The Care Quality Commission (CQC) has taken action to protect people after an inspection in March rated the forensic inpatient and secure wards at Brooklands Hospital, which is run by Coventry and Warwickshire Partnership NHS Trust, inadequate.
The forensic inpatient and secure wards provide care and treatment to autistic adults, and as well adults with a learning disability.
This inspection took place in March due to concerns CQC received about the quality of services being provided.
Following the inspection, the wards were again rated inadequate overall, and for being safe and well-led. The service’s rating for being responsive improved from inadequate to requires improvement. How effective and caring the service is remains rated as requires improvement.
Due to concerns found at the March inspection, CQC took enforcement action and served the trust with a warning notice to focus its attention on rapidly making significant improvements.
In July, CQC returned to inspect the service and found many of the issues identified within the warning notice had been addressed. However, due to further improvements being needed, the trust was issued with a requirement notice.
Sonia Brooks, CQC deputy director of operations in the midlands, said:
“When we inspected Brooklands Hospital in March, it was concerning to see that the provider hadn’t acted upon all recommendations from our previous inspection.
“Staff felt burnt out from working additional hours and carrying out extra tasks due to a shortage of permanent nurses. One nurse told us, senior managers didn’t acknowledge or care how being short staffed impacted on their mental health and wellbeing. We told the trust this must be addressed as a priority to ensure all staff are given the help and support they need to keep them well and be able to provide the best possible care to people.
“We also found that environmental checks weren’t always thorough, and there had been eight recorded incidents in 12 months. Some included people managing to eat items such as screws and batteries which could put them at risk of harm. However, these weren’t always accurately recorded which must be improved as a matter of urgency so staff can learn from these incidents and help prevent them from re-occurring.
“We were told that permanent staff treated people well and were kind, however, temporary staff didn’t care for them in the same way. People said they felt uncomfortable and paranoid when temporary staff were on duty.
“The trust was given a warning notice to direct their attention on areas which needed significant improvement. When we returned in July, we found the trust had met most of the requirements of the warning notice, however as there were still some areas which need improvement, the trust was given a requirement notice.
“During July’s inspection, we found there had been improvements since the March inspection. For example, the trust had put in place a comprehensive training programme to increase staff knowledge around security issues, including environmental safety checks. We also found staffing levels had improved and vacancy rates had reduced. Additionally, we saw several examples of staff using different ways to communicate with people, including easy read versions of care plans.
“We will continue to monitor the service closely and will return to carry out another inspection to ensure people are receiving safe care.”
In March, inspectors found:
- The provider did not ensure there were enough staff within the service trained to deliver safe, person-centred care suitable for a secure environment
- The environment wasn’t secure, fit for purpose and meeting the needs for people
- Staff did not have easy access to information
- People said they could only have a hot drink at certain times in the day
- People on a particular ward could only access leave once they had completed daily tasks and were looking clean, smart, and tidy
- The service did not adhere to the Mental Health Act Code of Practice in relation to long term segregation and seclusion practice, including timeliness of reviews
- People did not always have expected discharge dates and were delayed in their discharge from hospital, so were kept in hospital longer than necessary
- People did not have an individualised timetable and could not shape their own meaningful activities, independence, and quality of life. People said activities were often cancelled and did not happen on evenings or at weekends
- Staff weren’t carrying out observations of people in accordance with their policy and the National Institute for Health and Care Excellence (NICE) guidance to protect people from harm
- The service’s quality improvement plan and audits of the service were not effective in mitigating risk and improving quality for the people in their care
- Staff weren’t receiving supervision in line with trust policy, staff nurses said they felt burnt out
- People had access to contraband items, this led to subsequent incidents
- Staff weren’t completing accurate records when people were secluded and people didn’t feel safe with bank and agency staff.
However,
- Staff had the skills to develop detailed positive behaviour support plans and risk assessments
- Care plans were individualised and met people’s needs. People had a copy of their care plan and could attend their weekly ward review
- People received a range of treatments in line with national guidance for best practice. These were delivered in group and individual sessions
- Vacant occupational therapy posts had been recruited to.