Broomhill

Updated 28 February 2024

Broomhill provides care, treatment, and support to individuals with mental health concerns. Broomhill is part of the St. Matthews Limited, which consists of 5 care homes and 3 hospital locations in Northampton and Coventry.

Broomhill provides 99 beds across 2 core services and seven wards:

Acute wards for adults of working age and psychiatric intensive care units, consist of one ward.

• Holdenby ward – Acute admission ward - 14 beds for male patients.

Two acute wards were opened in 2020 as part of the provider’s action plan to address the breaches we found at an inspection of the long stay mental health rehabilitation service earlier in 2020. However, at the time of this inspection only one acute ward remained open.

Long stay or rehabilitation mental health wards for working age adults consists of 6 wards.

• Althorp ward – High dependency unit - 14 beds for female patients.
• Cottesbrooke ward – Highly specialist high dependency rehab unit - 14 beds for female patients
• Kelmarsh ward – Longer term high dependency rehab unit - 14 beds for male patients.
• Lamport ward – Highly specialist high dependency rehab unit - 14 beds for male patients
• Spencer ward – Longer term high dependency rehab unit - 14 beds for male patients.
• Manor ward – Longer term high dependency rehab unit - 15 beds for male patients.

At this inspection we visited the 1 acute ward and 5 of the 6 rehabilitation wards. We did not visit Lamport ward. This unannounced, comprehensive inspection took place over 4 days in July 2023. The inspection was in response to previous action plans and ongoing concerns received via whistleblowing and other enquiries. The main concerns related to the quality of care and treatment and safeguarding concerns. In addition, the provider had requested a re-inspection, as the service had not been reinspected since February 2020.

The last inspection of Broomhill long stay or rehabilitation service was in January 2023. The inspection was an unannounced, comprehensive inspection of the rehabilitation service only, and looked at 3 key questions: safe, caring, and well-led. The inspection took place following concerns about an increase in the number of notifications between July and August 2022 and the findings of a Mental Health Act review visit in October 2022. The overall rating for the rehabilitation part of the service following the inspection was requires improvement, with safe, caring, and well-led key questions all rated as requires improvement. We found breaches of regulations 9 and 12 and issued requirement notices.

The last inspection of Broomhill acute service was in October 2021. At that time this core service was rated RI overall with safe, caring and well led all rated RI. Effective and responsive were not and have not been rated.

The last comprehensive inspection of Broomhill took place in February 2020. At that time the provider did not have an acute core service. CQC rated the provider inadequate overall and placed the service in special measures. Between February 2020 and January 2023, we conducted three further inspections at Broomhill. These took place in July 2020, September 2020, and February 2021. Further to each inspection, a number of breaches of the Health and Social Care Act 2008 (Regulation Activities) Regulations 2014 were identified.

In response to these breaches Care Quality Commission issued a Notice of Proposal (13 August 2021), followed by a Notice of Decision (30 July 2021), to vary a condition of the provider’s registration (to remove the location). The provider submitted an appeal against the proposal. In the interim, a stay of proceedings was requested and approved until Friday 19 November 2021 to allow for a further inspection to be undertaken. The purpose of the ‘stay of proceedings’ was to enable the CQC to conduct a further inspection of Broomhill and determine if any of the breaches of regulation have now been addressed. As a result of this inspection, the appeal was upheld and enforcement action against the provider ceased.

Broomhill has a history of failing to respond adequately to serious concerns raised by the Care Quality Commission. While the provider does submit action plans to address the findings of each of our inspections these actions are often not sustained or embedded by the provider in practice. However, following our inspection in July 2023 the provider has implemented a range of further changes, which cannot be recorded within this inspection report.

What people who use the service say

While the rating from the most recent patient satisfaction survey undertaken by the provider for Broomhill, in July 2023 was positive. At this inspection we found peoples responses appeared to contradict this outcome.

During this inspection we spoke with 45 patients across both the acute and rehabilitation wards, and formally interviewed 24 patients.

