The Care Quality Commission (CQC) has rated Taplow Manor, which was formerly known as Huntercombe Hospital Maidenhead, as requires improvement following an inspection in June. CQC have also told the hospital to make urgent improvements to the way staff carry out observations to keep young people safe.
Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS) and also provides psychiatric intensive care units (PICU) for young people.
Following a focused inspection in March of this year, CQC took the decision to suspend the hospital’s ratings. CQC did this, as the inspection at the time only focused on some key areas of concern and they were not able to re-rate the service. CQC undertook this unannounced, inspection in June to check that improvements had been made and also to ensure they could provide an overall rating for the service.
Following this inspection, the hospital has again been rated as requires improvement overall. The rating for safe was previously requires improvement and has now dropped to inadequate. The ratings for effective and well-led remained requires improvement. Caring dropped from good to requires improvement, responsive moved up from requires improvement to good.
Deanna Westwood, CQC network director - said:
“Although we have seen improvements at Taplow Manor the developments in some areas have not been made as quickly as we would have wanted to see. We still have a number of serious concerns about some aspects of the safety and quality of care being provided.
“Taplow Manor have not fully met the requirements of the warning notice we issued to them in March, which is why their safety rating has dropped from requires improvement to inadequate. We still have significant concerns about how observations to keep young people safe are being undertaken. In addition, the hospital needs to ensure that staff undertaking observations are always competent to do so. Further environmental improvements are needed to the PICUs, Tamar and Kennett ward; young people need to be more involved planning their care and treatment and more activities are needed to ensure young people are kept occupied.
“We did find that a number of improvements had been made and staff morale has improved as a result. We also saw that staff treated young people with kindness and respected their privacy and dignity.
“We’ll continue to monitor the service very closely to ensure young people are safe and that improvements are made and fully embedded. We are aware that the local provider collaborative are supporting the service, and we are working closely with them. If the required improvements are not made in a timely manner, we won’t hesitate to take further action to keep young people safe.”
Inspectors found the following:
- There had been a significant number of incidents reported where staff had demonstrated poor practice when completing observations of young people. Incidents included staff falling asleep, leaving young people unattended to complete other tasks and not following young people when they left the member of staff’s direct vision. Young people across all wards told us that staff would not always follow them when they left the room, including those who needed to be directly observed at all times. Young people also told us that at times they would have to point out that their peer had left the room, and no one had followed them
- Not all staff had completed supportive engagement and observation training or passed the competency assessment. Some of these staff had been assigned to complete observation duties before being signed off as competent
- Not all the child and adolescent mental health wards were environmentally fit for purpose and not all wards were clean. Tamar ward had narrow corridors and the ward was split across different levels. Kennet ward was difficult to navigate with the ward being spread-out and having a small set of stairs to reach different areas. Thames ward was not thoroughly clean. The nursing office’s windows were dirty, smudged and partially obstructed by paper. Some young people and parents also commented that Thames and Kennet wards were not always clean, including the bathrooms
- The hospital did not have enough specialists required to meet the needs of the young people across all wards. There were gaps in the psychology, occupational therapy, and dietitian teams. There were also not enough youth engagement practitioners or activity co-ordinator teams to ensure that young people always received meaningful activities. Young people said they didn’t always receive therapy and were often bored due to the lack of activities or that activities weren’t meaningful for their recovery and often only involved crafts or watching TV. Parents commented that they didn’t know what therapy their loved ones were receiving or due to receive
- Young people said they were not involved in developing or aware of the content of their care plans. Parents said that they weren’t involved in their loved one’s care and were often not informed about changes to their care.
However:
- Staff treated patients with kindness, respected their privacy and dignity, and understood the individual needs of patients
- Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained young people only when these failed and when necessary to keep them or others safe. Staff were able to give inspectors examples of strategies that they would use to try and de-escalate situations
- Staff explained to each child or young person their rights under the Mental Health Act in a way that they could understand, repeated as necessary and recorded it clearly in the child or young person's notes each time.