St Andrews Healthcare Northampton

Updated 11 January 2024

St Andrew’s Healthcare has been registered with the CQC since 11 April 2011. The service has a nominated individual as required, and a controlled drugs accountable officer. At the time of the inspection, the provider had applied to change its registration with the Care Quality Commission to 1 location instead of multiple registrations across one site. In August 2023, CQC agreed to the change to the registration. Therefore, we have produced 1 single report for what was previously the Women’s and the Men’s services.

St Andrew’s Healthcare is registered to provide the following regulated activities:

• Assessment or medical treatment for persons detained under the Mental Health Act 1983.

• Treatment of disease, disorder or injury.

This location has been inspected 11 times. The most recent comprehensive inspection was in April to June 2022.

The Women’s service was rated as requires improvement overall. The forensic inpatient/secure wards were rated inadequate overall and wards for people with learning disability/autism were rated as requires improvement. The Men’s service was rated as requires improvement overall. At this inspection we inspected under the core service of forensic inpatient/secure wards only. Due to differences in current ratings across the wards, we will report on findings based on an overall previous rating of inadequate in safe and requires improvement in well led.

We undertook an unannounced focused inspection to check that improvements had been made against the conditions imposed on particular wards within the service under the following key questions:

• Are services safe?

• Are services well-led?

We visited 8 wards:

Five women’s wards:

Oak is a 10 bedded ward that provides care for people with learning disabilities in a medium secure setting.

Church is a 10 bedded ward that provides care for people with learning disabilities in a low secure setting.

Maple is a 10 bedded ward that provides care for people with a mental health illness in a blended low and medium secure setting.

Bracken is a 10 bedded ward that provides care for people with a mental health illness in a medium secure setting.

Willow is 10 bedded ward that provides care for people with a mental illness in a blended low and medium secure setting.

Three men’s wards:

Sunley ward is a 15 bedded ward that providers care for people with learning disabilities in a low secure setting.

Meadow ward is a 10 bedded ward that provides care for people with learning disabilities in a medium secure setting.

Mackaness is a 15 bedded ward that provides care for people with a mental illness in a medium secure setting. Following a MHA review visit to Mackaness ward on 19 June 2023, we were made aware of an incident that occurred on Mackaness ward on 14 June 2023. At that time we had not received a notification for the incident. It was reported that on the 14 June 2023 and during the evening shift 5 patients were able to access the nursing office shouting abuse with the intention of getting to another patient who was being nursed in the extra care suite, that could be accessed from the back of the nursing office.

Based on this information we included a visit to Mackaness ward as part of this inspection. The focus for visiting Mackaness ward was to follow up on the reported incident. Following this visit, speaking to the ward manager and staff and patients involved in the incident and reviewing various documents relating to the incident. We felt assured that the incident had been recorded and investigated correctly and a notification was in the process of being sent to CQC. Managers had identified the root cause for the incident and put in place measures to prevent a similar thing happening again.

What people who use the service say

We spoke with 15 patients across the women’s service.

Patients were positive about the support they received. They said they felt safe, staff were helpful and caring. There were activities available and they could speak with staff when they had concerns. Patients were working together on their treatment and discharge plans with the multi-disciplinary team and appreciated this collaborative working.

We spoke with 5 patients across both Sunley and Meadow wards.

Four patients told us that the wards are always short staffed and 1 patient said that this sometimes impacts the range of activities offered, whilst another said that staff from other wards come to cover and they do not know the patients.

Four patients said they like the staff and are happy on the ward.

Four patients said they like activities that are offered, visiting the café and having escorted leave to go into the town.

One patient told us they felt the ward was too restrictive with regard to observation levels and the use of mobile phones.

Updated 11 January 2024

St Andrews Healthcare is an independent organisation that provides mental health care across three sites in England. We visited the Northampton site to check on the quality of care provided.

Urgent enforcement action was taken following the inspection in July and August 2021 because of immediate concerns we had about the safety of patients on the forensic inpatient or secure wards, long stay or rehabilitation mental health wards for working age adults and wards for people with learning disabilities or autism.

We imposed conditions on the provider's registration that included the following requirements:

• the provider must not admit any new patients without permission from the CQC;
• wards must be staffed with the required numbers of suitably skilled staff to meet patients’ needs;
• staff undertaking patient observations must do so in line with the provider’s policy;
• staff must receive required training for their role and that audits of incident reporting are completed.

