St Andrews Healthcare Northampton

This assessment of forensic inpatient or secure wards at St Andrew’s Healthcare Northampton took place between 10 and 29 October 2025. This was an unannounced inspection due to the significant concerns raised by CQC and partner agencies during our previous inspection. The service was taking action to address concerns identified, which included an independent review of the culture of the hospital. Additionally, the service had undertaken individual patient safety interviews with all patients across the site. Further to our previous inspection, the service was required to undertake regular reviews of incidents involving restraint. This included a review of incidents via review of CCTV footage. The service had also focussed on staff training and awareness in relation to closed cultures.

St. Andrews Healthcare Northampton is an independent hospital, run by St Andrews Healthcare limited, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs. During our inspection we visited medium secure wards and a learning disability and autism services (LDA) ward.

An assessment has been undertaken of a specialist service that is used by autistic people or people with a learning disability. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the service guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities.’

This inspection was undertaken to determine if there had been any improvements further to our last inspection (in July and August 2025) and to identify progress against the service’s action plan and the sustainability of improvements made.

We visited 5 medium secure wards in the medium secure division, plus 4 secure learning disability/autism (LDA) wards. The wards visited were as follows:

• Fairbairn ward: a medium secure service for deaf men with 17 beds
• Robinson ward: A secure admission ward for adult males with a mental health diagnosis with 17 beds
• Mackaness Ward: A secure admission ward for adult males with a mental health diagnosis with 15 beds
• Cranford Ward: a medium secure service for older men aged over 55 years old with 17 beds
• Meadow ward: A medium secure admission, stabilisation and treatment service for men with a forensic history and distressed behaviour with 10 beds
• Sycamore ward: A medium secure admission, stabilisation and treatment service for men with a forensic history and distressed behaviour with 10 beds
• Marsh ward: A specialist medium secure admission, stabilisation and treatment service for men with a forensic history with distressed behaviour
• Oak ward: a recovery-orientated medium secure service for women aged over 18 with 10 beds
• Fern ward: A stabilisation and treatment secure service for men who may also have a forensic history with distressed behaviour with 10 beds

During this inspection we reviewed 14 quality statements under 3 key questions (safe, caring and well-led). We found ongoing breaches in relation to Regulation 12: Safe Care and Treatment; Regulation 13: Safeguarding service users from abuse and improper treatment; Regulation 10: Dignity and Respect ; Regulation 18 (staffing).

We will publish this information on our website after any representations and/ or appeals have been concluded.

In instances where CQC have decided to take civil or criminal enforcement action against a service, we will publish this information on our website after any representations and/ or appeals have been concluded.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

Staff were trained in and had a good understanding of the Mental Health Act (MHA), the Code of Practice and the guiding principles. As of September 2025, 95% of staff on medium secure wards, and 94% of staff on LDA wards were up to date with their Mental Health Act training.

Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Patients had easy access to information about independent mental health advocacy. However, the service had changed their advocacy service. Staff told us that access to independent advocacy had decreased.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded they had done it. Due to available staffing, staff were not able to ensure that patients were always able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so they were available to all staff that needed access to them.

Staff did regular audits to ensure the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Ninety five percent of staff in the learning disability and autism (LDA) and medium secure wards were up to date with their training in the Mental Capacity Act. Staff generally had a good understanding of the Mental Capacity Act, particularly the five statutory principles.

The service had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the service regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff had assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis regarding significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.

This inspection of services for people with acquired brain injury at St Andrew’s Healthcare Northampton took place in October and November 2025. This inspection was undertaken to follow up on the findings from the inspection carried out in July and August 2025. The wards supporting people with acquired brain injury formed one of the 3 service groups reviewed during this assessment. At the time of the earlier inspection, the CQC had limited the service from accepting new admissions. During this follow-up inspection, we reviewed whether those limits were still justified, whether they remained appropriate to the level of risk, and whether they were still required to protect people from harm.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

Within the neuropsychiatry division, there were 4 wards for people with acquired brain injury at the time of the inspection. These consisted of; Tavener ward, Allitsen ward, Elgar ward and Tallis ward. The division also had Walton ward, a specialist ward for males living with Huntington’s disease. During this inspection, we focused upon all 5 wards:

• Tallis ward – an admission, assessment and rehabilitation ward for males (11 beds).
• Allitsen ward- an admission, assessment and rehabilitation ward for males (11 beds).
• Tavener ward- an admission, assessment and rehabilitation ward for males (11 beds).
• Elgar ward – an admission, assessment and rehabilitation ward for females (12 beds).
• Walton ward – an admission, assessment and rehabilitation ward for males living with Huntington’s disease (14 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

At the time of this inspection, the service did not have a registered manager in place.

This assessment service group was last inspected in July and August 2025, when it was rated Requires Improvement.

At this inspection, we reviewed 14 quality statements across 3 key questions: safe, caring and well led. We identified ongoing breaches related to person-centred care (Regulation 9); dignity and respect (Regulation 10); safe care and treatment (Regulation 12); safeguarding (Regulation 13); governance (Regulation 17); and staffing (Regulation 18). As a result of these findings, we rated the service Requires Improvement.

We found significant shortfalls in risk mitigation and safeguarding arrangements. Staff did not consistently protect people from abuse and improper treatment, and individual risks were not always effectively managed or reviewed. Staff did not consistently engage with people during enhanced observations, and some people experienced care that did not fully protect their privacy or dignity, particularly during incidents requiring restraint or transfer across wards. There were repeated incidents of unexplained injuries, prolonged restraint, inconsistent use of de-escalation, and gaps in documentation, including falls assessments and body mapping. Governance systems, audits and incident reviews had not always been effective in identifying, escalating or addressing risks in a timely way, which limited assurance that lessons were learnt and embedded across the service.

However, where possible, patients were supported to have choice and control and were able to give feedback on their care through regular community meetings. The service had undertaken some work to review and reduce blanket restrictions following the previous inspection, including changes to vaping arrangements and individual risk assessments. Patients were supported to maintain relationships that mattered to them through visits, telephone calls and virtual meetings, and some carers described staff as kind and committed to supporting their relatives.

