The Care Quality Commission (CQC) carried out an inspection of wards for people with a learning disability or autism, run by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust in May.
The trust has nine wards that provide care to adults with learning disabilities and/or autistic people at Rose Lodge, Carleton Clinic and Northgate Hospital. This inspection included eight wards as one was closed to improve staffing levels across the other wards. Data was reviewed for this ward and is included in the report.
This was the first inspection of all these wards. The last comprehensive inspection was carried out before the trust acquired some wards from a different provider. In 2020, following a focused inspection, CQC issued four requirement notices. At this inspection these breaches had been met.
In April and May this year, CQC carried out a focused inspection of Rose Lodge and issued two requirement notices. At this inspection, the action in relation to physical health monitoring and staffing had been met for Rose Lodge.
Following this inspection, wards for people with a learning disability or autism is rated requires improvement overall and for being safe, effective, responsive and well-led. Caring is rated as good.
Debbie Ivanova, CQC’s director for people with learning disabilities and autistic people, said:
“When inspectors visited the wards for people with a learning disability or autistic people, they found leaders were visible and approachable and worked flexibly to understand the service, support staff and meet people’s needs. Also, staff felt respected and supported by managers and colleagues.
“However, it was concerning that there wasn’t enough staff on Cheviot ward to keep people safe and meet their needs. People told us that when they were short staffed, they couldn’t do their planned activities and therapies which was disappointing for them.
“Additionally, not all seclusion rooms were fit for purpose. On four wards, people didn’t have access to a nurse call alarm system. There were issues with regulating noise and the temperature on some wards, and three wards had accessibility issues due to stairs. Also, on Lindisfarne ward, people in seclusion didn’t have privacy and dignity as other staff not involved in their care, regularly entered the seclusion area which people found disruptive and had an impact on their wellbeing. The trust had acknowledged these environmental issues and were building new wards to improve medium secure wards.
“Although most of the feedback about the service was good, improvements are needed across the wards to improve patient care. Leaders know what action they must take, and we will return to check on progress.”
Findings from the inspection, included:
- Staff did not receive the right training to ensure they had the skills and knowledge to meet people’s needs. At the time of inspection training in learning disabilities, autism and alternative communication methods was not mandatory and a low proportion of staff had completed training in these areas
- Staff did not always ensure that people’s records contained evidence of their involvement in decisions about their care and treatment. Blanket restriction register did not contain all the restrictions in operation to ensure these were reviewed regularly
- The use of restrictive interventions was high and there was a high proportion of prone restraint. There was limited evidence of lessons learnt from incidents shared
- The food ordering system was not person centred as people had to order their food two days in advance. People also told us mistakes happened with meals and this meant they did not always get their food choice
- Carers told us that they wanted improved communication and involvement in their relative’s care
- There were issues with nursing assistants and registered nurses not feeling listened to and involved in multidisciplinary team discussions and decisions made on Mitford Unit which the trust was trying to improve
- It was not always clear in some peoples’ records the reason why they had been initially prescribed anti-psychotic medicines.
However:
- The service mostly met the principles of ‘Right support, right care and right culture’
- Staff managed discharge pathways as well as they could, but people stayed in hospital for longer than needed because it was difficult to find the right care and support in the community. This affected the services’ ability to care for new people who needed the service
- People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. Staff had a positive and warm approach to people and their roles
- People using the service provided mostly positive feedback on their care. Most people told us that they liked the staff that supported them and thought that staff knew them and their needs well
- Most carers told us that they felt their relative was safe and received support from staff that knew them well. They felt were welcomed by staff into the service when they visited
- Staff and people participated in research, clinical audits, benchmarking and quality improvement initiatives
- The service used systems and process to safely prescribe, administer, record and store medicines
- Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005