The Care Quality Commission (CQC) has told Cheshire and Wirral Partnership NHS Foundation Trust to make significant improvements following an inspection of acute wards for adults of working age and psychiatric intensive care units (PICUs) in November found them to be inadequate.
An unannounced inspection was carried out after CQC received concerns about the safety and quality of care being provided. These were specifically regarding Mulberry ward in Macclesfield and Brooklands and Lakefield wards at Clatterbridge Hospital on the Wirral.
Following this inspection, the overall rating for acute wards for adults of working age and PICUs has deteriorated from good to inadequate. How well-led the service is has also dropped from good to inadequate. The rating for safe has moved from requires improvement to inadequate. Caring remains rated as good as this was inspected but not rated. The ratings for effective and responsive were not inspected and also remain rated as good. The overall trust rating remains as good.
As a result of this inspection, CQC served the trust with a warning notice to ensure it concentrates its efforts on the management of seclusion incidents.
A further inspection will be carried out to ensure action has been taken to comply with the warning notice. CQC will also continue to monitor the progress of other areas which require improvement.
Karen Knapton, CQC deputy director of operations in the North, said:
“Our inspection of these services at Cheshire and Wirral Partnership NHS Foundation Trust was prompted by concerns about the safety and quality of the care being provided to people. Leaders at the trust should be acting as advocates for the vulnerable people in its care, but we found this wasn’t always happening and took enforcement action to focus their attention on this area.
“It was concerning there was no dedicated seclusion areas in some parts of the wards, and in some areas people were secluded in their bedrooms or rooms not designated as seclusion rooms. These rooms weren’t safe or appropriate environments to seclude people as they didn’t fully lock, could be overlooked by others and didn’t meet national guidance.
“When people are placed in seclusion there should be regular checks, but these weren’t always recorded by the trust.
“However, we did see some really good care away from these seclusion issues, with staff displaying the values of the trust and working well together.
“We will return to see what improvements have been made and embedded. If we’re not satisfied people are receiving safe care, we will not hesitate to take further action in line with our regulatory powers.”
Across the areas inspected CQC found:
- Records showed that people had been secluded in rooms that were not designated as seclusion rooms on Mulberry ward for varying periods of time, including using one of the therapy rooms and their own bedrooms. However, the trust’s own policy states that people’s rooms shouldn’t be used for seclusion. This is to ensure bedrooms are kept as spaces that are safe, and free from trauma related thoughts
- Managers were not taking sufficiently robust action to address the shortfalls they had identified through their own systems. For example, the trust did not have appropriate systems and processes to fully record and monitor seclusion and its safeguards
- The trust recognised that staff were not categorising seclusion episodes properly but did not take action to address this issue fully as there were further episodes where staff did not record or categorise seclusion episodes.
Read the report published 22 February 2023: Acute wards for adults of working age and psychiatric intensive care units