the sites we visited that there were inconsistencies across the trust in staff practice and this had an impact on the Board’s ability to be aware of the risks within the organisation regarding quality and safety. There was inconsistency in safe storage and administration of medication and practices, and some inconsistency in adhering to the Mental Health and Mental Capacity Acts.

There was not enough overview of the Board’s groups and subgroups to bring issues together from the CQC Mental Health Act monitoring visits.

There were examples of very good practice in one service that was not mirrored at another and good practice was not shared even within the same hospital site. Where an experienced ward-based manager offered good leadership, there were positive outcomes for patients and staff; these included access to information, staff supervision and development, following the safeguarding process and addressing concerns promptly.

Staff employed by the trust were caring and committed, made good patient care and safety central to their work, and interacted well with patients. People told us about individuals who gave excellent care and support. We also saw some examples of good physical healthcare in a mental health setting.

We found where wards were poorly staffed and where they frequently used agency workers or non-permanent staff, the ability of staff to provide consistent and compassionate care was reduced. We found a lack of age appropriate activities and access to facilities. This was partly due to a lack of consistent support.

Some teams were without a manager for long periods. Others reported that where they had a manager, they had not had team meetings and therefore were unaware of changes and other messages from the trust.

We saw some good evidence of multi-disciplinary team working, particularly from inpatient to community teams and in planning people’s discharge from hospital. We also saw some very good specialist areas. These included the specialist inpatient eating disorder service, the children’s respite services, Electro Convulsive Therapy (ECT) unit, community services and some specialist wards at the Brooklands site.

In children’s services there were waiting lists of up to 15 months to access a service.

We saw some positive examples of staff balancing and managing caseloads to ensure that they had the right amount of time to undertake their work well, particularly in the community services. Some good processes were in place to monitor and respond to serious incidents and identify early warnings of issues.

We had some concerns about the safety of patients and staff, particularly the medium secure unit at Brooklands. This was due to difficulties in repairing external gate and the fact that the lone working policy was not being consistently followed throughout the trust. Learning from incidents across the organisation required some improvement to give consistent messages to staff.

Training for some teams was excellent. However in some areas staff had limited knowledge of safeguarding and deprivation of liberty procedures and staff were not always following the trust’s procedures in reporting incidents and risks.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance


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


Mental Health Act Commissioner reports

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

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