Care Quality Commission (CQC) has rated the forensic inpatient and secure wards run by Avon and Wiltshire Mental Health Partnership NHS Trust as requires improvement, following an inspection carried out in January 2024.
CQC carried out the unannounced inspection due to concerns received by people using the service and their loved ones about the quality of care being provided.
Following the inspection, safe has also been re-rated as requires improvement and responsive is re-rated as good. How well-led, and caring the service was not assessed during this inspection and both remain rated as good, how effective the service is also wasn’t assessed and remains rated as requires improvement.
The overall rating for Avon and Wiltshire Mental Health Partnership NHS Trust is unaffected and remains requires improvement.
Catherine Campbell, CQC deputy director of operations in the south, said:
“When we inspected the forensic inpatient and secure wards run by Avon and Wiltshire Mental Health Partnership NHS Trust, we found very little had been done to improve people’s care since our previous inspection in July last year.
“We saw people’s care was being impacted by staff shortages, which was causing an over-reliance on agency staff who weren’t as familiar with the service or people’s individual needs. Nurses in charge of the ward told us they often had to ask staff to stay on past their shift to cover short notice absences of other staff and that the quality of some agency staff was poor which added extra pressure for permanent staff. People using the service also told us some staff weren’t always respectful towards them, which was something CQC has told the trust to address previously.
“Staff shortages were also impacting people’s freedom to use all of the public spaces at the service, such as not being able to use the garden at night as there weren’t enough staff to support people with access. However, it was positive to see blanket restrictions on people having access to the garden during the day had been removed.
“We found leaders had responded appropriately to a number of care concerns and suspended staff from duties whilst investigations took place. However, they didn’t always make sure staff followed the trust’s own policies which may avoid some of these incidents happening.
“Staff also told us they were still anxious about reporting incidents and speaking up when things went wrong, due to concerns about their job security if they did so. Leaders told us they were taking steps to address both of these issues by providing more training and staff said this was helping to improve the culture.
“We have informed the trust where they need to make improvements and we’ll continue to monitor them to keep people safe whilst they are doing so and well return to check on their progress.”
Inspectors also found:
- Inspectors saw people had made requests for different activities and food options however, there was no evidence that staff had taken action to meet these requests
- The ward had activity boards displayed with pictorial references to help with communication. However, people told us the boards did not accurately reflect the activities that were provided and they were not updated very often
- Relatives said they did not always feel involved in the care planning of their loved one.
However:
- The service had the right policies and procedures in place to handle incidents. Safety incidents and complaints were treated as opportunities to put things right, learn and improve
- Staff understood duty of candour and were open and honest with people and their families when things went wrong.
The report will be published on CQC’s website in the next few days.