The Care Quality Commission (CQC) has found improvement at St Andrew’s Healthcare – Essex following an inspection in March that sees its overall rating change from inadequate to requires improvement.
CQC inspected the hospital run by St Andrew’s Healthcare, based in North Benfleet, to assess the quality and safety of care being provided to people. The inspection was to follow up on the progress they were told to make after being issued with a warning notice at their previous inspection in June 2022, around safety and effectiveness. The hospital provides residential care for adults with mental health needs.
As well as the overall provider rating improving, the overall ratings for how safe and effective St Andrew’s Healthcare has moved from inadequate to good. How caring and well-led has improved from requires improvement to good. St Andrew’s remains rated as requires improvement for how responsive it is.
This inspection looked at three core services at this one location. The rating for the acute wards for adults of working age and psychiatric intensive care units (PICU) as well as the forensic inpatient wards have improved from requires improvement to good. The long stay and rehabilitation mental health wards for working age adults remain rated as requires improvement.
Ceri Morris-Williams, CQC deputy director of operations in the east of England, said:
“We were pleased to see there had been progress since our last inspection, with the managers addressing the issues we told them to at our last inspection, which is why the warning notice we issued is no longer active. However, there is still work that needs to be done.
“While we saw that ward environments were safe and staff assessed and managed risk well, there wasn’t always enough of them on shift who were up to date with their mandatory training to keep people safe.
“It was also concerning that people on Tiptree ward didn’t always know how long they were going to stay, and they weren’t supported to participate in education and work opportunities in the wider community, which is a key part of people’s rehabilitation.
“We saw they had made improvements in their processes around people’s observations, but leaders still need to ensure staff are recording them in a timely manner, as we saw delays which could put people at risk of harm.
“However, we found that ward staff worked well together and treated people with compassion and kindness, actively involving them and their carers in decisions. One person told us they were receiving good treatment, aimed by staff at making sure they were well enough to go back to the community.
“We will monitor the service closely, to ensure they continue to improve and take action on the areas identified, so that people using the services get the care and help they deserve.”
In the acute wards for adults of working age and PICU, inspectors found:
- The service was well-led, and the governance processes ensured that ward procedures ran smoothly
- The service provided safe care. Ward environments were safe and clean, with enough nurses and doctors. Staff assessed and managed risk well, minimising the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding
- However, wards were tired and in need of redecoration
- People from Benfleet ward requiring seclusion were taken to Tiptree ward through the ward area, potentially not maintaining privacy and dignity.
In the forensic inpatient wards, inspectors found:
- The hospital had installed a new observations system for staff to record observations in real time and managers had oversight
- Staff maintained confidentiality of the people on the wards
- The service had enough staff who knew people and received basic training to keep them safe from avoidable harm
- Learning and development needs of individual staff members need to be assessed at the start of employment and reviewed regularly, and training completion figures need to be increased to keep people safe
- Danbury ward needed cleaning when inspectors visited, and people using the service told CQC that the ward was not clean.
In the long stay or rehabilitation mental health wards for working age adults, inspectors found:
- Not everyone could access and participate in education and work opportunities
- The service wasn’t reviewing their current recovery model of care, people’s expected length of stay or creating clear discharge pathways
- People could not freely access the kitchen for drinks or snacks
- There wasn’t always enough nursing and support staff on all shifts to keep people safe
- There was a seclusion room on the ward, this had a potential negative impact on the therapeutic environment
- Staff discussed each person’s individual needs in detail at shift handovers sharing key information and both staff and people using the service spoke positively about the ward
- Staff assessed and managed risks to patients and themselves, and minimised restrictive practice to facilitate people’s recovery
- Staff followed best practice in anticipating, de-escalating, and managing challenging behaviour
- The ward teams included or had access to the full range of specialists required to meet the needs of people on the wards.