Staff we spoke with were generally positive about working at the hospital and told us they felt supported by their immediate line managers. We met staff who were passionate about improving outcomes for people with acquired brain injury, despite ongoing staffing pressures and reliance on bank staff.

Mental Health Act and Mental Capacity Act Compliance

Most patients on the 5 wards were detained for treatment under the Mental Health Act 1983. Staff stored copies of detention papers and associated records within the electronic patient record, which could be accessed when required.

Staff received mandatory training on the Mental Health Act, with compliance above 90% at the time of inspection.

Staff were able to explain the Mental Health Act Code of Practice and clearly described the guiding principles that informed how they supported and treated people using the service.

Staff had access to advice and support through the provider’s Mental Health Act administration team. The service had clear policies and procedures in place that reflected the relevant legislation and were consistent with the Mental Health Act Code of Practice.

Staff explained patients’ rights under the Mental Health Act and repeated these as required, with records maintained in care notes.

Patients were provided with information leaflets in accessible formats where needed and had access to an Independent Mental Health Advocate (IMHA). Advocacy was provided through the Local Authority, on an individual referral basis.

Mental Capacity Act

Staff received training on the Mental Capacity Act and the five statutory principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards formed part of mandatory training, with compliance above 90%.

Capacity to make decisions was monitored and discussed at multidisciplinary team meetings. Where people lacked capacity, staff completed decision-specific capacity assessments and best-interest decisions. However, records did not always show how people and their carers were involved in planning and reviewing their care.

This inspection of services for people older people with mental health problems at St Andrew’s Healthcare Northampton took place in October and November 2025. This inspection was undertaken as a follow up to the previous inspections in July and August 2025, with the wards for older people with mental health problems being one of 3 assessment service groups reviewed. The CQC had placed restrictions upon new admissions to the service. We needed to assess if these restrictions remained fair and proportionate, and whether all were still needed to keep patients safe.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

In the neuropsychiatry division of the location, there were 2 wards open for older adults with mental health problems at the time of our assessment. One ward (Aspen ward) had been closed shortly after our last inspection. During this inspection, we visited both wards, Cherry and Redwood:

• Cherry ward - a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits (12 beds).

• Redwood ward – a specialist older adult service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits (12 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of this inspection.

This assessment service group was most recently inspected in July and August 2025 and rated as Inadequate. At the time of this inspection, CQC were aware that the provider had plans in place to close the older peoples service in the future. CQC were not aware of any definitive dates for this planned closure at that time. As the assessment progressed, the provider confirmed closure of the 2 remaining wards would be at the end of November 2025.

During this inspection we reviewed 13 quality statements under 3 key questions (safe, caring and well led). We found ongoing breaches in Person centred care (Regulation 9); Safe care and treatment (Regulation 12); Safeguarding (Regulation 13); Governance (Regulation 17) and Staffing (Regulation 18). We rated the service Requires Improvement.

Systems to learn from incidents and embed lessons were not consistently applied, and governance arrangements required external oversight to maintain safety and drive improvement. Risk assessments were in place, but care plans often lacked sufficient detail. Daily progress notes were mostly task-oriented, which could compromise continuity of care.

Staffing continued to be a challenge, with a continued reliance upon bank staff, and occasional delays in meeting patients personal care needs. Raised concerns from staff about staffing were not always acted upon, and the service did not consistently foster a culture where staff felt confident their voice would be heard.

The provider’s chosen dementia care model was not consistently applied. Opportunities to promote independence and choice were sometimes missed, and dignity had not always been maintained.

However, some improvements had been made since the last inspection. We observed examples of compassionate care and staff spending quality time with patients. Staff tried to personalise care and engage people in activities they enjoyed. Documentation of injuries had improved across both wards. There had been some improvements with restrictive practices, with individual risk assessments replacing blanket restrictions, for example around the use of metal cutlery. Ward managers were visible and supportive, and staff described a positive team culture despite uncertainty about planned ward closures.

Mental Health Act and Mental Capacity Act Compliance

Patients on the 2 wards were detained for treatment under the Mental Health Act 1983.

Staff received training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff. Compliance was over 90% at time of inspection.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the providers’ Mental Health Act administration department.

The service had the relevant policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Many patients had cognitive impairments which meant they had difficulties processing this information. Where possible, staff had involved and consulted relatives who were involved in their care.

Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. Access to advocacy was through the Local Authority. Due to cognitive impairment of some patients, emphasis was on the staff to refer patients to the advocacy service if the patients themselves were unable to. Prior to the Local Authority arrangement, advocates would spend time on wards with patients. Advocacy was available, but at a reduced level to previously.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to, requested by the patient’s responsible clinician.

Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.

Managers and staff made sure the service applied the Mental Health Act 1983 correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers.

Mental Capacity Act

Staff received training about the Mental Capacity Act and understood the key principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law. Compliance was over 90% at time of inspection.

Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings.

Initial findings from a recent culture review (August 2025) highlighted a need for enhanced MCA /DoLS training for staff beyond e-learning, with focus upon practical application in a ward setting.

Overall Summary

This assessment of forensic inpatient or secure wards at St Andrew’s Healthcare Northampton took place between 11 July and 13 August 2025. This was an unannounced focused inspection which was carried out in response to a serious incident of concern. The incident (which took place in June 2025), took place on a learning disability/autism ward (LD/A). The incident resulted in staff injury. The incident was identified by the provider. Managers completed a review of the incident, including viewing the incident on closed circuit television (CCTV) on 1 July 2025. Upon review of the incident via CCTV, the provider identified several serious concerns regarding the management of the incident, and inappropriate use of safe intervention techniques (SIT). The provider then took immediate steps to safeguard the patient and take the appropriate action regarding the staff members involved. The incident raised questions in relation to people’s safety, alleged inappropriate use of restraint, alleged staff assault on the person and a lack of privacy and dignity. The incident also raised concerns about a closed culture within the organisation.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs. During our inspection we visited wards across the medium secure, low secure, child and adolescent (CAMHS) and learning disability/autism services (LD/A) wards.

