Monday 23 September 2019
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Northamptonshire independent mental health service for adolescents placed into special measures

The Care Quality Commission has rated St Andrew’s Healthcare Adolescent Service in Northamptonshire as Inadequate following a Care Quality Commission inspection.

The inspection took place at the independent hospital for adolescents with mental health conditions in March and April 2019 and highlighted a number of concerns. The service has now been placed into special measures.

This means the service will be re-inspected within six months and, if improvements have not been made, CQC will take action to begin the process of preventing the provider from operating the service.

In May 2017, CQC rated the service as Requires Improvement overall following a comprehensive inspection. CQC also carried out a focused inspection between October 2018 and January 2019, in response to concerns. While that inspection did not alter the trust’s rating, CQC told the service it must make improvements to how it manages patients who required long term segregation.

Following its latest inspection, the service is now rated as Inadequate overall as well as for whether the service being provided is safe, caring and well-led. The service is rated as Good for whether it is effective and responsive.

CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said:

“This is the third time that we have inspected St Andrew’s Healthcare Adolescents Service in the past two years. Over that time, the service has failed to address some of the concerns we have raised. In some important respects, the safety of care has deteriorated.

“We were particularly concerned about how the service responds to patients whose behaviour staff find challenging. Staff did not follow best practice when using seclusion and long-term segregation. This is an issue that we have raised with the provider on 12 separate occasions following previous inspections of the various hospitals that they manage. Staff did not undertake reviews of patients in seclusion or segregation, as required by the Mental Health Act Code of Practice, nor had they completed seclusion care plans, involved advocates or informed the local authority when required. We found three instances of where staff had secluded patients for longer than necessary.

“Staff did not always treat patients with dignity, compassion or respect. The majority of seclusion rooms did not have basic furnishings such as a bed, pillow, blanket or mattress, and records referred to patients as sitting or lying on the floor while in those rooms. On one occasion, staff did not respect a patient’s privacy and dignity when changing her clothing. While female staff were present, there were also male staff there at the time. It was the inspection team’s view that this was uncaring, undignified and disrespectful to the patient.

“The physical environment was not always safe. There were sharp edges on door frames in seclusion rooms and extra care suites, blind spots in seclusion rooms and pieces of exposed sharp metal. All of these posed a risk to patients. Staff did not always follow safety procedures in relation to cutlery checks and food hygiene, they did not always check emergency equipment and medicines and did not always keep accurate records of adverse events. Worryingly, there were also discrepancies between written incident reports, staff recollection of incidents and images of those incidents captured on CCTV.

“The service failed to ensure that shifts were fully staffed and made heavy use of agency and bank staff in an attempt to make up the numbers. While many patients and carers were positive about care, some patients told us that agency staff were “not always as nice” as permanent staff. Staff shortages sometimes resulted in staff cancelling escorted leave, appointments or ward activities.

“We concluded that the leadership and governance of the service did not always support the delivery of safe, person-centred care.

“We have told St Andrew’s Healthcare that it must take immediate action to address the problems we identified. We will continue to monitor the service closely and if urgent improvements are not made to ensure people are safe, we will take action to prevent the provider from operating this service”

The service has been told it must make a number of improvements, including:

The provider must ensure staff treat patients with kindness, respect and dignity. They must ensure patients’ comfort when using seclusion rooms as required by the Mental Health Act Code of Practice and ensure their privacy and dignity is upheld at all times.
The provider must ensure that staff follow the Mental Health Act Code of Practice in relation to seclusion, long term segregation and blanket restrictions.
The provider must ensure safety concerns are identified and addressed in a timely manner and that staff follow procedures in relation to checking cutlery, food hygiene and the checking of emergency bags and medical equipment.
The provider must ensure sufficient staff of the right experience to deliver patient care and facilitate access to leave and other activities.
The provider must ensure that leadership and governance arrangements support the delivery of high quality, person-centred care, operate effectively and address risk issues.

Inspectors highlighted some outstanding areas of practice, which included:

The service provided an impressive range of therapies within excellent facilities. The environment was well designed and spacious which allowed staff to carry out therapies, education and activities in both group and one to one settings.
The service provided outstanding support for patients with lesbian, gay, bi-sexual and transgender needs and encouraged staff diversity through the promotion of lesbian, gay, bi-sexual, bi-sexual, transgender, black, Asian and minority ethnic rights.