Out of 24 patients we interviewed, and who told us if they were happy or not with their care and treatment, 16 patients (67%), told us that they were not happy. Of these 16 patients, 13 patients told us that they felt unsafe on the wards. One patient said that only having 1 ward round a month was not enough and ward rounds were rushed. Another patient told us that “the day is just full of people going to smoke outside. All day long - every half hour. If I am playing a game with staff, someone will interrupt asking for a smoke break and the staff will have to go, and I will have to put the games away.” Two other patients raised concerns about the food and 1 patient stated that “there was very limited occupational therapy resource, and limited opportunities to take positive steps forward in my mental health.”

Six patients raised concerns regarding their length of stay in the hospital. Comments from patients included “I’m stuck”,” I’ve been here too long”,” I have no discharge plans in place”,” I want to leave and move into a flat” and” I am not moving on.”

Three patients also shared several positive comments about staff stating, “staff are amazing and friendly,” “good staff and good service,” “very good staff and service overall “thank you for keeping me safe.” Positive comments were also shared about patient’s rooms, which were described by one patient as “very big and the fact you have en-suite is great.”

We also spoke with 8 carers. Four out of 8 carers (50%) were mostly happy with the care and treatment provided. However, 3 carers expressed concerns regarding care and treatment. One carer told us that there were issues with communication, they said promises were made by staff which had not been delivered. One carer told us that their relatives need in relation to their diagnosis of autism were not being met. Another carer was concerned that their relatives’ diabetes was not being monitored properly.

Updated 28 February 2024

The Chief Inspector of Hospitals is placing St Mathews Broomhill Hospital into special measures. Services placed in special measures will be inspected again within six months. If sufficient improvements have not been made such that there remains a rating of inadequate overall or for any key question or core service, we will act in line with our enforcement procedures to begin the process of preventing the operator from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Our rating of this location went down. We rated it as inadequate because:

• The provider had not ensured they had effective governance structures and processes to provide oversight and assurance of all aspects of service delivery to be able to identify and improve practice in a timely manner and sustain that improvement. Examples included patients’ identifiable information was not always kept securely. There was no effective monitoring to ensure patients received debriefs after incidents of violence or aggression from other patients. Such incidents were not recorded in a timely manner to allow for effective monitoring. There was little oversight to ensure that all patients received a comprehensive assessment and treatment plan in a timely manner, managers had not realised that some care planning information was cut and pasted between records, leading to recording errors. Managers were not monitoring the quality of the food served on the wards. Managers were not effectively monitoring the mandatory training compliance for all staff. A lack of governance oversight regarding mandatory training and sustainable action plans had been cited in previous inspection reports and enforcement action we had taken. This related to all wards in the hospital wide issue.

• The provider did not provide an environment which was safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff could not observe patients in all parts of the hospital and there were reports of staff sleeping while on observation duties. We saw multiple blind spots throughout the wards in the long stay rehabilitation, which were not mitigated by mirrors or individual risk assessments. Numerous ligature points were identified on the ligature risk assessment, however the mitigation identified did not address the identified risk. This was reported on in previous inspection reports.

• Staff failed to ensure that all corridors were kept clear of hazards to enable safe exit from ward areas in the case of emergency and that patients had access to call alarms.

• The provider had failed to address maintenance issues and repairs in a timely way, leaving areas of risk for some patients. Staff had not ensured that all necessary repair works to improve the quality of the environment were completed within reasonable timescales and that high-risk requests were resolved on the same day. Not all ward areas were clean, and some wards had ripped, dirty, or broken furniture and fittings.

• Staff had not fully risk assessed all patient activities on the ward including potential risks relating to other patients. We saw electrical equipment placed on the floor in patient areas and staff had not fully risk assessed this issue. We found plastic bags in a drawer on one ward.

• Staff were not adhering to the hospital’s policy and procedure when bed rails were used.

• The service did not work to a recognised model of mental health rehabilitation, to meet patients’ needs. Staff were not routinely offering patients regular access to activities that promoted rehabilitation such as employment and education opportunities. This had been cited in previous inspection reports.

• Staff did not always adhere to the hospital’s infection prevention and control policy. Examples include food hygiene and storage of food. Lack of cleaning in areas where patients ate their food. Bedrooms that had not been cleaned before admission. Staff who were not bare below the elbows and wearing jewellery. Staff did not ensure that the traps used to manage the current mouse infestation on Manor ward were not placed in patient areas.

