The Care Quality Commission (CQC) has rated acute wards for adults of working age and psychiatric intensive care units at Herefordshire and Worcestershire Health and Care NHS Trust, inadequate, following an inspection of Hill Crest in July.
The inspection at Hill Crest was carried out to follow up on information of concern regarding people’s safety. Inspectors looked at the areas of safe and well-led only. The trust’s other two acute mental health wards for adults – Holt Ward and Mortimer Ward – were not inspected.
Hill Crest is a 18-bed mixed gender ward for adults of working age based in Redditch. The ward supports people who experience acute mental health difficulties, and those who may be detained under the Mental Health Act.
Following the inspection, the service was issued with a warning notice due to the level of concerns found. The overall rating for the service dropped from good to inadequate, and the areas of safe and well led also dropped from good to inadequate. We did not inspect or re-rate effective, caring or responsive.
The trust’s overall rating remains as good.
Craig Howarth, CQC’s deputy director of operations in the Midlands, said:
“When we inspected Hill Crest, it was disappointing to see significant deterioration in safety and quality of the wards, as well as the care being provided.
“It was concerning that lessons were not being learned from serious incidents where people could have been seriously harmed.
“For example, we were made aware of a serious incident which involved a patient attempting to throw boiling water and sugar at a member of staff. On the day of inspection, two boilers were still in use indicating that lessons had not be learned following this incident and no actions had been taken to mitigate any future risk.
“Areas of the ward were visibly dirty, including the main food preparation area, showers and toilets. We saw exposed electrical wires hanging from light fittings from the removal of ligature points which could place people at harm.
“In addition, people’s bedrooms were sparsely furnished with no wardrobes or areas to store personal items. Clothes and belongings were in bags or stacked in piles on the floor which did not support people’s dignity, wellbeing or make them feel at home.
“However, it was positive that the provider promoted equality and diversity in its day-to-day work and provided opportunities for career progression.
“We will continue to monitor the service closely and will return to check if the necessary improvements have been made. If we find this is not happening, we will not hesitate to take further action to keep people safe.”
The latest inspection found that:
- Staff did not always know about any risks to each patient and acted to prevent or reduce risks
- The trust did not ensure that risk assessments were created and reviewed in a timely way
- Patients told inspectors that male patients regularly entered a female-only lounge area without being challenged by staff
- Staff told inspectors they could raise any concerns without fear but were not confident that their voices would be heard by senior leaders
- Inspectors found equipment without in date check stickers attached including fire extinguishers. Inspectors also found fire exits blocked by equipment
- The trust did not ensure that the environment was well-maintained and fit for purpose
- Not all staff felt positive or proud to be working as part of the team. Staff told us that they felt that staffing issues had left them feeling under pressure
- Staff could not observe patients in all parts of the wards due to the large size of the building, and there were several blind spots.
However:
- Staff kept up to date with their safeguarding training. We saw on the managers dashboard that all ward staff were up to date with their training
- Records were stored securely. All patients' notes were electronic, and password protected
- Care plans that were in place were personalised, holistic and recovery orientated
- Staff explained to each patient their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly
- Managers made sure staff and patients could get help from interpreters or signers when needed. The trust had a contract with interpreter services which included access to British sign language signers if required.