The Care Quality Commission (CQC) has found improvements at Ivetsey Bank Hospital in Stafford following an inspection in June that sees its overall rating change from inadequate to requires improvement.
CQC carried out an unannounced comprehensive inspection at the hospital to assess the quality and safety of care being provided to people. This was to follow up on the progress they were told to make after being issued with four warning notices following their previous inspection last November.
Following this latest inspection in June, CQC were satisfied that improvements had been made and the requirements of the warning notices had been met. However, other areas of concern were identified, and further enforcement action was taken. The service remains in special measures. which means it will be kept under close review by CQC to keep people safe and re-inspected to check sufficient improvements have been made.
As well as the overall hospital rating improving from inadequate to requires improvement, as has how safe the hospital is. Effective and caring have again been rated requires improvement, responsive has declined from good to requires improvement and well-led has again been rated as inadequate.
Ivetsey Bank Hospital, run by Active Young People Limited, is a child and adolescent mental health service, which provides care for up to 37 people aged 12 to 18 years. It has three wards: Hartley, Thorneycroft and Wedgewood.
Andy Brand, CQC deputy director of operations in the Midlands, said:
“When we visited Ivetsey Bank Hospital, we were pleased to see there had been progress since our previous inspection in November, and the requirements of the warning notices had been met. However, due to further issues being found, we took further enforcement action so they could focus their attention on making urgent improvements in the areas identified.
“While we saw the hospital managed safety incidents well, investigated them and shared lessons with the team, they didn’t always involve families and children and young people in these investigations. This must be addressed as a priority, so everyone is aware what action is being taken to keep people safe.
“It was concerning people told us they didn’t have enough access to fresh air, as there weren’t enough staff to escort them off the wards and take them to the gardens. People also didn’t receive weekly one to one sessions with their named nurse. Both of these are really important to help with people’s health and wellbeing, and the provider must take action to ensure these happen.
“However, the provider had made improvements with staff completing body maps after people had sustained injuries after incidents of restraint. They also completed relevant observations after incidents of headbanging and updated risk plans as needed to keep people safe.
“Also, we found staff respected children and young people’s privacy and dignity and helped support them to understand and manage their care.
“We’ll continue to monitor this service, including through future inspections, to make sure the provider has made further improvements and people are receiving the safe care they deserve. We won’t hesitate to take further action if we find this isn’t happening.”
Inspectors found:
- Staff now updated risk plans after incidents
- Young people were given to opportunity to raise sexual safety concerns with the police and staff raised these with the local authority for external investigation. The provider now ensured staff received training workshops on safeguarding and boundaries and used specifically developed crib sheets to identify potential safeguarding concerns
- Closed circuit television footage showed staff applied least restrictive principles when restraint was required to maintain safety
- Staff now completed personalised positive behavioural support plans for young people with a dual diagnosis of autism, which meet the guidance within the Mental Health Act 1983: Code of Practice
- The provider had recruited a full-time psychologist to work on site at the hospital
- The provider ensured young people who had a preferred gender of staff delivering care were receiving this. Staff received a written handover for each shift and this information was included
- When things went wrong, staff apologised and gave children and young people honest information and suitable support.
However:
- There were gaps in electronic records, and it was difficult to access young peoples’ records
- Staff did not always manage dynamics between young people within the wards, young people said this made them feel unsafe
- Families and young people raised concerns about the lack of experience of some staff working on Wedgewood specialist eating disorders unit
- Families said they did not always receive feedback after raising a complaint, and they were not routinely invited to attend multi-disciplinary team meetings and when they tried to join remotely it was difficult to participate
- Staff did not always respect a young person’s preferred name and pronoun on Wedgwood
- Staff did not regularly check emergency equipment was in working order
- Young people did not have regular access to outside space.