An inspection has been undertaken of a specialist service that is used by autistic people or people with a learning disability. We have assessed the service against ‘right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

During our inspection, we visited the following wards as part of the assessment:

Brook ward: a low secure ward for persons diagnosed with a major mental illness, Learning Disability and/ or Autism for men with 10 beds

Oak ward: a recovery-orientated medium secure service for women aged over 18 with 10 beds

Bracken ward: a blended forensic admissions Ward for women with 11 beds

Fairbairn ward: a medium secure service for deaf men with 17 beds within the medium secure and learning disability/autism services (LD/A) wards. In addition, we reviewed 12 patient records, 26 incidents from across the forensic services (including medium and low secure, LD/A) and CAMHS ward via review of CCTV, spoke to 14 staff and undertook observations on 3 wards.

During the inspection we inspected 5 quality statements under 3 key lines of enquiry safe and caring, and 4 quality statements under well-led.

We found evidence of a hospital wide closed culture resulting in improper and abusive treatment of people and patients. We took urgent enforcement action to impose a condition on the provider’s registration to restrict new admissions across the entire location.

We rated the service as Inadequate.

The provider was previously in breach of the legal Regulations of safe care and treatment, safeguarding, good governance, and staffing. Improvements were not found at this inspection, and the provider remained in breach of these regulations.

The provider was also found to be in breach of the legal Regulation of dignity and respect.

In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983.

Staff stored copies of patients’ detention papers and associated records within the electronic health record. Staff could access them when needed.

Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. However, the contract for providing advocacy services had recently changed. We were informed that contact with the new advocacy service had to be requested via an appointment system. We were concerned that the new arrangements for advocacy could have an adverse effect on patients being able to obtain independent advocacy support in a timely manner.

Due to staffing levels, staff were not always able to ensure that patients could take section 17 leave (permission to leave the hospital) when this was agreed by the multidisciplinary (MDT) team.

Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Patients were provided with leaflets, and these were available in a different formats or languages if required. Patients told us they were informed of their rights.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the provider’s Mental Health Act administration department.

Staff received and kept up to date with training on the Mental Health Act, this was mandatory for staff.

The service had relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Mental Capacity Act

Staff generally had a good understanding of the Mental Capacity Act, in particular the five statutory principles

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff had assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.

On the child and adolescent mental health ward, staff considered Gillick competence (a test in medical law to decide whether a child of 16 years or younger is competent to consent to medical examination or treatment).

People’s experience of the service

During our inspection, we spoke to 7 patients (4 patients on Fairbairn and 3 patients on Brook ward). On Fairbairn Ward, 4 patients raised concerns regarding the lack of effective communication between staff and patients on the ward. Two of the four patients on Fairbairn ward told us that they felt “unheard”. One of the patients described feelings of “despair and isolation”, another patient spoke of “extreme loneliness, pain and lack of engagement from staff”.

Patients on Fairbairn ward told us of numerous consequences of ineffective communication. One patient raised frustration with staff, particularly around facial expressions and non-verbal cues, which they told us they found triggering. Another patient told us they had been falsely accused of aggression; they told us they felt misunderstood due to the lack of staff awareness of deaf culture and facial expressions. Concerns from patients on Fairbairn included allegations of “ongoing racial abuse from other patients”, which patients claimed were being ignored by staff members and management.

People on Brook ward were mostly positive about their care and treatment. However, one person told us that bank staff “grab your wrist”. The same person spoke to us about concerns relating to swearing on the ward and that there had been violence on the ward (for example a television had been smashed by a patient).

This inspection of services for people with acquired brain injury at St Andrew’s Healthcare Northampton took place in July and August 2025. This inspection was undertaken due to ongoing concerns CQC had received about the service, including a poor standard of care and numerous safeguarding concerns of allegations of abuse from staff to patients.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

In the neuropsychiatry division of the location, there were 5 wards for people with acquired brain injury at the time of the inspection. These consisted of; Tavener ward, Church ward, Allitsen ward, Elgar ward and Tallis ward. The service made the decision to close Church ward shortly following this inspection. The division also has Walton ward, a specialist ward for male people living with Huntington’s disease. During this inspection, we focused upon 3 of these wards:

• Tallis ward – an admission, assessment and rehabilitation ward for males (11 beds).
• Elgar ward – an admission, assessment and rehabilitation ward for females (12 beds).
• Walton ward – an admission, assessment and rehabilitation ward for males living with Huntington’s disease (14 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of this inspection.

At this inspection, we identified breaches of regulations: 10 dignity and respect, 12 safe care and treatment, 13 safeguarding service users from abuse and improper treatment and 17 good governance.

We rated the service as Requires Improvement. We found breaches relating to a lack of risk mitigation, patients being kept safe from potential abuse, patients not being treated with dignity and respect, and some shortfalls with monitoring the service to make improvements in patient care. We found staff did not consistently protect people from abuse and improper treatment, staff did not always successfully mitigate individual patient risks where identified and governance systems and audits had not always been effective in identifying or addressing areas for improvement.

However, we found where possible, patients were supported to have choice and control and could give feedback on their care through regular community meetings. We noted the service had undertaken some work in relation to blanket restrictions following our previous inspection.

Staff we spoke with were happy working at the hospital and felt supported by their line managers. Ward managers had systems in place enabling them to monitor staff performance and care delivery, although poor practice had not always been identified. We met some staff who were very passionate about making a difference to patients they cared for. Patients were encouraged and supported to maintain contact with people who mattered to them.

Mental Health Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983. Staff stored copies of patients’ detention papers and associated records within the electronic health record, which could be accessed when needed.

Staff received and kept up to date with training on the Mental Health Act, which was mandatory for staff. Compliance was over 90% at time of inspection.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff could access support from the providers’ Mental Health Act administration department.

The service had relevant and up-to-date policies and procedures that reflected relevant legislation and the Mental Health Act Code of Practice.

Staff explained to each patient their rights under the Mental Health Act. Rights were repeated to patients as required and this was recorded in patient records. Patients were provided with leaflets, and these were available in a different formats or languages if required.

