The Care Quality Commission (CQC) has published reports on two services run by Avon and Wiltshire Mental Health Partnership NHS Trust, following inspections undertaken in January.
Inspectors assessed the trust’s acute wards for working-age adults and psychiatric intensive care units, and its long stay or rehabilitation mental health wards for working-age adults.
These services care for people experiencing poor mental health, including those detained under the Mental Health Act.
Following the inspections, the acute wards and psychiatric intensive care units were rated requires improvement. The long stay or rehabilitation mental health wards were rated good.
These services were also issued these ratings following their previous inspections.
In response to issues on the acute wards, CQC served the trust a warning notice requiring it to improve the safety of the care and treatment it provides to people in the service.
These inspections were not wide-ranging enough to update overall ratings for the trust. It remains requires improvement overall.
Serena Coleman, CQC deputy director of operations in the south of England, said:
“While we found care on the trust’s long stay wards met standards people have a right to expect, people’s safety wasn’t always being ensured on the acute wards and psychiatric intensive care units.
“The acute wards faced significant pressure due to staffing shortages, which meant observations weren’t always undertaken often enough. This was worsened by some poor record management, and environments that didn’t always support people’s safety.
“While staffing challenges are affecting much of the NHS, leaders must ensure this doesn’t undermine people’s safety. We’ve issued the trust with a warning notice, so it’s clear about the improvements it must make in these areas.
“Despite the pressure they were under, staff created a positive culture, collaborating well together to support people’s best interests.
“Care and treatment of people on the long-stay or rehabilitation wards continued to meet good standards overall. Risks were well managed, and the service had enough staff to ensure people’s safety.
“However, there were gaps in staff training, including to support people whose distress presented risk to themselves and others. Although managers told us they are addressing this.
“We reported our findings to the trust so it knows where it must make improvements, and where there’s good practice on which it can build.
“We’re monitoring the trust closely to ensure people’s safety, and we’ll return to assess whether improvements have been made.”
On acute wards for working age adults and psychiatric intensive care units, inspectors found:
- Staff didn’t consistently update risk assessments, report or respond to safety incidents, or always take action to manage the risk of abuse
- Wards were not sufficiently maintained and monitored to mitigate risks, and the trust had been slow to address some longstanding issues regarding how its premises supported people’s safety
- Medicines and equipment were not always safely managed
- Vacancy rates were high and rising
- The trust had not ensured all staff who needed physical emergency response training had completed it, despite this being a longstanding issue
- Staff did not consistently ensure people’s leave was administered in line with the Mental Health Act
- Leaders did not have a good understanding of all issues the service faced, so strategies to address problems were not always developed. Some staff also reported limited engagement with the trust’s leaders.
However:
- Most staff had completed the training they needed for their roles
- Staff felt positive about refurbishments that had been undertaken at one of the service’s sites
- Teams generally worked well together, and managers dealt with internal team appropriately.
On long stay or rehabilitation mental health wards for working-age adults, inspectors found:
- Staff assessed and managed risks well
- Safety incidents were managed well. People were suitably supported, and lessons were shared across the service
- Individual care plans were developed with people receiving care and reviewed regularly
- Leaders were knowledgeable and approachable
- Staff felt respected, supported and valued.
However:
- Although staff had received basic training to keep people safe, some had not received training to defuse situations where people could become a danger to themselves and others. None of the staff inspectors spoke to knew of the Oliver McGowan Training, which supports people with a learning disability or autism, and some staff had not received adequate training, including for safeguarding
- Windswept ward, one of three visited in the service, did not have enough medical staff to ensure people’s safety and adequately meet their needs
- Cleaning records were not always available
- Some blood monitoring machines had not been calibrated to ensure accuracy
- Data and opportunities for improvement were appropriately reviewed, but inspectors were not assured this information was adequately shared with staff.