The Care Quality Commission (CQC) has found services at St Andrews Healthcare Northampton need further improvement to protect people following an inspection in October and November.
St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, autistic people and people with a learning disability.
CQC carried out this inspection of its Northampton site to follow up on concerns identified at previous inspections. CQC assessed whether a previously imposed condition on St Andrews Healthcare Northampton’s registration to restrict new admissions needed to remain in place to keep people safe. These restrictions remained in place following this inspection.
CQC found the service still had 14 breaches of regulation related to person centred care, safe care and treatment, safeguarding, dignity and respect, good governance and staffing. CQC told the service to submit an updated action plan showing what immediate and widespread action it is taking in response to these concerns.
CQC has again rated forensic inpatient or secure wards as inadequate. It has upgraded the rating for wards for older people with mental health problems from inadequate to requires improvement, and has again rated services for people with acquired brain injury as requires improvement.
The overall rating for St Andrews Healthcare Northampton remains inadequate and in special measures to protect people.
Since this inspection, NHS England has announced plans to remove people from St Andrew's Northampton. CQC is in contact with NHS England and St Andrews to ensure people have a safe transition to alternative accommodation.
Ceri Morris-Williams, CQC deputy director of mental health in the midlands, said:
“At this inspection of St Andrews Healthcare Northampton, we found the service still needed to make significant improvements to ensure people were receiving safe care.
“While St Andrews had made some improvements in their forensic services including in incident reporting and safeguarding training, we found there were still deeply concerning issues in areas including staffing, communication and risk management which were putting people at risk of unsafe care.
“The ward culture of openness and safety was inconsistent, and allegations of abuse by staff still remained the highest proportion of safeguarding incidents. Inspectors reviewed CCTV footage and were concerned about an inappropriate restraint and assaults by staff towards people in the service.
“People told us there weren’t enough staff on these wards, and this had resulted in pre-planned leave and activities being cancelled. This had also resulted in some people feeling ignored by staff. This was echoed in what staff told us about not feeling like they had enough time to spend with people. However, some people had more positive experiences. They described pleasant interactions with staff and were appreciative of the challenges they faced.
“In services for people with acquired brain injury, we found repeated incidents of unexplained injuries, prolonged restraints and gaps in documentation. Without clarity on what had happened or how people had been affected, the service couldn’t identify learning opportunities to help improve the service and stop these happening again.
“However, staff supported people to have choice and control in their care where possible and held regular community meetings. Staff also helped people maintain relationships that mattered to them by facilitating visits, telephone calls and virtual meetings.
“While visiting wards for older people with mental health problems, St Andrews made us aware they had plans to close this service, which happened in November.
“We have told leaders at St Andrews where further improvements are needed to keep people safe.”
Inspectors found in forensic inpatient and secure wards:
- Leaders hadn’t taken preventative measures to avoid incidents happening again, which led to avoidable harm. Some wards had large backlogs of incidents waiting to be reviewed, which meant learning opportunities hadn’t been identified.
- Staff told inspectors about low staffing levels and how this made them feel unsafe and at risk. Inspectors found six cases of staff asleep during enhanced observations, putting people at risk.
- Staff didn’t feel leaders were visible or approachable and were frustrated with the levels of management in place.
- St Andrews had commissioned an independent review into the culture of the hospital to identify where improvements could be made and carried out safety interviews with all people receiving care.
Inspectors found in services for people with acquired brain injury:
- Staff didn’t always safeguard people from abuse and improper treatment. They also didn’t effectively manage or review the risks people faced, which put people at risk of avoidable harm.
- Leaders didn’t always have enough experienced staff to provide safe and consistent care due to workforce pressures.
- While some people told inspectors they felt safe and staff were kind and respectful, others had more mixed experiences of care.
- However, leaders had reduced blanket restrictions following the previous inspection, including in individual risk assessments and vaping arrangements.
- Many people using the service were positive about their care, and some carers described staff as kind and committed to supporting their relative.
- Staff were positive about working at the hospital, felt supported by their managers and were passionate about improving people’s outcomes.
Inspectors found in the now closed wards for older people with mental health problems:
- The service didn’t consistently use processes to learn from incidents and make improvements as a result. Leaders didn’t have enough systems in place to fully understand the level of care being delivered, to keep people safe and drive improvements.
- Staff didn’t put enough detail in people’s care plans, but risk assessments were in place.
- However, the ward had improved how it recorded and followed up injuries that occurred in the service.
- Managers were supportive and visible, and staff told inspectors there was a positive team culture despite uncertainty about the service’s future.