The Care Quality Commission (CQC) has rated the forensic inpatient and secure wards at Avon and Wiltshire Mental Health Partnership NHS Trust as requires improvement following an inspection July.
This inspection of forensic inpatient and secure wards was carried out at Fromeside, based at Blackberry Hill Hospital in response to concerns received by CQC. Fromeside is an 81-bed medium secure service caring for people who cannot be treated in mainstream mental health services.
Following this inspection, the trust’s rating for forensic inpatient or secure wards has dropped from good to requires improvement overall, as have the ratings for being safe, caring and well-led. The ratings for effective and responsive remain rated as good overall.
The overall rating for Avon and Wiltshire Mental Health Partnership NHS Trust remains rated as requires improvement.
Roger James, CQC deputy director of operations in the south, said:
“During our inspection of the trust’s forensic services we saw a high vacancy rate, with agency staff filling roles instead. This put people at risk of being cared for by staff less familiar with them or the service and leaders must do more to support agency staff in this area to improve people’s experiences.
“The trust used a high number of bank or agency staff to support with individual cover and to help with vacant shifts. However, leaders did little to ensure agency staff were supporting people on the wards or working to the values of the organisation despite permanent staff telling them it was an issue. People using the service told our inspectors that some temporary staff weren’t always respectful towards them. This must be addressed urgently and leaders must listen to staff who have important insight about how things can be improved.
“Staff imposed blanket restrictions on people when giving everyone access to the garden. Staff opened the doors to the garden area for 15 minutes every hour, however, when those doors were open the doors to all other communal areas were closed. This doesn’t support people to have maximum choice and independence within these wards.
“However, people were supported to by staff to maintain relationships with families and loved ones. There were visitor’s rooms for people to see visitors in private and staff accompanied patients on visits to see loved ones when they were required.
“We have shared our findings with the trust so they know where improvements must be made and where there is good practice to build on. We’ll continue to monitor the service to ensure people’s safety.”
Inspectors also found:
- Temperatures of clinic rooms were often above 25 degrees meaning medication wasn’t always being stored to preserve its effectiveness. Staff didn’t always follow the trust’s guidance on taking action when temperatures were above the recommendations. Senior leaders were aware of this happening, but no action was taken
- People didn’t always have access to meaningful or regular activities which is important for their wellbeing
- Despite wards having quiet areas and sensory rooms, inspectors noted high levels of noise from staff keys and doors slamming. This had been raised by people using the service and inspectors also raised these issues.
However:
- The trust was taking steps to develop community relationships which would support the smooth transition of people into discharge
- The service provided wards which were clean
- People cared under Mental Health Act were told about their rights and their Section 17 leave or leave of absence from the hospital was rarely cancelled.