• Staff had not always followed best practice after administration of rapid tranquillisation regarding the monitoring and recording of physical observations. This had been cited in previous reports.

• Staff did not always ensure that patient medication was prescribed within British National Formulary limits and where this was needed, they were not recording a clear rationale for doing so and there was no evidence that second opinion was always sought. Staff had not ensured that all patients could give consent to treatment by medication.

• Staff had not always followed National Institute for Health and Care Excellence guidelines when undertaking enhanced patient observations. This was an area of concern in February and September 2020. Staff had not always used the correct techniques when restraining patients. Staff did not always have access to de-escalation facilities.

• Staff had not always routinely checked cleaned or calibrated medical equipment. Staff had not regularly checked the emergency grab bags and defibrillators, and emergency equipment was accessible in a timely manner.

• Staff had not always ensured that patients were protected from harm and safeguarded. Incidents included patient on patient assaults, sexual vulnerability and staff not managing known allergies. Managers had not managed the numbers of assaults and altercations between patients. Patients told us they did not always feel safe on the wards or received debriefs from staff following any incidents. Adequate safeguarding of patients was an area of concern in February 2021.

• Staff did not always treat patients with compassion and kindness, dignity, and respect. Staff did not always respect their privacy and dignity and did not always understand the individual needs of patients. We heard of several occasions when staff had been speaking to one another in front of the patients, in a language other than English. Staff did always knock on bedroom doors before entering. Staff who had made hurtful, racist, and derogatory remarks to patients. Dignity and respect issues been cited in previous inspection reports and enforcement activity.

• There were limited rooms for use as quiet areas on some wards. Wards had limited space for patients to meet visitors in private.

• Staff had not always made sure that patients were fully involved in the development and ongoing monitoring of their care plans, some patients told us they did not have copies of their care plans and there was no evidence in the care plan records that copies were routinely given to patients.

However:

• The ward teams included or had access to, the full range of specialists needed to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team. This was an improvement on previous inspection findings.

• Staff had developed care plans informed by a comprehensive assessment. This was an improvement on previous inspection findings.

• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983.

Updated 28 February 2024

Our rating of this service went down. We rated it as inadequate because:

• The ward environments were not safe. The provider had not identified appropriate mitigation for identified ligature risks. Staff had identified the potential ligature anchor points in the service; however, the identified mitigation did not adequately mitigate the risks identified to keep patients safe. Staff could not fully observe patients in all areas of the wards due to blind spots. Patients did not have access to a de-escalation room.
• Wards were not clean or well maintained. We found ripped, dirty, and damaged furniture and fittings.
• Staff had blocked the ward corridor on Manor ward with chairs, which would prevent the safe exit from the ward in the case of an emergency.
• Staff had not checked and cleaned medical equipment regularly or ensured that clean stickers were in place. There was no evidence that medical equipment had been calibrated regularly. Regular checks of access to emergency grab bags and defibrillators had not taken place.
• A patient had seen a mouse in his room on Manor ward. This had not been safely managed as we saw mouse traps on the ward.
• Staff had not always undertaken non-contact observations post rapid tranquillisation, when patients refused to have their physical health observations undertaken.
• Staff were not fully adhering to the hospital’s infection prevention and control policy. Some staff were not bare below the elbows, and we saw that some staff were wearing earrings, watches, and other jewellery.
• Staff had not conducted risk assessments in line with the hospital’s policy and procedure for the use of bed rails.
• We saw two incidents where staff had not restrained patients in line with hospital’s policy.
• The provider had not ensured that the hospital’s policy on patient observations reflected the National Institute for Health and Care Excellence guidelines. We found that staff had not safely stored food and drink on the ward. Food items had been left out of the fridge and there were undated items which had been transferred into plastic containers.
• Staff had not ensured that electrical items (including toaster and kettle) were placed in a safe place on Manor ward or that any associated patient risks had been fully assessed.
• Not all patient medicines had been included within the patient’s consent to treatment form. Some patient medications had not been prescribed within BNF limits.
• The provider did not have fully effective governance structures and processes in place to provide oversight and assurance of all aspects of service delivery, to be able to identify and improve practice in a timely manner and sustain that improvement.
• Staff had not supported all patients (where appropriate) in finding opportunities for education and employment.
• Staff had not fully met all mandatory training requirements.
• Staff had not maintained the safety of all patients, ensuring that patient safety risks (including allergies and sexual vulnerability) were safely managed. Staff had stored plastic bags in a drawer in the patient’s dining room on Althorp ward, however staff removed these at the request of the inspector.
• Staff had not always treated patients with compassion and kindness or respected their privacy and dignity. They had not actively involved all patients and families and carers in care decisions.
• Not all patients had not been fully involved in the development and ongoing monitoring and given a copy of their care plan.
• The service did not work to a recognised model of mental health rehabilitation.

