Care regulator lifts condition as Devon Partnership NHS Trust improves systems for supporting staff

4 March 2011

The Care Quality Commission has decided to lift a condition which had been placed on Devon Partnership NHS Trust following improvements to its systems for supporting its staff with regular supervision and appraisals.

The trust had been registered with a condition on its licence in April last year because it was not meeting the 16 essential standards of quality and safety, as required by CQC's new system of registration.

Today CQC publishes detailed reports on the services provided by the trust at 10 locations throughout Devon. Inspectors made a series of unannounced visits, speaking to staff and people using the service, and reviewing all 16 essential standards.

The reports conclude that at nine of the 10 locations, the trust has made the required improvements to its systems for supporting staff. The only exception was the Melrose Unit at Tiverton, which the trust had already decided to close on a temporary basis. CQC inspectors will meet with the trust to discuss planned improvements before the unit reopens.

The inspection team reviewed a range of information on the trust, seeking views of Devon’s Local Involvement Network (LINk) and Devon County Council, among others, to inform their decision.

Overall, inspectors found that three of the 10 locations were meeting all 16 essential standards, with no further improvements recommended:

• Abbotsvale Unit, Bideford Hospital
• St Johns Court, Exmouth
• Haytor Unit, Fernworthy and Oak Ward, Torbay Hospital

Melrose Unit, Tiverton Hospital was not meeting 10 of the 16 standards.

• Respecting and involving people who use services
  People's privacy and dignity were sometimes compromised and they are not always involved in discussions about their welfare.
• Care and welfare of people who use services
  People’s health needs were met but there was a lack of stimulation and activities to maintain people’s skills.
• Meeting nutritional needs
  People were supported to have adequate nutrition and hydration but some of the food served was overcooked and appeared unappetising.
• Cooperating with other providers
  People have not always received the coordinated care, treatment and support they require.
• Safeguarding people who use services from abuse
  People using services were not adequately safeguarded from abuse at the Melrose Unit because care workers were not fully aware of all the procedures in place to protect people.
• Safety and suitability of premises
  People's wellbeing was not fully promoted because of the design and layout of Melrose Unit, which does not lend itself to the needs of people with dementia. Immediate hazards to people's safety were not always identified and made safe by care workers on the unit.
• Staffing
  There was not always an appropriate skill mix of staff available to meet the needs of people using the service.
• Supporting workers
  People who use service may not have been safe and their health and welfare needs may not have been met because care workers did not receive regular supervision of their work and their training needs may not have been met.
• Assessing and monitoring the quality of service provision
  The trust has systems and processes in place to monitor the quality of its service but people using services at the Melrose Unit may not have benefited from adequate management of risks to their health, welfare and safety.
• Complaints
  Comments and complaints may not be acted upon effectively if made to care workers on the unit and information on complaints policy and procedure is not readily available for people using services and their family.

Langdon Hospital, Dawlish was not compliant with one standard:

• Management of medicines
  Inspectors said that there were shortfalls in the documentation for some patients detained under the Mental Health Act.

Improvements were also required in six outcomes:

• respecting and involving people in their care.
• consent to care and treatment.
• cleanliness and infection control.
• management of medicines.
• safety and suitability of premises.
• record keeping.

Five locations were meeting the 16 essential standards, but still need to make further improvements.

Brunel Lodge, Newton Abbot

• Safety and suitability of premises
  The layout does not meet the relevant NHS guidance on separate facilities for men and women.
• Staffing
  The unit was not able at times to obtain replacement staff to maintain these staffing levels when staff are sick.

The Bungalow, Honiton

• Management of medicines
  There were gaps in record keeping.
• Respecting and involving people who use services

Moorland View, Barnstaple

• Management of medicines
  There were gaps in record keeping

Knightshayes, Exeter

• Respecting and involving people who use services
  Inspectors said that privacy and dignity have been compromised through the indiscriminate use of observation windows.

Wonford House Hospital (including community teams)

• Cooperating with other providers
  Some people’s access to crisis teams was variable and may mean that some individuals do not get the support they need.
• Management of medicines
  There were gaps in record keeping.
• Records
  Some of the Mental Health Act documents are not always accurately kept and could compromise people’s rights.

Ian Biggs, Regional Director of CQC in the South West said that the trust had already provided plans setting out improvements, and inspectors would follow up these reports as required.

He said: “It is clear that Devon Partnership Trust has made considerable progress to address the staffing issues that we had raised in the past. We are now satisfied that regular supervision is in place and is seen as a positive experience by the staff.

“We know that if staff aren't being properly supervised and supported, this can have a significant effect on the quality of care that people receive. People we spoke to have been keen to ensure that they receive regular supervision and appraisal. In addition, there is a good programme of training across the trust which care workers from all backgrounds are using to develop and improve their skills.

“We have highlighted some issues at the Melrose Unit – and these issues will have to be addressed if the trust decides to reopen the unit at some time in the future.

“We have also identified improvements which are needed at six other sites, and we told the trust that it must report back to us when these improvements are in place.

“This has been a very thorough review of the services provided for people with mental illness in Devon. Devon Partnership Trust provides a vital service to a large population – and overall the trust has emerged with a clean bill of health.”

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors

• In June 2010 CQC published a detailed investigation into older people’s mental health services in Devon which found that a history of inadequate supervision of staff had allowed poor practice to continue unchallenged until 2008.

• Last year the trust was registered with a compliance condition resulting from declared non compliance with the essential standards of quality and safety for supporting workers. There were insufficient systems and arrangements for the supervision and appraisal of care workers, which meant that people may not be kept safe or their health and welfare needs not met.