The acute wards for adults of working age and psychiatric intensive care units at South West London and St. George’s Mental Health NHS Trust, have retained their rating of good overall, following an inspection by the Care Quality Commission (CQC) in August. However, some improvements are needed.
CQC carried out an unannounced focused inspection after receiving information about the quality and safety of the service. Following the inspection, the rating for safe dropped from good to requires improvement. Effective, caring, responsive and well-led were inspected, but not rated, and therefore remain as good. Helen Rawlings, CQC’s head of hospital inspection, said:
“I am pleased to report that our findings at South West London and St. George’s Mental Health NHS Trust were largely positive and that most of the time, the service had enough nursing and medical staff with the right training to keep people safe. Most patients we spoke to said that the majority of staff were caring and treated them with respect and kindness.
“However, we did find some issues which resulted in the rating for safe changing from good to requires improvement. We have told the trust that it must ensure that it is managing people’s physical, as well as mental, health risks. We were also concerned that staff were observing some patients at exactly the same times each hour. This meant there was a risk that people could anticipate when staff would be carrying out their checks and plan to harm themselves when they knew that they would not be watched. We also pointed out a number of other areas for improvement and we will continue to monitor the service to ensure that these are made.”
Inspectors found:
- All ward environments were safe, clean, well equipped, well furnished, well maintained and fit for purpose
- The service had staff, who knew the patients and received appropriate training and supervision to keep patients safe from avoidable harm
- Staff felt respected, supported and valued and described an open, compassionate and responsive culture. Staff worked well together and were supportive of each other
- Staff were observed engaging with patients in a kind and caring way during the inspection. However, patients said that a few staff could be abrupt and didn’t speak to them in a caring manner. Staff involved patients in their care and asked them to give feedback about their experience
- Staff listened to patients’ complaints and tried to address them. Complaints and lessons learned were shared with the staff teams
- Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
However:
- After patients had been seen by a specialist, staff did not always follow up on recommendations the specialist made in relation to the patient’s physical health. We found one patient whose care plan lacked sufficient detail about their physical health care. Subsequently the patient developed a suspected urinary tract infection
- On several occasions, records showed that staff completed intermittent observations at regular, predictable intervals. By conducting observations at exactly the same time within a specific time period there was a risk that patients could predict what time staff would be observing them and plan to harm themselves in between times. The trust’s engagement and observations policy did not set out clear and achievable expectations regarding the need to carry out observations four times an hour
- Newly introduced electronic physical health monitoring and engagement and observation forms were not completed accurately and consistently by staff. Some staff told us they would like more training
- Some staff reported that while most of the time there were the correct number of staff working, they were sometimes so busy that it was not always possible to take breaks. Patients also told inspectors that sometimes there were not enough staff on shift to enable them to take escorted leave
- Staff did not always report and grade incidents clearly and in line with trust policy
- Patient notes were comprehensive, and all staff could access them and all information about patient’s was stored on an electronic patient record. However, the system for accessing records was often very slow and it could take staff a long time to enter and access information
- Staff did not always complete and record Mental Capacity Act assessments when appropriate
- Relatives and carers told us it was difficult to contact the wards as their phone calls often went unanswered
- The female lounge on Ward 3 was full of furniture and the belongings of former patients making it impossible to use.
Full details of the inspection are given in the report published on our website.
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