Patients had access to an Independent Mental Health Advocate (IMHA). Posters were displayed on noticeboards on the wards with contact details to reach this service. Provision of the advocacy service had changed, with access through the Local Authority. This meant patients had access, but not as easily as previously where drop-in sessions had been facilitated by advocates visiting the wards.

Mental Capacity Act Compliance

Staff received training about the Mental Capacity Act and the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law. Compliance was over 90% at the time of inspection.

Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings.

This inspection of wards for older people with mental health problems at St Andrew’s Healthcare Northampton took place in July and August 2025. This inspection was undertaken due to ongoing concerns CQC had received about the service, including a poor standard of care and numerous safeguarding concerns of allegations of abuse from staff to patients.

St Andrew’s Healthcare Northampton is part of St Andrew’s Healthcare, which is a registered charity. The charity provides specialist mental healthcare for patients who may have complex presentations, with challenging mental health needs.

In the neuropsychiatry division of the location there were 3 wards for older people with mental health problems. These consisted of Cherry ward, Aspen ward and Redwood ward. The service made the decision to close Elm ward before our inspection took place and Aspen ward closed immediately before our visit. During this inspection, we visited 1 ward (Redwood ward) and reviewed data for 3 wards:

• Redwood ward – a specialist older adult service for males with c complex dementia and / or progressive neurological conditions, who present with cognitive deficits (12 beds).
• Cherry ward - a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits (12 beds).
• Aspen ward - an admissions service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits (8 beds).

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of this inspection.

At this inspection, we have rated the service Inadequate. The provider was in continued breach of 5 Regulations; person-centred care (Regulation 9), safe care and treatment (Regulation 12), safeguarding (Regulation 13), staffing (Regulation 18) and good governance (Regulation 17).

This was an unannounced inspection, which means the service was not told an inspection was going to be taking place beforehand. The inspection was carried out in response to a serious incident of concern. During this inspection we looked at quality statements within the Safe, Caring and Well-Led key questions. The scores for these areas have been combined with scores based on the rating from the previous inspection, which was rated as Inadequate.

Staff continued to not consistently deliver safe care and treatment to keep patients safe. Not all patients were supported to remain safe. Staffing numbers remained insufficient to meet patients’ needs or keep them safe. This had a significant negative impact on outcomes for patients and created barriers to staff members to provide good quality person centred care.

Patients continued to not receive person centred care because staff were not effectively applying the provider’s chosen model of care ‘enhanced dementia care’. Staff did not always have time to read care plans, so they fully understood patients’ needs and preferences.

The learning culture across the division remained ineffective. Patients were not always protected from improper treatment. There was no evidence of consideration of the least restrictive way to manage the personal care for 1 patient. This was causing the patient distress for most personal care interventions and a lack of clear therapeutic plan of care. Not enough action was taken to manage patient’s distress.

There was a delay in identifying injuries and records did not always provide enough detail or accurate detail. Body map records of injuries found on patient’s bodies were not always followed up or there was a delay. Not enough detail was provided about the nature of the injuries.

At our previous inspection we identified the blanket use of plastic cutlery, this was still the case at this inspection, however we were told plans were underway to carry out individual risk assessments.

Leaders continued to fail to have a clear oversight of risk and quality monitoring on the wards. Governance processes remained ineffective including seeking feedback from patients or establishing methods to gain an understanding of patient’s experience. However, communication with patients’ relatives or significant others was good.

This assessment service group was most recently inspected in March and April 2025 and rated as Inadequate.

This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Most patients were detained for treatment under the Mental Health Act 1983.

Staff received training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice.

The service had the relevant policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The service had developed procedures for the implementation of the specific sections of the Act. These procedures each included a checklist for staff to complete to support legal compliance.

Patients had easy access to easy read information about their rights under the Mental Health Act. However, many patients had cognitive impairments which meant they had difficulties processing this information, so patients’ relatives were involved and consulted.

After our previous inspection the providers arrangements for accessing advocacy services changed. We were concerned this would result in a reduced access to these services. Clinical governance meetings recorded there were ongoing issues with access to advocacy and social work support because of known capacity issues in the wider Northamptonshire area.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. SOAD’s were requested by the patient’s responsible clinician.

Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.

Managers and staff made sure the service applied the Mental Health Act 1983 correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers.

Mental Capacity Act

Staff received training about the Mental Capacity Act and understood the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law.

Individuals’ capacity to make decisions was monitored and recorded at multidisciplinary team meetings. However, restrictions regarding access to ordinary cutlery had been imposed without appropriate consent or rationale. We were concerned this decision had not considered individual patients’ best interests as is required by the Mental Capacity Act 2005. The restriction was imposed as a blanket restriction to keep patients safe from others with an identified risk. Staff did not adopt the least restrictive principle such as facilitating access to cutlery in safe way or developing a person-centred care plan in relation to eating and drinking needs.

St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities and challenging behaviours. The providers' vision is to be the national leader in specialist mental health care.
St Andrews Hospital Northampton has five service divisions. These are:
• Child and Adolescent Mental Health Services (CAMHS),
• Autism Spectrum Disorder and Learning Disability Division (ASD/LD)
• Medium Secure Division,
• Low Secure and Specialist Rehabilitation Division, Acute and Psychiatric Intensive care units,
• Neuropsychiatry Division.

This assessment looked at services within the acute wards for adults of working age and psychiatric intensive care units. The wards included Naseby, a 15 bedded acute ward for males. Wards Heygete and Bayley, psychiatric intensive care unit for males, each offering 10 psychiatric intensive care unit for males. At the time of our assessment there was a low bed occupancy within all 3 of the locations. The two 10 bed psychiatric intensive care unit wards had 7 patients each and the 15 bed acute ward had 4 patients during our visit. Leaders stated that this was due to the service only accepting appropriate referrals while discharging patients at an appropriate rate.

The service provided mental health care to adult males across a spectrum of specialist mental disorders. Care is provided to those who need the relational, physical, and procedural security of a secure unit, in line with the National Medium Secure Specifications from NHS England.

