The Care Quality Commission (CQC) has lowered the rating for Sussex Partnership NHS Foundation Trust’s child and adolescent mental health (CAMHS) ward at Chalkhill, from good to requires improvement following an inspection in June that found improvements were needed.
Chalkhill is 16-bedded mixed gender inpatient unit, is a sole mental health facility in the grounds of a general acute hospital, where young people aged 12-17 are admitted if they require assessment and treatment for acute mental health needs. They offer assessment and treatment of a wide range of mental health difficulties and needs, as well as support for eating disorders and disordered eating.
This inspection was carried out because CQC had received concerns regarding:
- the safety and wellbeing of young people using the service
- high levels of incidents leading to harm
- staff training and competence
- low staffing numbers
- ineffective observations of young people
- poor leadership and support.
Before the inspection the trust along with the commissioners of the service had identified some safety concerns and had an action plan had been in place to address them. However, the action plan had not been fully implemented and some of these areas remained a concern during this inspection.
As well as the service’s overall rating dropping from good to requires improvement as have the service’s ratings for how safe, and well-led it is. Caring, effective and responsive were not rated at this inspection.
The overall rating for Sussex Partnership NHS Foundation Trust remains good.
Following the inspection CQC issued a warning notice to focus the trust’s attention on making rapid and widespread improvements regarding good governance. CQC will closely monitor the service during this time to keep young people safe and will inspect again to assess if improvements are made.
Neil Cox, CQC deputy director of operations in the south, said:
“When we inspected Chalkhill we found a decline in the quality of leadership at the service which was having an impact on the level of care being provided to the young people using this service.
“It was incredibly concerning some young people had come to harm, and others had been put at risk, because leaders had poor oversight, and didn’t always have good enough systems in place to keep them safe.
“Leaders didn’t always manage risks well, and they didn’t learn from incidents when things went wrong, to stop them from happening again. Also, despite the trust having an action plan in place, we didn’t feel assured those improvements were happening quick enough.
“We also saw there were signs of a closed culture at the service. The trust didn’t do everything they could to ensure they were being open and transparent, and young people told us they didn’t always feel safe or supported to raise concerns. Staff confirmed this, as well as telling us the impact this had on their morale as a result. Leaders need to do more to listen to the experiences of people using the service as well as staff, to make improvements.
“We found a number of blanket restrictions in place for the young people staying there. For example, due to one person’s behaviours, all young people had to ask for staff to make them hot drinks and weren’t allowed to do this for themselves. We also saw it was practice that all the internal ward doors to the lounge, quiet room, garden space and bedrooms should be locked which infringed people’s human rights.
“However, we have also seen more recent positive changes to the management of the service. They know where they need to improve and we’ll return to check on their progress. We will monitor them closely during this time to make sure people using the service are safe.”
Inspectors found:
- Staff did not always manage risk well. Although staff completed daily environmental checks of the service environment, they did not always identify, remove or reduce risks that were evident on the ward. Repairs to the ward were not carried out in a timely manner which impacted on staff being able to keep people safe
- Staff weren’t always able to keep young people safe from avoidable harm. There were high levels of repeated incidents which caused harm and potential harm to young people. Staff did not always identify and report all incidents or near misses and these were not always reviewed and investigated. Action was not always taken to prevent future incidents
- Staff did not always develop care plans that appropriately reflected young people’s assessed needs. Care plans were not always personalised, holistic and recovery oriented. Staff did not always follow care plans when delivering care to young people
- There was not enough staff deployed with the skills, expertise and experience to meet the needs of the young people
- Staff did not always follow the trust’s policy and procedures when observing young people assessed as being at higher risk of harm to themselves and others
- Feedback from young people, relatives and carers was negative. Young people did not always feel safe on the ward.
However, inspectors also found:
- Young people eligible to take leave were able to take this with staff support
- Young people had been supported to successfully move on from the service
- There had been recent positive changes to the management of the service
- Young people had access to a range of specialists including nurses, occupational therapists, physical health nurses, psychologists and social workers.