The overall rating for Uplands Independent Hospital in Fareham has dropped from good to inadequate, following a Care Quality Commission (CQC) inspection in January.
The hospital, which is run by Coveberry Limited, provides long stay and rehabilitation mental health services for up to 30 adults. At the time of the inspection there were 19 inpatients. The hospital was originally established to provide life-long care for people with mental health issues, however, national guidance has since changed, and the hospital should now be focused on supporting people to learn to live independently in the community.
CQC carried out an unannounced inspection of the hospital after receiving a number of concerns about the safety and quality of care being provided. Following the inspection, the overall rating for the service dropped from good to inadequate overall. The ratings for being effective, caring, responsive and well-led also dropped from good to inadequate. Safe dropped from requires improvement to inadequate.
Karen Bennett-Wilson, CQC’s head of hospital inspection, said:
“When we inspected Uplands Independent Hospital, we were concerned to find that the service wasn’t focused on supporting people to regain the skills and confidence to live independently so they could be discharged as quickly as possible. Instead, the culture in the hospital was more like a care home where people stay on a long-term basis. We found people were staying in the hospital for an average of five years, and some had been there for as long as 22 years. This is far too long, putting people are at risk of becoming institutionalised and not being able to live a full and active life in the community.
“It was distressing to hear that people receiving care at Uplands Hospital didn’t always feel safe, and that some staff didn’t always speak kindly to them. In addition, people told us that some staff could be threatening, dictating and on occasions, they laughed at them, which impacted on their mental health. People also told us some staff didn’t always act in their best interests or respond when they asked for help, emotional support or advice. Some staff told us that some colleagues used derogatory language when talking to people, but they didn’t feel confident about raising the issue of disrespectful, discriminatory or abusive behaviour that they witnessed with managers.
“We found out-of-date care plans and risk assessments which meant people may not be receiving the care or treatment they needed. When we asked about these, senior managers told us they were not sure who had written the care plans and risk assessments. This should have been picked up and addressed by managers and demonstrated the lack of oversight of the care needs of people at the hospital.
"An improvement plan for the hospital had been developed when the hospital director took up post which identified many of the issues we found where improvements were needed. However, little action had been taken to make the improvements.
“Following the inspection, we told the provider it must make a number of immediate improvements to ensure people receive safe care. The hospital is now in special measures which means we will continue to monitor it closely to ensure improvements are made and fully embedded in a timely manner.”
CQC found the following during this inspection:
- The hospital did not have suitably qualified, skilled and experienced staff to deliver person-centred and recovery-focused care safely to patients. Not all staff had completed their mandatory training, including emergency first aid, conflict management and use of restraint, training on the Mental Capacity Act and safeguarding training
- The senior leadership did not have robust governance arrangements in place to monitor the safety of care and ensure any necessary improvements to protect patients from avoidable harm were made in a timely manner
- There was little evidence of a rehabilitation and recovery model of care being implemented at the hospital. Patients said there was a lack of suitable things to do and inspectors did not see any activities to support patients to learn new skills, such as cooking or budgeting, to help them move on and live more independently
- Staff had failed to plan care according to the individual needs of the patients, so they did not always receive the best support from staff. Physical health plans lacked detail so staff were unsure what they needed to do to monitor patient’s physical health
- Risk assessments did not identify all the risks for patients and had not been robustly reviewed. This meant staff did not have a full understanding of how they might protect patients from avoidable harm
- Staff did not always manage medicines effectively and safely. They had not considered the impact of the medicines on patients’ physical health and had not initiated high dose antipsychotic monitoring for patients. They were unsure of who was on a high dose of antipsychotics and therefore were not taking steps to protect patients from avoidable harm. Inspectors also found several out of date medicines and incomplete medicine charts
- None of the care plans reviewed had a discharge plan and there was no evidence of discussion with patients around their discharge. Some patients said that they were not included in planning their care, which meant they were delayed from moving on from the hospital to an appropriate placement
- There was insufficient oversight to ensure incidents were appropriately reported and staff said there were problems with the current reporting process. This meant there was a risk some incidents were not being reported and investigated appropriately
- Wards were not being cleaned regularly. Bedrooms that were no longer used had not been cleaned after patients had been discharged and contained broken furniture and dirty clothes left by previous patients. Staff did not understand their infection control responsibilities. Inspectors found open-topped bins containing dirty aprons and masks.
However:
- A number of new staff were being recruited at the time of inspection and the service had access to a range of specialists to help meet the needs of the patients on the ward
- Staff spoke fondly about patients and said they had built good relationships with them over a period of time
- Patients had some access to psychological therapies and occupational therapy. The psychologist and occupational therapist had met all patients on the ward and there was a psychology assistant who helped provide therapies identified by the psychologist
- The therapy team was keen to implement training for all staff about relevant issues including positive behaviour support plans
- Staff mitigated risks in the environment by use of mirrors and observations and were aware of ligature risk points
- Care records were kept securely. Staff had access to the care records and made daily notes about patients.
Full details of the inspection are given in the report published on our website.
For enquiries about this press release please email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters.)
For general enquiries, please call 03000 61 61 61.