The Care Quality Commission (CQC) has published a report on Huntercombe Hospital Maidenhead, following an inspection which took place in July.
Huntercombe Hospital Maidenhead is a specialist child and adolescent mental health inpatient service (CAMHS) including psychiatric intensive care units (PICU) for young people. On 5 March 2021, Huntercombe Young People Ltd took over the running of the hospital.
Under the previous provider, the service was rated inadequate overall and it was placed in special measures. Shortly after the new provider had taken over, CQC carried out a focused inspection of the hospital. Huntercombe Young People Ltd was then served with a warning notice which required it to make improvements to the governance of the hospital. Conditions* were also applied to the provider’s registration.
In July, CQC carried out the first comprehensive inspection of the service under the new provider and found that it had made improvements which meant that the warning notice could be lifted. However, the conditions remain in place. The hospital is now rated as requires improvement overall, and requires improvement for being safe, effective, responsive and well-led. It was rated good for being caring.
As further concerns were found during the July inspection, the provider was then served with a further warning notice for failing to comply with regulations under the Health and Social Care Act 2008 which relate to safe care and treatment, premises and equipment and staffing.
Karen Bennett-Wilson, CQC’s head of hospital inspection for mental health, said:
“It is encouraging to report that Huntercombe Young People Ltd, the new provider at Huntercombe Hospital Maidenhead, has made a number of improvements since taking over in March. A new senior leadership team is now in place with the right skills and experience to drive forward the required improvements. Despite only being in post a short amount of time, we saw the positive impact being made by some structured, sustainable changes that have been put in place which have improved staff morale and made services safer, more effective and caring for the young people using them.
“However, there is still some way to go. There are improvements that need to be made to the environment to make it more suitable for the delivery of safe, good quality care. Staff need more training to enable them to do their job effectively, particularly in caring for young people with eating disorders. More therapeutic interventions and activities also need to be made available, and the provider needs to ensure that the delivery of care and treatment is robustly monitored, so improvements can be made in a timely manner.
“Although young people using the service generally felt that staff were kind and treated them with respect, the service did not always have enough staff with the right skills, qualifications and training to support them, including around safeguarding.
“Some young people with eating disorders told us they didn’t get enough support at mealtimes and that staff often made unhelpful or inappropriate comments about food. For example, a suggestions board placed in Kennet ward, offered enjoying food and baking as suggested activities, which resulted in some young people becoming distressed. They also had to wait a long time for one-to-one therapy which may have delayed their recovery.
“Other people who needed to be fed via a tube that was passed down their throat into their stomach (nasogastric** feeding) said that staff didn’t speak to them to help keep them calm while they were being fed. This process can be very distressing, and some young people saw it as a punishment. Staff told us they were under a lot of pressure when trying to support people being fed in this way and they needed more support.
“We have pointed out the improvements that need to be made in our report and have asked the provider to send us an action plan outlining how they intend to address these. We will continue to monitor the service closely to ensure that the improvements are made and fully embedded.”
Inspectors found the following:
- Managers had begun to embed a positive behaviour support (PBS) approach to care at the hospital. This had a positive impact on young people’s care and treatment. Inspectors received positive feedback from young people and staff about this improved approach and young people said they felt more involved in their care
- Staff morale had improved since the previous inspection. Staff were optimistic about the future of the hospital under the direction of the new senior leadership team
- Staff were discreet, respectful, and responsive when caring for young people. They gave young people help, emotional support and advice when they needed it. Inspectors saw lots of examples of staff caring for young people in a compassionate manner during the inspection, reassuring young people, laughing with them appropriately, engaging them in games and utilising the outside space. Staff were much more engaged with young people than on previous inspections
- The hospital was cleaner and brighter than on our previous inspections
- The use of restrictive interventions had reduced on three out of four wards
- Young people had up to date risk assessments in place with clear plans for managing identified risks.
However:
- The hospital had a high vacancy rate for registered nurses. Staffing across the hospital was inconsistent, with the same number of doctors, administrative staff and youth engagement practitioners allocated to a 20 bedded ward as a 10 bedded ward
- Less than half of staff had received an annual appraisal in the last year. Some mandatory training courses had very low compliance. These included managing medications (60%) and sepsis awareness (56%)
- Staff working with young people with eating disorders had not all received relevant training to equip them sufficiently to care for young people as effectively as needed. Meal support training was offered to staff on Kennet ward but not to staff on Thames ward. An eating disorders e-learning course was available however this was not mandatory. This meant that staff who had not undertaken this course lacked an understanding about how to support young people with eating disorders and therefore young people did not always receive adequate support at mealtimes
- Several staff involved in assisting young people with nasogastric** feeding told us that they did not feel adequately supported to undertake this role effectively
- Young people did not always receive the therapeutic intervention required to support them adequately. Young people had to wait a long time to access one-to-one therapy with appropriately trained therapists. The hospital had struggled to recruit therapy staff, hence there were very few of these available to support the therapeutic interventions required
- Documentation and incident reports lacked sufficient detail to clearly portray what had happened during an incident. For example, not detailing the actions taken by staff to try and de-escalate a young person prior to restraining them
- Tamar ward required modification to ensure it met the needs of young people. It was located over two floors which made observation difficult. There was a lack of communal space and the corridors were very narrow which meant it was difficult for people to pass one another safely. There were also issues with the sound and ventilation on the ward
- The communal space on Kennet ward was too small to accommodate the 20 young people cared for on the ward
- Although frequency of communication with relatives had improved, there were still inconsistencies in communication and relatives did not always feel listened to by staff
- The ligature audit for Severn ward did not include plans to mitigate all identified risks.
Full details of the inspection are given in the report published on our website.
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