However

• Staff knew how and where to access ligature cutters.
• Most patients told us they would tell staff if they had any concerns.
• Staff were aware of their individual responsibility in identifying any individual safeguarding concerns and reporting these promptly.
• The provider used a recognised risk assessment and risk management tool.
• The ward teams included or had access to the full range of specialists needed to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision, and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. The provider had effective processes for the management and recording of Mental Health Act paperwork.
• There was good access to the garden areas and fresh air.
• Staff followed good practice with respect to safeguarding.
• Staff engaged in some clinical audit activities to evaluate the quality of care they provided.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare.

Updated 28 February 2024

Our rating of this service went down. We rated it as inadequate because:

• The ward environments were not safe. The provider had not identified appropriate mitigation for identified ligature risks. Staff could not always observe patients in all areas of the wards due to blind spots. The provider had not ensured that the hospital’s policy on patient observations reflected the National Institute for Health and Care Excellence guidelines.
• We saw two incidents where staff had not restrained patients in line with hospital’s policy. Patients did not have access to a de-escalation room.
• We found that staff had not maintained the safety of all patients, ensuring that patient safety risks (including allergies and sexual vulnerability) were safely managed. Staff had stored plastic bags in the drawer on Althorp ward.
• Wards were not clean or well maintained. We found dirty and damaged furniture and fittings.
• taff had not checked and cleaned medical equipment regularly or ensured that clean stickers were in place. There was no evidence that medical equipment had been calibrated regularly. Regular checks of access to emergency grab bags and defibrillators had not taken place.
• Staff had not conducted risk assessments in line with the hospital’s policy and procedure for the use of bed rails had not been fully adhered to.
• Staff had not always undertaken non-contact observations post rapid tranquillisation, when patients refused to have their physical health observations undertaken.
• Staff were not always adhering to the hospital’s infection prevention and control policy. Some staff were not bare below the elbows, and we observed that some staff were wearing earrings, watches, and other jewellery. We found that staff had not safely stored food and drink on the ward. Food items had been left out of the fridge and there were undated items which had been transferred into plastic containers.
• Not all patient medicines had been included within the patient’s consent to treatment form. Some patient medicines had not been prescribed within BNF limits.
• The provider did not have fully effective governance structures and processes to provide oversight and assurance of all aspects of service delivery, to be able to identify and improve practice in a timely manner and sustain that improvement.
• Staff had not fully met all mandatory training requirements.
• The service did not work to a recognised model of mental health rehabilitation. Staff had not supported all patients (where appropriate) in finding opportunities for education and employment.
• The provider had not ensured that all patient activities on the ward had been fully risk assessed including potential risks relating to other patients.
• Staff had not always treated patients with compassion and kindness or respected their privacy and dignity. They had not actively involved patients and families and carers in care decisions. Patients had not been fully involved in the development and ongoing monitoring and given a copy of their care plan.

However

• Staff knew how and where to access ligature cutters.
• Most patients told us they would tell staff if they had any concerns.
• Staff were aware of their individual responsibility in identifying any individual safeguarding concerns and reporting these promptly.
• The provider used a recognised risk assessment and risk management tool.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. The provider had effective processes for the management and recording of Mental Health Act paperwork.
• There was good access to the garden areas and fresh air.