The Care Quality Commission (CQC) has rated Ashwood Court Nursing Unit in Cheshire, inadequate overall and suspended further admissions to the service, following an inspection in May.
Ashwood Court, run by Making Space, is an independent hospital for people aged 18 to 65 who need support with a severe mental illness.
CQC inspected the unit as part of its regular checks on the services it regulates.
Following this inspection, CQC took urgent action and placed conditions on the service’s registration which prevent the provider from admitting any further patients to the unit. The service was also asked to urgently ensure lifesaving equipment was in place and fit for purpose, and to complete risk assessments for all patients.
In addition, CQC served two warning notices relating to concerns around the safe care and treatment of patients and a lack of good systems and processes.
CQC has told the provider to take action to address the concerns identified. The service is now in special measures, which means it will be monitored closely and re-inspected to assess whether sufficient improvements have been made.
The overall rating for the service has now gone down from good to inadequate. The ratings for being safe and well-led have also gone down from good to inadequate and its ratings for being effective, caring and responsive to people’s needs have gone from good to requires improvement.
Brian Cranna, CQCs head of hospital inspection, said:
“When we inspected Ashwood Court, we found leaders didn’t have enough oversight of the service to ensure patients were receiving safe care and treatment, and it was worrying they weren’t aware of the concerns until this inspection.
“We found staff didn’t have the knowledge and skills needed to keep people safe. They didn’t have adequate training to safely manage incidents of violence and aggression, and weren’t up to date with mandatory training or have training in basic life support.
“We had concerns staff didn’t follow the provider’s absent without leave policy. There were two incidents where patients had gone absent without leave, following which risk assessments were not updated for both incidents and relevant staff weren’t informed which could place people at serious risk of harm.
“It was also disappointing that medical equipment hadn’t been routinely checked, as well as disposable items being out of date which was raised at the last inspection in 2018. Resuscitation equipment was also out of date or missing and had been for several months which isn’t acceptable and must be checked to ensure its safe, in case it is needed in an emergency.
“However, I’m pleased to report the staff had a caring attitude and patients spoke positively about the unit. Patients also had a good relationship with bank and agency staff.
“Due to our concerns we have issued the provider with two warning notices and placed the service in special measures to ensure significant improvements are made quickly, and embedded.
“We’ll continue to monitor the service closely and return to check on progress. If we feel people are at risk of harm, we will not hesitate to take further action.”
During the inspection, CQC found:
- Staff did not complete a risk assessment or crisis plan for all patients and did not review patient risk following incidents. Opportunities to prevent or minimise harm were missed
- The service did not have an environmental ligature risk assessment
- Information about people’s care and treatment was not appropriately shared between staff or with partner agencies. Staff did not notify CQC of all incidents that met the threshold for reporting
- There was insufficient attention given to safeguarding. Staff did not follow the provider’s own safeguarding policy. Staff did not report all safeguarding concerns to the local authority that met the threshold for reporting
- The service did not involve patients, families and carers in their care and treatment. Discharge planning was not well managed and not all patients had a discharge plan in place
- Privacy and dignity of patients was not protected. Male patients could see into female patients’ bedrooms from the garden
- The governance arrangements were unclear and there was no clear audit system in place to assess, monitor and improve the quality and safety of the service. The medicines audit was out of date, equipment checks were not completed in line with manufacturers requirements and managers did not audit care records.
However:
- Patients described the unit as clean and comfortable
- Staff supported patients to take up volunteering opportunities within the local community
- The service had a good physical health pathway in place for patients.