Northcroft Site

We found the following issues that the trust needs to improve:

• We were concerned about the safety of the ward environment. The layout of the ward offered poor lines of sight to assist staff in monitoring patients. We saw high-level ligature points around the ward; the trust had not adequately addressed these through the trust’s ligature risk assessment and management plan. A ligature point is anything that could be used to attach a cord, rope or other material for the purpose of hanging or strangulation.

• We had concerns about the robustness of the governance arrangements in relation to assessing, monitoring and lessening risks of ligatures in the patient care areas. Whilst ligature risk assessments and action plans were in place, they did not address all ligature risks and there was an unacceptable number of ligature risks remained on the wards.

• The trust had not reviewed ligature risks following incidents in a timely manner.

• Staff did not routinely update risk assessments and management plans. They did not always reflect incidents reported. This means that staff could be unaware of any risks the patients may pose to themselves or others, or it could lead to inconsistent management of incidents.

• Staff patient observations did not always carried out correctly or accurately recorded. This could compromise patient safety.

• Many of the care plans were not up to date and did not always reflect need. There was a lack of care planning for mental health needs; only 10 of the 24 care plans we reviewed had a mental health care plan in place. These were not holistic, recovery focused or personalised. Staff had not updated seven 72-hour care plans, despite, the patients being in hospital for more than two weeks, in five cases, the patients had been in hospital more than three weeks.

• We were not assured that the ward always had sufficient numbers of staff to make sure they could meet patients care and treatment needs. Despite the use of bank and agency staff, over the last three months prior to inspection, the ward had been left with one qualified nurse (instead of two) on 11 shifts. Medical cover was not always in place and as a result, patient’s treatment had been delayed. Most staff had not had a yearly annual review.

• Governance arrangements on the ward were weak in relation to assessing, monitoring and improving the quality of care plans and risk assessments. We did not see any care record audits in place. There were no systems to ensure regular reviews and updates of care records. The ward had received verbal feedback following a routine CQC Mental Health Act review concerning poor risk assessments and care plans. We were concerned that the trust had not been addressed this after the feedback.

• The staff we spoke with had concerns about the new management structure and the changing criteria of the ward. They did not feel that the process had been smooth and were not clear in which direction the ward was developing.

However,

• The ward had a wide range of non-nursing professionals in place to develop and support patient care.

• The trust had employed a “User Voice” worker. They visited the ward regular to gather feedback from patients, which would then be fed back directly to the ward staff.