The Care Quality Commission (CQC) has rated child and adolescent mental health (CAMHS) services at Cheadle Royal Hospital inadequate, following an inspection in January.
CQC carried out an unannounced inspection of the services in response to concerns about safety. At this inspection breaches were found in relation to safe care and treatment, premises and equipment, systems and staffing.
Cheadle Royal Hospital, run by Affinity Healthcare Limited, is a 150-bed hospital with 13 wards which provides care to people with diverse nursing needs. Including adults with acute and psychiatric intensive care needs, personality disorders, eating disorders and adults requiring long stay rehabilitation.
This inspection only looked at three CAMHS wards – Woodlands, Orchard and Meadows.
Following this inspection, the rating for this service has dropped from good to inadequate, it has also gone from good to inadequate for being safe. Well-led has dropped from requires improvement to inadequate. Being effective and responsive has declined from good to requires improvement and caring remains rated as good.
The service will be kept under close review by CQC to ensure people’s safety and re-inspected to assess whether improvements have been made.
Alison Chilton, CQC deputy director of operations in the north, said:
“When we inspected mental health services for children and young people at Cheadle Royal Hospital, we found standards of care were well below those people have a right to expect.
“The child and adolescent mental health (CAMHS) wards weren’t well-led and information systems didn’t ensure that wards ran smoothly.
“We found ward environments weren’t always well maintained. On Meadows for example, people had graffitied doors, on Woodlands there were rooms with broken windows, although there was no safety risk from broken glass, they didn’t provide a therapeutic environment for people to live in. Also, on Orchard we saw several bedrooms either without curtains or they were too short, although the provider informed us curtains were on order. People shouldn’t have to live in an environment with these poor conditions and the provider must address these issues as a matter of priority. Also, young people couldn’t easily access the outside space which is really important to help them live healthier lives.
“Additionally, the wards had high vacancy rates and were reliant on agency and bank staff. Some young people told us that agency staff didn’t always treat them with dignity and respect.
“Some carers told us they didn’t feel supported, and communication from staff wasn’t always good. It was concerning that they weren’t informed about any incidents which had taken place, or supported when their loved ones were on home leave, which must be addressed.
“However, it was promising that ward teams had access to the full range of specialists required to meet the needs of the children and young people on the wards.
“Following the inspection, we provided feedback to the leadership team who must address our concerns. We will continue to monitor the service closely and if we’re not assured improvements have been made and embedded, we will not hesitate to use our enforcement powers to keep people safe.”
Inspectors found:
- Staff assessed and managed risk well but did not always update risk assessments after incidents
- The service recorded high levels of restraint and seclusion. However, staff used restraint and seclusion only after attempts at de-escalation had failed
- Staff did not ensure that physical health monitoring took place after every incident of rapid tranquilisation. They did not always ensure that medication side effects were monitored
- Young people and their families told us they were not always involved in investigations
- Managers did not ensure that staff received training, supervision and appraisal. Mandatory training, supervision and appraisal figures were below the provider’s target
- Discharge planning was generic and only developed as children and young people approached discharge
- Competency check lists and agency profiles outlining staff training were not always available so managers could not reassure themselves the agency staff working were suitably trained
- Young people did not have easy access to outside space.
However:
- The service provided a range of treatments suitable to the needs of the children and young people and in line with national guidance about best practice
- The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.