Two mental health services found to be ‘inadequate’ in latest inspections
VISITS FOLLOW ‘SERIOUS INCIDENT’ AT ONE WARD WHERE STAFF WERE SUSPENDED
THE Care Quality Commission (CQC) has found improvements need to be made by a mental health NHS trust in Nottinghamshire.
Following inspections from October to December 2023, Nottinghamshire Healthcare NHS Foundation Trust has seen the ratings of two services drop from “requires improvement” to “inadequate”.
Unannounced focused inspections were carried out at the trust’s acute wards for adults of working age and psychiatric intensive care units (PICU) and wards for older people with mental health problems, due to information received about the safety and quality of services. The overall rating for acute wards for adults of working age and PICU has dropped from “requires improvement” to “inadequate”.
The safe and well-led categories have again been rated “inadequate”. Effective, caring and responsive were not included in this inspection and remain rated as “requires improvement”.
Following this inspection, CQC told the trust they must make improvements to mitigate urgent risks. The trust responded with an action plan to mitigate the risks which gave CQC assurance.
The overall rating, as well as safe and well-led of the wards for older people with mental health problems, has been downgraded from “requires improvement” to “inadequate”. Being effective was again rerated as “requires improvement”.
Responsive was not included in this inspection and remains rated as “requires improvement”. Caring was not included and remains rated as “good”.
Greg Rielly, CQC deputy director of operations in the Midlands, said: “When we inspected acute wards for adults of working age and psychiatric intensive care units (PICU), as well as wards for older people with mental health problems, it was concerning to find a lack of oversight from leaders across the services. We also found staff weren’t always being kind and respectful to the people they were caring for.
“When we visited Cherry ward for older people, there was a significant impact on staffing due to a serious incident which took place last November. That incident resulted in a number of staff being suspended, which heavily impacted on the standard of care people were receiving due to staffing levels.
“A trust investigation of close circuit television (CCTV) found that these staff had falsified care records to show that observations had been done when they hadn’t. Our inspectors also reviewed CCTV footage in the acute wards for adults of working age and PICU and found staff had assaulted people causing physical harm.
“There had been four occasions where two people had been physically assaulted on Elm ward. The staff involved had been suspended and the trust have investigated the incidents. This is totally unacceptable behaviour and must be addressed by the trust as a priority. Leaders must take urgent action to have better oversight of issues, to ensure people are safe and receiving the care they deserve.
“Since the inspection, we have told the trust where we need to see rapid and widespread improvements and have issued requirement notices, so they know where they need to focus their attention. We will continue to monitor the trust closely whilst these improvements are being made to keep people safe.
“If we’re not assured improvements have been made and embedded, we will not hesitate to use further enforcement powers to keep people safe.”
Inspectors found at acute wards for adults of working age and PICU there was an inconsistent approach to recording people’s details when they accessed leave from their wards, as well as on which docu
mentation to use when recording seclusion observations.
There were also ligature risks which had not been identified or acted on to reduce the risk of harm to people and a high use of agency staff due to staff vacancies. Staff did not always share key information to keep people safe when handing over their care to others did not always raise concerns and report incidents and near misses in line with trust policy.
However, inspectors found that all wards were clean, well equipped, and well furnished. On wards for older people with mental health problems inspectors found that there were missing signatures on the administration of medicines.
On the same wards, there were examples where sedatives had been administered against the prescribed dose and against medical advice. Inspectors also found there was an inconsistent approach on which documentation to use when recording people’s risks, as well as in the completion of charts.
There were wards that did not have single en suite rooms, and dormitories were still in place on three out of the four wards visited. There was also no assurance that people’s dietary intake was being effectively completed by staff or that management had timely oversight over data collected by staff regarding risk.
However, on the wards for older people with mental health problems, activities were taking place on two out of four wards visited.
The acute wards for adults of working age and PICU report and the wards for older people with mental health problems report are available on the CQC’S website.