The service was last rated as Requires Improvement (published September 2016). The report was published following Care Quality Commission's (CQC) old inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following CQC's new approach to assessment; Single Assessment Framework (SAF).

This was an unannounced assessment, which means the service was not told an assessment was going to be taking place beforehand. During this assessment we looked at all quality statements across all 5 key questions. As we assessed all quality statements at this visit the current rating reflects the findings from this assessment.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

The organisation employed Mental Health Act caseworkers who all provided advice and support for staff. Caseworkers regularly visited the wards, and staff knew how to contact them for advice. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient's notes each time. Staff made sure patients could take section 17 leave (permission to leave the hospital) when this was agreed with the Responsible Clinician.

Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were automatically referred to the service. Information about patients' rights under the Mental Health Act were displayed in an `easy-read' format on notice boards. Advocates visited the wards regularly. Advocates attended ward rounds and manager's hearings. Hospital managers requested advocates to be present at hearings where patients lacked capacity and were not represented by a solicitor.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to, and patients were able to request a SOAD by their responsible clinician. The Mental Health Act office reminded responsible clinicians of the need to contact a SOAD at least two weeks before their certification was required.

Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers. The audit team conducted audits of specific matters relating to the Mental Health Act.

Mental Capacity Act

Staff supported patients to make decisions on their care for themselves. They understood the policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff had assessed all patients' capacity to consent to treatment and to be in hospital. Assessments of capacity were routinely updated at multidisciplinary ward rounds. For patients detained under the Mental Health Act, responsible clinicians had completed the appropriate statutory certificates authorising treatment. Second opinion appointed doctors authorised treatment when patients lacked capacity to consent.

Staff received and kept up-to-date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law.

Staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Staff sought to encourage patients to make decisions for themselves whenever possible. For example, when staff were supporting a patient to get dressed, they would lay out different clothes and help the patient to choose.

Overall Summary

St. Andrews Hospital Northampton is an independent hospital, run by St Andrews Healthcare limited, which is a registered charity. During our inspection we visited wards across the forensic services and CAMHs. This included medium secure, low secure, child and adolescent and learning disability/autism services (LDA) wards.

An assessment has been undertaken of a specialist service that is used by autistic people or people with a learning disability. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.’

This was an unannounced inspection (undertaken between 11 and 13,18 and 20, 25 and 26 March), which was carried out firstly to determine if the provider had met the requirements laid out in the Section 29 warning notice, following our last inspection of the LDA wards, and secondly, in response to ongoing concerns received. These concerns had raised questions in relation to patient safety (incidents of deliberate self-harm, patient on patient assaults), alleged poor attitude of some staff, high use of agency and low staffing levels.

During the inspection we inspected all quality statements under all 5 key lines of enquiry safe, effective, caring, responsive and well-led.

Across the forensic and CAMHs services, we visited a total of 14 wards. This included 5 medium secure wards, 2 low secure wards, 1 child and adolescent ward and 6 learning disability/autism (LDA) wards.

The medium secure wards provide secure mental healthcare to adults across a spectrum of specialist mental disorders: mental illness, personality disorder, borderline or mild learning disability and mentally disordered people who are deaf. Care is provided to those who need the relational, physical, and procedural security of a medium security unit, in line with the National Medium Secure Specifications from NHS England. The provider also provides a blended Secure Service for Women developed as part of a national pilot and meeting a draft service specification linked to the main medium secure service specification.

The low secure wards provide high-quality assessment, care, and treatment, helping patients to progress to the least restrictive setting by equipping them with the skills required to live as independently as possible, closer to communities of their choosing.

The Learning Disabilities and Autistic Spectrum Disorder (LDA) services are designed to help people living with a learning disability, autism and complex mental health needs to progress towards living in the community. The learning disability service provides a treatment therapy ethos based on Positive Behavioural Support (PBS). The learning disability service provides a treatment therapy ethos based on PBS; equipping people with the skills required to live as independently as possible.

The Child and Adolescent Mental Health Service (CAMHS) service is designed for young males and females aged 13 to 18 with complex mental disorders, severe emotional and behavioural difficulties, intellectual disabilities, mental illness and autistic spectrum disorders. The CAMHS is a trauma informed care service, ensuring that treatment is driven by an understanding of how trauma affects the whole person; physically, mentally and socially. The objective of the service is to enable young people to live well and to their full potential in the least restrictive environment possible.

We found that whilst there had been improvements in clinical supervision and mandatory training rates, the service still did not have enough regular staff who knew the people they were providing care and treatment for.

NARRATIVE SUMMARY

The governance systems in place had failed to identify and rectify the widespread and significant concerns found at this inspection. The rating for the safe domain from this inspection was inadequate. People were not receiving safe care and treatment that met their needs. This was because there were not enough suitably trained and skilled staff to provide continuity of care. Staffing levels did not always meet the requirements of the wards, and there was a high use of temporary staff,

Patients had not always been protected from harm. Patients did not always feel safe on the ward. There were incidents of harm or abuse from other patients, and staff had not always undertaken enhanced observation in line with provider policy. The risks to people had not been consistently recorded in a timely manner, and people had not always received their medicines safely or as prescribed. We found numerous concerns with the environment including poor maintenance of toilets and showers, lack of cleanliness, poor standards of the environment and Infection Prevention and Control (IPC) risks.

During inspection we found indicators of a closed culture, as defined by CQC guidance on closed cultures. This included inherent risk factors such as restrictive practices and low staff morale. We found that warning signs of a closed culture including care plans not reflecting the patient’s voice, poor or absent communication plans for patients who were deaf, and blanket restrictions are in place and are not necessarily the least restrictive option. Staff did not feel supported by leaders, who we were informed were rarely seen on the wards. Some staff told us that they were afraid to raise concerns as when they had raised concerns, these had been ignored.

The service was in breach of legal regulation in relation to Regulation 12: Safe Care and Treatment; Regulation 13: Safeguarding service users from abuse and improper treatment; Regulation 15: Premises and equipment; Regulation 18 (staffing):

We will publish this information on our website after any representations and/ or appeals have been concluded.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

Ninety five percent of staff were trained in and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles. Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.

Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice. Patients had easy access to information about independent mental health advocacy. However, we were told that the provider was in the process of changing their advocacy provider. Staff told us that access to independent advocacy would be decreased.

Staff explained to patients their rights under the Mental Health Act in a way that they could understand, repeated it as required and recorded that they had done it. Due to available staffing, staff were not able to ensure that patients were always able to take Section 17 leave (permission for patients to leave hospital) when this had been granted.

Staff requested an opinion from a second opinion appointed doctor when necessary. Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so they were available to all staff that needed access to them.

Staff did regular audits to ensure the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

Ninety five percent of staff of staff had had training in the Mental Capacity Act. Staff generally had a good understanding of the Mental Capacity Act, in particular the five statutory principles

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it. Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.

Staff took all practical steps to enable patients to make their own decisions. For patients who might have impaired mental capacity, staff had assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. The service had arrangements to monitor adherence to the Mental Capacity Act.

On the child and adolescent mental health ward, staff considered Gillick competence (a test in medical law to decide whether a child of 16 years or younger is competent to consent to medical examination or treatment).

During this inspection we found regulatory breaches in regulations relating to safeguarding, safe care and treatment, premises and equipment, good governance and staffing. We have asked the provider for an action plan in response to the concerns found at this assessment.

St Andrew's Healthcare Northampton is an independent hospital for people with mental health needs, people with a learning disability and/or autistic people. This assessment looked at the wards for people with a learning disability and autistic people which we rated as requires improvement. When we have reported on St Andrew’s Northampton’s wards for people with a learning disability before, we have included our assessments of the forensic low and medium secure services for people with a learning disability and autistic people. For this assessment, we have changed our approach. Our findings about forensic low and medium secure services for people with a learning disability and autistic people are now included in the mental health forensic inpatient or secure wards assessment report. This assessment was a comprehensive unannounced assessment where we looked at all quality statements across the key questions.

The wards for people with a learning disability and autistic people assessment related to 3 services at St Andrew's Healthcare Northampton which provided individual bespoke services for people in hospital but not in forensic secure care. Each of these 3 wards provided care and treatment for one person. These services were Glendale, Billing Lodge and Lime Trees Cottage. This unannounced assessment took place from 11 to 13 March 2025. We visited Glendale and Billing Lodge. We have also used data about Lime Trees cottages to form our judgement. In this report, we may not give as much detail as we usually do. This is because the report relates to just 3 people that may be identifiable if we gave fuller details. As part of the wider inspection, we did some out-of-hour visits.

We have assessed the wards against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

Right Support: People had complex needs and regular staff knew people well. However, people's care plans, positive behavioural support plans and risk assessments were not always clear and lacked the detail required to robustly guide staff on appropriate care and to help them to fully understand people’s distress. People were not always safeguarded from abuse. There were not enough suitably skilled staff to support people as staff had not received appropriate training to interact with people.

Right Care: People did not always receive person-centred care that promoted their dignity, privacy and human rights. Most staff were kind and caring but people reported that they were not always treated with respect and dignity, especially by staff who didn’t regularly work on the wards. People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible as staff had not looked at appropriate safeguards when caring for people away from others. Staff communicated with people in ways that met their needs.

Right Culture: Governance arrangements were not as effective or reliable as they should be. Some quality audits were in place; however, managers had not always ensured that the audits were relevant or specific to these wards. Managers recognised that improvements were needed (including the need for better, autism-informed care plans) but actions identified had not been followed through, and sustainability was not embedded into the service.

During this inspection we found regulatory breaches in regulations relating to person-centred care, safeguarding, safe care and treatment, good governance and staffing. We have asked the provider for an action plan in response to the concerns found at this assessment.

We completed an assessment and inspection of St Andrews Healthcare Northampton on 12 and 13 March 2025.

This assessment was carried out following the CQC's new approach to assessment; Single Assessment Framework (SAF). We inspected the long stay rehabilitation mental health wards for adults of working age. We looked at all quality statements under each key question. We carried out a mix of onsite and offsite inspection and assessment activity between 12 March 2025 and 22 April 2025. This was an unannounced assessment, which means the provider was not told an assessment was going to be starting beforehand.

St Andrews Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities and behaviours of distress.

The long stay or rehabilitation mental health wards for working age adults ASG (assessment service group) is made up of 5 wards/lodges. We assessed Silverstone, Watkins House and 37 Berkeley Close. We also assessed Berkeley Lodge and Sitwell Ward. At the time of the inspection there were 24 patients at the service in long-stay or rehabilitation mental health wards for working age adults.

We rated the service as Requires Improvement as we identified 6 breaches of the Health and Social Care Act 2012 regulations. Staff did not always record capacity and consent in relation to the clinical treatment model and support level framework on Silverstone ward. The service did not ensure to keep the clinic room clean and tidy and assess the risks to people's health and safety for safe care and treatment. Staff did not always use the least restrictive interventions. We found there were also blanket restrictions applied to patients on all wards.

The service did not ensure to manage and mitigate maintenance risks on premises in a timely manner. Governance systems and audits were not effective in identifying or addressing areas for improvement. The service did not always ensure that staff had the necessary specialist skills to support patients' needs and implement the proposed clinical treatment models.

However, the rehabilitative model was evident and there was good multi-disciplinary input into it. Care records including risk management were detailed and up to date. Many staff were compassionate caring and skilled.

During this assessment and inspection, we found 6 breaches of regulations.

