Archived: St Andrew's Healthcare - Mens Service

Updated 24 February 2023

St Andrew’s Healthcare – Men’s Service registered with CQC since 11 April 2011. The service did not have a registered manager in post at the time of the inspection but does have 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 CQC to one location instead of multiple registrations across one site. A new application for a registered manager was in progress at the time of the inspection. 

At this inspection, we visited one ward in the following core services:

• Acute wards for adults of working age and psychiatric intensive care units: Heygate ward – a psychiatric intensive care unit with 10 beds for males.

We had planned to visit the following core service, but due to a COVID-19 outbreak, this ward was in isolation at the time of our inspection. Therefore, we carried out a remote review of data and the incidents that had been reported to us.

• Forensic inpatient or secure wards: Fairbairn ward, a 17-bed medium secure ward for adult males who are deaf.

CQC have inspected this location 12 times. The most recent comprehensive inspection of this location was in June 2022. The overall rating for the location was Requires Improvement. We rated Safe as requires improvement, Effective, Caring, and Responsive as good and well-led as requires improvement. Forensic inpatient or secure services, the overall rating was requires improvement, with safe, effective and well led rated as requires improvement and caring and responsive as good. Acute wards for adults of working age and psychiatric intensive care units was rated requires improvement overall. Safe and well led were rated requires improvement with effective, caring and responsive as good.

What people who use the service say

Acute ward for adults of working age and psychiatric intensive care units:

We spoke with five patients on Heygate ward.

Three patients told us they felt safe on the ward. While another patient told us they did not feel safe because “co patients were all at different levels of wellness and could be unpredictable in their behaviours”. He said that one night during an incident “staff put me in the seclusion room and grabbed me. I have a broken right hip and it affects the way I walk so I am not feeling safe about my hip. He also said he put in a complaint about this and how staff did not know about his physical health concerns and asked to go to a different hospital as being here isn’t helping my care”.

A fifth patient told us that while he felt safe “things often kicked off at night-time when some patients became rude and pushed the boundaries. This results in staff becoming cross and taking people into seclusion”. He told us that one evening he witnessed “an unreasonable restraint when a co patient had been shadow punching a wall. He felt this was not justified and it’s the staff who play games and 'enjoy' themselves, they break the rules, and they joke about me, indirectly”.

Three patients said they thought there were enough staff who got on well with patients, however one patient felt “staff had too much paperwork to do and this meant they could not spend time with them”. Another patient told us “he could see some improvements in staffing and felt staff were more available for help”. Two patients told us that “staff at night-time were not always as friendly as those in the daytime and they just seemed to do their own thing”.

Three patients told us they had been involved in discussions about their care and treatment plans and all three patients felt staff were considerate and treated them well.

Three patients confirmed they had all had regular physical health check-ups and staff did blood pressure and temperature check every day.

Forensic inpatient or medium secure wards:

Following a COVID-19 outbreak and subsequent isolation of the ward on the day of our inspection, we did not go onto Fairbairn ward or speak with any patients on that ward. However, we did have feedback from one patient who had raised a complaint prior to our inspection:

The patient reported that while he felt safe on the ward, he had noticed staff had been sleeping during their observations of him. He also reported this had not been the first time this had happened.

Updated 24 February 2023

This unannounced focused inspection was triggered by the receipt of information which gave us concerns about the safety and quality of services on two wards at the hospital. CQC received this information of concern between July and September 2022. Our last inspection of this service was in June 2022.

The concerns received included the following:

• safe staffing levels and how incidents were safely managed
• physical healthcare and care of the deteriorating patient
• one incident of poor medicine management
• use of restrictive practices.

Our rating of this location stayed the same. We rated it as requires improvement because:

We found:

• On Heygate ward, the night shift lacked leadership to support staff to make decisions on how to minimise restrictive practice and maintain effective relational security.
• On Heygate ward, there was a delay in prescribing medication to one patient. Referrals to the physical healthcare team for out of hours admission were not always robust.
• On Heygate ward, night staff implemented a blanket restriction without clear rationale.
• Despite remedial action taken by the provider there was a strong smell of drains from the toilets in the therapy corridor of Malcom Arnold House, leading to Heygate ward.
• We found 4 incidents of staff sleeping on duty on Fairbairn ward.

However:

• Both wards showed that while nursing shifts had not started with the planned number of staff, managers filled gaps with known bank staff to bring staffing levels up to safe numbers. Staff told us that in the previous few months staffing levels had improved. The provider had improved pay and conditions for staff and had measures in place to address both recruitment and retention of staff. We found the staffing issue had improved at our last inspection of these services in June 2022, and there was evidence of slow but continued improvement since our last inspection.
• All staff we spoke with knew how to report incidents and record them in the electronic system. We reviewed incident records against safeguarding referrals and daily care notes which confirmed this judgement. Managers shared lessons learned from incidents within teams to prevent future occurrence of the same incident.
• Compliance with safeguarding training was 100% on Fairbairn ward and 80% on Heygate ward. All staff we spoke with understood what constituted a safeguarding concern.
• Staffing levels meant enhanced observations had been carried out safely.
• Staff managed the routine physical healthcare of patients well and managed physical healthcare incidents well.

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 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 16 September 2016

• Rose ward is a medium secure male ward.

• Tallis, Tavener, Althorp, Berkeley Close (1st floor) are male locked wards.

