4 July, 5 July, 6 July 2023
During an inspection looking at part of the service
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.