The provider did not always:

• Ensure to obtain and record capacity and consent for care and treatment on Silverstone Ward
• Ensure care and treatment was provided in a safe way and to adhere to infection prevention and control processes.
• Ensure patients are safeguarded from abuse and improper treatment such as the application of blanket restrictions
• Ensure premises and equipment including maintenance risks are recorded and mitigated within a timely manner.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
• Ensure there were sufficient, suitably competent, and experienced staff trained to apply and provide care within the clinical treatment model and dialectical behavioural approach for service users accessing specialist rehabilitation services

We have asked the provider for an action plan in response to the concerns found at this assessment.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

• Staff had received training in the Mental Health Act with a compliance of 95% and had a good understanding of the Mental Health Act, the Code of Practice and the guiding principles.
• Staff had easy access to administrative support and legal advice on implementation of the Mental Health Act and its Code of Practice. Staff knew who their Mental Health Act administrators were.
• The provider had relevant policies and procedures that reflected the most recent guidance.
• Staff had easy access to local Mental Health Act policies and procedures and to the Code of Practice.
• Patients had easy access to information about independent mental health advocacy.
• There was a lack of information relating to the care of informal patients within the clinical treatment model and consent policies. The leave section of the clinical treatment model and support framework did not include guidance or information around rights of informal patients. Staff and patients did not have sufficient understanding of informal patient's rights and management of risks in relation to time away from the ward, as there was a serious incident reported where one patient accessed leave without it being agreed.
• Staff did not always ensure patients were able to take Section 17 leave (permission for patients to leave hospital) when this had been granted due to lack of staff.
• Staff requested an opinion from a second opinion appointed doctor when necessary.
• Staff stored copies of patients' detention papers and associated records (for example, Section 17 leave forms) correctly and so that they were available to all staff that needed access to them.
• The service displayed a notice to tell informal patients that they could leave the ward freely.
• Staff did regular audits to ensure that the Mental Health Act was being applied correctly and there was evidence of learning from those audits.

Mental Capacity Act

• Staff had had training in the Mental Capacity Act with a compliance of 95%.
• Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles, however not on Silverstone Ward.
• The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. Staff were aware of the policy and had access to it.
• Staff knew where to get advice from within the provider regarding the Mental Capacity Act, including deprivation of liberty safeguards.
• Staff took all practical steps to enable patients to make their own decisions
• For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions, however not on Silverstone Ward.
• The service had arrangements to monitor adherence to the Mental Capacity Act.
• Staff audited the application of the Mental Capacity Act and took action on any learning that resulted from it.

This assessment of services for people with acquired brain injury at St Andrew’s hospital Northampton took place in March and April 2025. St Andrews Hospital Northampton is an independent hospital run by St Andrews Healthcare Limited, which is a registered charity. The charity provides specialist mental health care, to meet the needs of people with psychiatric illness, developmental disability, acquired brain injury and related disorders. The assessment was carried out to ascertain whether concerns raised following an assessment in August 2024 had been addressed.

This assessment covered services for people with acquired brain injury. During this assessment, we focused on a sample of 4 out of 10 wards at St Andrew’s Hospital Northampton that admitted patients with acquired brain injury. These were:

• Elgar Ward admitted up to 12 female patients for rehabilitation.
• Allitsen Ward admitted up to 14 male patients for continuing care and rehabilitation.
• Tallis Ward admitted up to 11 male patients for acute care and stabilisation.
• Walton Ward admitted up to 14 male patients with Huntington’s disease.

We also assessed 2 houses at 19 The Avenue and 38 Berkeley Close that provided community facing rehabilitation for 2 patients. Patients were admitted to the service from across the United Kingdom.

The service was registered to provide treatment of disease, disorder or injury and assessment or medical treatment for persons detained under the Mental Health Act 1983.

There was no registered manager in post at the time of the inspection.

We rated this service as good. The service had made improvements. The service managed risks well through comprehensive assessments, personal behaviour support plans and daily safety huddles. Staff assessed patients’ needs and provided appropriate care and treatment. Care plans reflected patients’ individual needs. Staff treated patients with kindness compassion and dignity. They understood patients’ needs, aspirations and preferences. They offered patients choices and encouraged patients to make decisions about their daily lives. Leaders were visible and engaged with staff at all levels. Ward managers actively sought to address the risks associated with closed cultures. Staff felt confident to raise concerns. Clinical governance meetings provided a thorough oversight of performance within the service. Staff made good use of data to identify trends and inform clinical decisions.

The service had conducted extensive recruitment to increase the number of staff working on each ward. There were now sufficient staff to meet patients’ needs.

We found one breach of regulation in relation to safeguarding.

Patients had restricted access to drinks, food and vaping. On one patient’s record, we found that the reasons for this had not been included in the care plan. This meant that staff were failing to safeguard service users from abuse and improper treatment.

We have asked the provider for an action plan, setting out how they will address this matter.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

Most patients were detained for treatment under the Mental Health Act. A handful of patients were detained under the Mental Health Act by an order of the court or had been transferred from prison.

Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff. The training covered the most frequently used sections of the Mental Health Act, the provisions of the Code of Practice, restrictions on patients, the role of the Ministry of Justice and information about where staff can go for advice.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. The organisation employed 6 Mental Health Act caseworkers and a senior caseworker who all provided advice and support for staff. Caseworkers regularly visited the wards, and staff knew how to contact them for advice.

The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The service had developed procedures for the implementation of the specific sections of the Act. These procedures each included a checklist for staff to complete, in order to confirm legal compliance.

Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were automatically referred to the service. Information about patients’ rights under the Mental Health Act were displayed in an ‘easy-read’ format on notice boards. Advocates visited the wards regularly. Advocates attended ward rounds and manager’s hearings. Hospital managers requested advocates to be present at hearings where patients lacked capacity and were not represented by a solicitor.

Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the patient’s notes each time. The Mental Health Act office sent reminders to staff to talk to

patients about their rights under the Act whenever a patient was admitted, when their period of detention was renewed, when there was a change to their section or when the requirements for consent to treatment changed. Each ward had a dashboard showing when staff last discussed each patient’s rights with them.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. SOAD’s were requested by the patient’s responsible clinician. The Mental Health Act office reminded responsible clinicians of the need to contact a SOAD at least two weeks before their certification was required. Typically, SOADs visited the hospital twice every month.

Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed. Detention papers were uploaded to the electronic patient record. Original documents were stored in locked filing cabinets in rooms adjacent to the Mental Health Act Office.

Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers. The audit team conducted audits of specific matters relating to the Mental Health Act. For example, the team had recently conducted an audit of certificates authorising treatment without consent to ensure they were being reviewed by clinicians.

Mental Capacity Act

Staff received and kept up-to-date with training in the Mental Capacity Act and had a good understanding of the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law.

Staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Staff sought to encourage patients to make decisions for themselves whenever possible. For example, when staff were supporting a patient to get dressed, they would lay out different clothes and help the patient to choose.

Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. Staff had assessed all patients’ capacity to consent to treatment and to be in hospital. Assessments of capacity were routinely updated at multidisciplinary ward rounds. For patients detained under the Mental Health Act, responsible clinicians had completed the appropriate statutory certificates authorising treatment. Second opinion appointed doctors authorised treatment when patients lacked capacity to consent.

St Andrew's Healthcare is a registered charity specialising in the assessment, treatment and rehabilitation of people with psychiatric disorders, including people with developmental disabilities. The providers’ vision is to be the national leader in specialist mental health care.
St Andrews Hospital Northampton has five service divisions. These are:
• Child and Adolescent Mental Health Services (CAMHS),
• Autism Spectrum Disorder and Learning Disability Division (ASD/LD)
• Medium Secure Division,
• Low Secure and Specialist Rehabilitation Division, Acute and Psychiatric Intensive care units,
• Neuropsychiatry Division.
This assessment looked at services for older people with mental health needs. We assessed 3 wards (Elm, Cherry and Aspen wards). Elm ward has 10 beds and is a specialist older adult service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits.

Cherry ward has 12 beds and is a specialist older adult service for females with complex dementia and / or progressive neurological conditions, including Huntington's disease, who present with cognitive deficits.

Aspen Ward has 8 beds and is a specialist older adult Admission service for males with complex dementia and / or progressive neurological conditions, who present with cognitive deficits.

The service was last rated as Good in August 2017. The report was published following Care Quality Commission’s (CQC) previous inspection approach using key lines of enquiry (KLOEs), prompts and ratings characteristics. This assessment has been completed following CQC’s new approach to assessment; Single Assessment Framework (SAF).

This was an unannounced assessment, which means the service was not told an assessment was going to be taking place beforehand. During this assessment we looked at all quality statements across all 5 key questions. As we assessed all quality statements at this visit the current rating reflects the findings from this assessment.

We rated the service Inadequate. The provider was in breach of 5 regulations in relation to person-centred care (regulation 9), safe care and treatment (regulation 12), safeguarding (regulation 13), staffing (regulation 18) and good governance (regulation 17).

Patients were not receiving person centred care because staff were not effectively applying the providers chosen model of care ‘enhanced dementia care’. Positive behaviour support (PBS) plans and care plans did not contain all the information staff required to meet patients’ individual needs or in the way they preferred.

Staff did not consistently deliver safe care and treatment to keep patients safe. Not all patients were assisted with adequate food and fluid intake. Not all staff adhered to the provider’s enhanced observation policy. We saw poor management of risks in the environment, including infection prevention and control. The learning culture across the wards was ineffective.

Patients were not always protected from improper treatment because restrictions imposed across all 3 wards did not adhere to the ‘least restrictive principle’.

Leaders did not have a clear oversight of risk and quality monitoring on the wards. Governance processes were ineffective including seeking feedback from patients or establishing methods to gain an understanding of patient’s experience.

Staffing arrangements did not provide a sufficient skill mix or continuity of care, treatment and support. This had a significant negative impact on outcomes for patients and created barriers to staffs ability to provide good quality person centred care.

There was no registered manager in post at the time of the inspection.

Action we have taken

The provider was in breach of 5 regulations in relation to person-centred care (regulation 9), safe care and treatment (regulation 12), safeguarding (regulation 13), staffing (regulation 18) and good governance (regulation 17). In instances where CQC has begun a process of regulatory action, we may publish this information on our website after any representations and/or appeals have been concluded, if the action has been taken forward.

This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Mental Health Act and Mental Capacity Act Compliance

Mental Health Act

Most patients were detained for treatment under the Mental Health Act 1983.

Staff received and kept up-to-date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Online training on the Mental Health Act was mandatory for all staff. Compliance with this training was above 87% across all 3 wards. The training covered the most frequently used sections of the Mental Health Act, the provisions of the Code of Practice, restrictions on patients, the role of the Ministry of Justice and information about where staff can go for advice.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. The organisation employed 6 mental Health Act caseworkers and a senior caseworker who all provided advice and support for staff. Caseworkers regularly visited the wards, and staff knew how to contact them for advice.

The service had the relevant and policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The service had developed procedures for the implementation of the specific sections of the Act. These procedures each included a checklist for staff to complete to support legal compliance.

Patients had easy access to easy read information about their rights under the Mental Health Act. However, many patients had cognitive impairments which meant they had difficulties processing this information, so patients’ relatives were involved and consulted.

At the time of our inspection, changes were being made to advocacy service arrangements and there was some concern access to advocates would be reduced.

Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. SOAD’s were requested by the patient’s responsible clinician. There were at times a delay in responses to these requests. There is a national shortage of SOAD’s so this was not within the provider’s control.

Staff stored copies of patients’ detention papers and associated records correctly and could access them when needed.

Managers and staff made sure the service applied the Mental Health Act 1983 correctly by completing audits and discussing the findings. The implementation of the policy was overseen by the Mental Health Act Steering Group comprising of the Mental Health Act lead, a clinical director, a solicitor, responsible clinicians, nurses and social workers.

Mental Capacity Act

Staff received training about the Mental Capacity Act and understood the five principles. Training on the Mental Capacity Act and Deprivation of Liberty Safeguards were incorporated into mandatory training on Mental Health Law and compliance with this training was above 87% across all 3 wards.

Individuals capacity to make decisions was monitored and recorded at multidisciplinary team meetings. However, restrictions regarding access to snacks, use of ordinary cutlery and access to alcohol as described in the safeguarding quality statement within this report had been imposed without appropriate consent or rationale. We were concerned these decisions had not considered individual patients’ best interests as is required by the Mental Capacity Act 2005 and were imposed as a blanket restriction to keep patients safe from others with an identified risk. Staff did not adopt the least restrictive principle such as facilitating access to cutlery in safe way or developing a person-centred care plan in relation to eating and drinking needs.