Following the previous inspection, we wrote to the provider on 9 May 2022, to vary one condition to allow, from 10 May 2022, that St Andrews Healthcare Women’s service could admit up to a maximum of 1 patient per week to each ward without seeking permission from the Commission. The admissions could not be carried over to following weeks should an admission not occur. All other conditions outlined in the section 31 notice of decision from July 2021 remained applicable. The provider was required to provide CQC with an update relating to these conditions on a fortnightly basis.

This inspection was a focussed inspection of the wards that had conditions attached to see if improvements had been made. We found that sufficient progress had been made and that the conditions could be removed. This service has been removed from special measures due to the improvements we found.

Previous inspections have produced 2 reports: one for the Women’s service and one for the Men’s service. Following the provider re-registering as single site, we have completed a single inspection report.

Our rating of this service improved. We rated it as requires improvement because:

• Easy read information was not available on Church ward for patients who may have required it so they could fully understand their care and treatment.
• Staff undertook physical observations following periods of rapid tranquilisation although they were not consistently recorded in the same place within the patient care record.
• Not all medical devices and equipment was maintained in line with the supplier’s guidance and was not appropriately recorded.
• Medicines management processes were not always adhered to in line with the provider’s policy and procedures.
• Not all health care assistants thought their safeguarding training was sufficient.
• Compliance for safety intervention training was lower than required across all the wards. Not all staff on Bracken and Maple ward were up to date with basic life support training.
• Staff on the Men’s wards did not always plan shifts effectively. Often, staff carried out enhanced observations one after the other without any break in between.
• Staff on the Men’s wards did not always receive regular clinical supervision in line with provider’s policy.
• Governance processes did not always work effectively to ensure good oversight of quality and performance data to ensure that ward procedures ran smoothly.
• Staff on the Men’s wards did not always feel as though they were respected, valued and supported.

However:

• The service had made sufficient improvements in relation to the conditions applied at the last inspection so we removed them and took them out of special measures.
• The service provided safe care. The ward environments were generally safe, clean and appropriately risk assessed.
• Staffing had improved. The service had sufficient, appropriately skilled staff to meet patient’s needs and keep them safe. Patients were able to access escorted leave when they wanted to, and there was a wide range of readily accessible activities.
• Training compliance had improved for most required training, and most staff received regular supervision on the Women’s wards. Staff were provided with sufficient information to ensure patients were kept safe.
• Staff assessed and managed risk well. Staff undertook patient observations in line with the provider’s policy and had a good awareness of individual patient’s risks.
• Staff followed good practice with respect to safeguarding and recognised abuse, reporting concerns appropriately.
• Incident reporting and record keeping had improved. Staff knew what incidents to report, how to report them, and they were recorded appropriately in the patient care record and the incident reporting system.
• Culture on the wards had improved and the provider had introduced a number of approaches to prevent an occurrence of a closed culture.

Updated 10 February 2015

• There was a need to assess and treat patients based on individual risk and identified needs, rather than placing emphasis on generic, restrictive risk management processes.
• Agency and bank staff did not have adequate information about individual patient care and any safeguarding protection plans on the wards where they are working.
• The complaints process was not always clearly displayed on the wards in formats people can understand.
• Feedback from the outcome of complaints was not shared with the complainant on all occasions. 
• Seclusion facilities were being used for de-escalation and time out.

Updated 10 February 2015

• The information about the complaints process was not clearly displayed on the wards in formats people can understand.
• Agency and bank staff did not always have adequate information about individual patient care.
• Seclusion facilities were being used for de-escalation and time out.
• Not all of the staff could demonstrate an understanding about appropriate use of the seclusion facilities.
• The CQC have not been sent notifications relating to incidents affecting service or the people who use it, in line with requirements.
• Not all wards had resuscitation equipment. There were a number of locked doors, stairs and potentially an unpredictable patient group, which may impact how quickly the equipment arrived where it was needed. The provider must ensure that lifesaving equipment is available without delay.

Updated 16 September 2016

• Bayley ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning disabilities / autistic spectrum disorder.

• Heygate ward is a medium secure inpatient ward that can accommodate up to 10 children and adolescent males with learning disabilities / autistic spectrum disorder.

• Fenwick ward is a low secure inpatient ward that can accommodate up to 10 children and adolescents females with neuro-disability / autistic spectrum disorder.

