Cedar House in Barham, Canterbury, has been rated inadequate overall, following an inspection by the Care Quality Commission (CQC) in January.
Cedar House is a specialist hospital, managed by Coveberry Limited, which offers low secure services for people with a learning disability or autistic people who have a forensic history, challenging behaviour and complex mental health needs.
The service has six wards and capacity for 39 people. At the time of the inspection there were 32 people using the service.
CQC carried out an unannounced comprehensive inspection after receiving concerning information about the care and treatment being provided, as well as issues with leadership and staffing.
Following the inspection, the overall rating for the service dropped from requires improvement to inadequate. Its ratings for being safe, effective and well-led also dropped from requires improvement to inadequate, and its ratings for being effective and caring dropped from good to requires improvement.
CQC has also placed the service is in special measures, which means it will be closely monitored and re-inspected within six months to assess whether improvements have been made.
Following the inspection, CQC also told Coveberry, as provider of the service, it must make immediate and ongoing improvements to the service to ensure that people were provided with safe care and treatment. However, the provider was not able to offer enough assurance that it would be able to address the concerns.
To help it make the improvements, CQC imposed conditions on the service preventing it from admitting any new people without prior written agreement. The provider was also asked to submit a detailed action plan explaining how it would make improvements, and to provide regular updates on the progress of the action plan.
Karen Bennett-Wilson, CQC’s head of hospital inspection, said:
“When we inspected Cedar House, we were disappointed to find the provider, Coveberry Limited, hadn’t done enough to make the improvements it said it would make after our last inspection and we were worried about people’s experience of living here.
“All the wards were unclean and in a state of disrepair which made it an unsafe and unpleasant place for people to live. We saw damaged flooring, boarded-up windows, rotten window frames, damaged furniture, leaking baths and sewage problems. Some areas were not fit for purpose, particularly the enhanced low secure ward, which the provider agrees needs to be closed, but it needs to remain open until alternative, appropriate care placements are found for people. This is unacceptable and placements need to be found speedily.
“Staff shortages meant people weren’t being encouraged to be independent or to stay active. They couldn’t go outside when they wanted to and were stuck on wards with nothing to do. Relatives told us they were worried about this and also about the unhealthy food which people were being served.
“We were also concerned that care plans didn’t include discharge planning when people were admitted, with clear goals to support people to move out of the hospital to more suitable accommodation. One person’s discharge had been delayed for over 10 years due to a lack of available accommodation with safe staffing in the community. This is unacceptable.
“Staff didn’t have the right training to support people, and relatives didn’t feel assured staff could manage their family member’s complex needs, but they weren’t invited to assist with planning care for their loved one.
“Manager’s weren’t supporting or supervising staff properly or sharing feedback and learning from incidents with staff.
“Our priority is the safety of people, so we have imposed conditions on the service preventing it from admitting any more people until improvements have been made.
“We continue to monitor the service closely. If the required improvements aren’t made, we will consider taking further action which could lead to closure of the service.”
CQC found the following during this inspection:
- Leadership was not always effective and governance processes did not always ensure the service kept people safe, protected their human rights and provided good care, support and treatment.
- The service did not ensure care, support and treatment was delivered by trained staff and specialists able to meet people’s needs. Staff did not receive adequate training on areas including the Mental Health Act, safeguarding, safe observations and therapeutic engagement. Most relatives said they felt staff lacked training specific to learning difficulties and autism and did not understand their relatives’ complex needs.
- Ward managers were not based on the wards they managed, making them less approachable. Leaders did not recognise the necessity for staff to have consistent support and training to meet the needs of the people using the service.
- Managers did not always share lessons learned with the whole team and the wider service. There were a lack of processes and systems to address concerns, which meant there had been little or no change in areas where improvement should have been made.
- People did not always receive care and treatment that kept them safe or enabled them to meet their needs and aspirations. Staff did not understand how to implement effective Positive Behaviour Support (PBS) plans. Instead, PBS plans were mostly used by staff to assist with the management of challenging behaviours, instead of to support and understand people’s behaviour.
- Care plans were not consistent in quality and did not take the person’s physical, psychological and social care needs into account. Most people did not have clear plans in place to support them to return home or move to a community setting.
- People did not always have access to information in appropriate formats for someone with a learning disability to understand.
- People’s care and support was not provided in a safe, clean, well equipped, well-furnished and well-maintained environment suitable for people's sensory and physical needs. Two wards were noisy and decorated with extremely bright colours which would be overwhelming for people with sensory processing difficulties. People did not always have access to outside space as some wards did not have a secure outside area.
- One annexe did not uphold the basic rights of privacy, dignity or humane treatment. It lacked any comfort, other than a bed, and food and drink were passed through a window, or placed on the floor while the person was made to sit on the bed. The hospital seclusion room bathroom could be directly observed by staff, providing no privacy and dignity for the person using these facilities.
- People could not always be observed in all parts of all wards, and observation levels were not always maintained as prescribed in care plans.
However:
- People said staff treated them well and behaved kindly. People could give feedback on the service and their treatment, and staff supported them to do this.
- The service had some processes in place to safely administer and record medicines use. Medicines were stored safely and securely. Medicines for use in emergencies were easily accessible to staff. Staff reviewed each person’s medicines regularly and provided advice on their medicines. Staff could access advice from a clinical pharmacist.
- People’s treatment, including medicines, were discussed in a weekly meeting by a multidisciplinary team of healthcare professionals. Staff were able to demonstrate the impact of people’s medicines on their treatment and how care plans would be updated with new treatment plans if needed.
- People’s risks were assessed, recorded and reviewed regularly by the multidisciplinary teams, including after any incident and at monthly multidisciplinary meetings. People were involved in managing their own risks whenever possible. People were engaged in developing their care to help them understand how they viewed their needs and communication styles and what helped them at times of upset or anger.
- When discharge was agreed, staff worked well with services that provide aftercare to ensure people had the right care and support in place when they went home. Staff also held multidisciplinary meetings to support the person and keep them informed of plans and changes.
Full details of the inspection are given in the report published on our website.
Notes to editors
For enquiries about this press release, email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact our media team. (Please note: the press office is unable to advise members of the public on health or social care matters.)
For general enquiries, call 03000 61 61 61.