The Care Quality Commission (CQC) are demanding improvements to ensure children and young people are safe following an unannounced focused inspection at Taplow Manor in Huntercombe Lane South, Maidenhead.
This comprehensive inspection in December was able to follow up on progress made by the service, following previous action taken by CQC.
Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS). It provides specialist mental health services for adolescents and young people from 12 to 18 years of age. The hospital delivers specialised clinical care for young people requiring inpatient CAMHS, including psychiatric intensive care (PICU) and eating disorders.
Following the inspection, the overall rating for Taplow Manor has dropped from requires improvement to inadequate. How well-led the service is has also dropped from requires improvement to inadequate. The service remains inadequate for being safe, requires improvement for effective and caring, and good for responsiveness.
The service is now in special measures which means it will be kept under close review, by CQC and re-inspected to check sufficient improvements have been made.
Deanna Westwood, CQC’s director of operations in the south, said:
“Following our inspection of Taplow Manor, we still have significant concerns regarding the care of the children and young people living in this service.
““There were concerns related to feeding young people under restraint. While there were care plans in place there was little detail. The recording of feeding a young person via naso-gastric tube when needed did not record of the length the tube that was inserted. No record of which nostril the tube was inserted into and no record of clinical assessment of the nasal cavity. There was no indication the practice guidance had not been followed and there were no incidents of misplacement, however, the recording didn’t have enough detail and evidence of all the interventions undertaken.
“We also reviewed records where rapid tranquilisation had been used. In three of the records the young person had only been followed up for physical health observations for the first hour afterwards and none after that. In the fourth record no physical health observations were recorded and the young person was only noted to be sleeping. This is not what the national guidance or the providers policy states and has a very high impact in terms of the young person’s safety.
“Taplow Manor have made some improvements where we identified that they should, however, this has reduced their focus on other areas which means that children and young people are still not safe. Also, other improvements that we have been assured would take place are not happening at the pace we want to see, given the seriousness of the concerns.
“The leadership at Taplow Manor have had more than enough time to implement new strategies and improvements on the service. We have already taken enforcement action which is still in place.
“When we return if there are no further improvements or we are not satisfied with progress – we will not hesitate to use further action if needed to protect the young people in their care, even if that means removing the registration of the service.”
Findings from the inspection included:
- Tamar ward remained unfit for purpose and this had been a concern in the last three inspections. The provider was submitting a planning application so a new purpose built ward could replace it. However, there had been little progress to manage the immediate concerns about the ward environment and it was not well maintained
- Not all of the wards at the hospital were well maintained. Ward furniture was in a state of disrepair, there was graffiti on the walls and peeling paint. Tamar ward was unclean. The floors and carpets were heavily stained and there was dirt throughout the ward. Bathroom areas and the clinic room were also unclean
- The layout of Kennet ward continued to be problematic. This is a specialist eating disorder ward and the layout could be challenging for individuals in poor physical health. The ward was divided over different levels and involved going up and down small sets of stairs to access the different areas of the ward. For example, the bedroom areas were up a small set of stairs, to access the lounge area involved going up and down stairs across a landing area. This increased the risk of trips and falls
- The hospital’s only seclusion room was located on Juniper ward. The seclusion room had the toilet, shower and sink located within the seclusion room and not in an en-suite arrangement. Young people in seclusion were required to sleep, eat and be in the same room as the toilet. Despite having a screen so that young people could use the toilet without being observed. This still meant that young people using these facilities would have to sleep, eat and be in the same room as the toilet which compromised their dignity
- Staff did not always involve children and young people or give them access to their care plans and risk assessments
However:
- Staff made every attempt to avoid using restraint by using de-escalation techniques and restrained children and young people only when these failed and when necessary to keep the child, young person or others safe.