• Richmond Watson ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent males with complex mental health needs.

• Church ward is a low secure inpatient ward that can accommodate up to 10 children and adolescent males with neuro-disability / autistic spectrum disorder.

• Boardman ward is a low secure inpatient ward that can accommodate up to 11 children and adolescent females with complex mental health needs.

• Heritage ward is a low secure inpatient ward that can accommodate up to 12 children and adolescent females with complex mental health needs.

• John Clare ward is a low secure inpatient ward that can accommodate up to nine children and adolescent females with complex mental health needs.

Updated 6 March 2023

Prior to this inspection we received 2 safeguarding concerns, 2 whistleblowing accounts and 1 injury notification. The safeguarding concerns were in relation to staff lack of knowledge to carry out tube feeding for one patient, staff allegedly not having sufficient information about a patient when handing over to an ambulance crew. One whistleblowing concern was in relation to a concern about low staffing levels affecting patient care and a second about staff knowledge of a patient when providing a handover to an ambulance crew in an emergency. The injury notification was regarding a delay to a patient receiving an x-ray at the local hospital. In order to review the circumstances around all concerns we reviewed staffing numbers, how staff were trained to provide safe care, and we reviewed the safeguarding practices. We also reviewed how staff documented and knew about how to manage patient risk.

We rated this core service based on our findings. Our rating for this service went down. We rated it as requires improvement.

• We were not assured that Allitsen ward was compliant with all mandatory training requirements. Specifically, basic life support and safety intervention training (previously MAPPA). Data submitted by the provider was contradicted by that given to us by the nurse manager on the day of inspection.
• Leadership on Allitsen was not always visible. We heard how leadership changes in senior staff on the ward had de-stabilised the ward, and some governance processes such as monitoring mandatory training were not always used effectively.
• Managers had not ensured that all shifts had the correct number of qualified nurses for the duration of the shift. Although the ward was staffed with the right numbers of staff to keep patients safe. The start of some shifts did not always meet the planned numbers. Though gaps were filled during the shift with bank staff which brought staffing levels up to safe numbers.
• Communication processes between the ward staff and the physical healthcare team were not always followed when making referrals for physical healthcare following incidents.

However:

• Staff managed incidents safely. Staffing numbers did not have an impact on the ability to manage incidents. All staff we spoke with on Allitsen ward knew how to report incidents and record them in the electronic system. We reviewed 4 serious incident notifications, which confirmed this judgement. Lessons learned from incidents were shared within teams in order to prevent future occurrence of the same incident.
• Staff managed safeguarding incidents well. We reviewed 2 safeguarding concerns related to patients’ physical healthcare and one whistle blowing report relating to short staffing. We saw staff had reported, recorded, escalated and investigated all incidents in line with provider policy. We saw evidence of the providers investigation reports, response letters and a duty of candour letter. All staff we spoke with understood what constituted a safeguarding concern.
• Staff managed patients’ physical healthcare well.

Updated 16 September 2016

• Hawkins is medium secure ward for men with learning disabilities (LD).

• Sitwell is a medium secure ward for women with LD.

• Naseby is a low secure ward for men with LD.

• Spencer North is a low secure ward for women with LD.

• Mackaness is a male medium secure ward for people with ASD.

• Harlestone is a male low secure ward for people with ASD.

Updated 11 January 2024

Updated 16 September 2016

• Thornton ward is a locked rehabilitation unit for women.

• Ferguson ward is a locked rehabilitation unit for men.

• Spring Hill House is a locked facility rehabilitation unit for Women offering 23 beds.

Updated 7 August 2017

O’Connell North ward

O’Connell South ward

Compton ward

Updated 16 September 2016

• Sherwood ward is the psychiatric intensive care unit.

Updated 10 February 2015

• We observed and staff reported good and supportive multi-disciplinary team working.
• Additional systems were in place to review enhanced support and seclusion/segregation, such as arranging for doctors across wards to give a second opinion/ independent review on the management of these incidents.
• Robust systems were in place for the management and auditing of medicines.
• We found that the monthly patient safety and experience group held at St Andrew’s Healthcare Essex was an effective forum for managing and learning from patient safety incidents that took place in the hospital.
• We identified good examples of the provider supporting staff to attend additional training to prepare them to care for people with specific mental healthcare needs.