• Berkeley Close (ground floor) is a female locked ward.

• Berkeley Lodge, 37 and 38 Berkeley Close and 19 The Avenue are locked units

• Walton is for male patients with Huntingdon’s disease.

• Harper – specialist ward for male and female patients with Huntingdon’s disease.

Updated 24 February 2023

We were not able to go onto this ward as on the day of inspection the ward was in isolation due to a COVID-19 outbreak. We did however carry out a desk top review of 2 serious incident notifications and a whistle blowing report received by CQC, away from the ward setting.

Prior to this inspection we received 2 notifications of staff sleeping on duty, 1 allegation of inappropriate touch and 1 incident of inappropriate force during a restraint. We also received intelligence from a key stakeholder that staffing numbers were low and safety of the ward was compromised. In order to review the circumstances around all concerns we reviewed staffing numbers, and we reviewed how staff documented and knew about how to manage patient risk.

Our rating of this location stayed the same. We rated it as requires improvement because:

• We found 4 incidents of staff sleeping on duty on Fairbairn ward. Two incidents had been reported to CQC and 2 other incidents were recorded in the electronic incident records.
• Actual numbers of staff against the planned establishment were not always met at the start of a shift. However vacant shifts were filled with bank and agency staff which brought staffing levels up to safe numbers. The provider had improved pay and conditions for staff to increase numbers and started to put measures in place to address both recruitment and retention of staff. We found the staffing issue had improved at our last inspection of these services in June 2022, and there was evidence of slow but continued improvement since our last inspection.
• All staff we spoke with knew how to report incidents and record them in the electronic system. We reviewed incident records against safeguarding referrals and daily care notes which confirmed this judgement. Managers shared lessons learned from incidents within teams to prevent future occurrence of the same incident.
• All staff had completed safeguarding adults’ level 3 training on Fairbairn ward.

Updated 11 November 2022

At our inspection of long stay rehabilitation mental health wards for working age adults, we visited three wards. Following the inspection, we became aware that two of these wards are commissioned as secure wards. Therefore, we have amended our report to reflect the commissioning arrangements for the wards at St Andrew’s Healthcare Men’s service. We have moved two wards from long stay rehabilitation mental health wards for working age adults, into the forensic inpatient or secure wards section of the report. The report now reflects our findings of one ward visited at the time of inspection.

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

• The service provided safe care. The ward environment was safe and clean. The ward had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward team included or had access to the full range of specialists required to meet the needs of patients on the ward. Managers ensured that these staff received 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. The service worked to a recognised model of mental health rehabilitation.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service had carried out significant work on improving the culture on the ward, had visible local and senior leadership and had improved governance systems to monitor service delivery.

However,

• The ward had not completed effective audits in all areas of their service delivery.

Updated 6 June 2018

Foster ward

Cranford ward

Updated 24 February 2023

Prior to this inspection we received 4 concerns about incidents that had occurred on Heygate ward. We received 2 patient concerns about quality of care. One was in relation to a patient who told us their leave was cancelled without good reason, and a second was that staff used seclusion inappropriately. We received 1 safeguarding notification in relation to use of force from staff on a patient and 1 serious incident notification in relation to omission of a medication for diabetes. 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.

Our rating of this location stayed the same. We rated it as requires improvement because:

• The night shift on Heygate ward lacked strong leadership to support staff to make decisions on how to minimise restrictive practice and maintain effective relational security. Dynamics between staff and patients were strained as staff did not always feel confident to manage the aggression of patients and to manage ward rules effectively.
• As a result of a decision made by night staff, we found a blanket restriction in place on Heygate ward. Hot drinks were not readily available to patients. There were no care plans or risk assessments that documented reasons for this restriction.
• In one incident, communication between ward staff and the physical healthcare team did not occur in a timely way to manage an out of hours admission.
• One concern had been reported to us around a delay in prescribing medication following the admission of a patient. We found evidence to support the concern. The medicines error was identified but not until 10 days after admission. However, the provider had investigated the omission and had put plans in place to prevent a reoccurrence of the incident.
• There was a strong smell of drains from the toilets in the therapy corridor of Malcom Arnold House. Although remedial action was in place the smell remained at the time of our inspection.

However:

• 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, but gaps were filled during the shift with bank staff which brought staffing levels up to safe numbers. Staffing had improved since our last inspection of these services in June 2022, and there was evidence of slow but continued improvement in the time since our last inspection.
• Staff managed incidents safely. Staffing numbers did not have an impact on the ability to manage incidents. All staff we spoke with on Heygate ward knew how to report incidents and record them in the electronic system. We reviewed 2 whistleblowing reports and 1 serious incident made to us and found incident records, safeguarding records, and daily care notes supported this. Lessons learned from incidents were shared within teams to prevent future occurrence of the same incident.
• Staff managed safeguarding incidents well. We reviewed 1 safeguarding concern and 2 complaints reported to us and found staff had reported, recorded, escalated, and investigated all incidents in line with policy. We saw evidence of the providers investigation reports, response letters and a duty of candour letter. Compliance with safeguarding adults level 3 training on Heygate ward was 80%. All staff we spoke with understood what constituted a safeguarding concern.
• Staff managed the routine physical healthcare of patients well. Patients had full physical healthcare checks on admission and at regular intervals thereafter.