This is not in line with the providers policy and does not adhere to guidelines by the National Institute for Health and Care Excellence (NG10). 30 October 2018, Published However, we did find that improvements were needed to meet full compliance with the regulations in relation to the use of seclusion. Staff administered backslaps and dislodged the food. Staff did not always ensure patients physical healthcare needs were met at the psychiatric intensive care, forensic and long stay rehabilitation wards. The provider was in the process of obtaining funding for renovating the seclusion room. Levels of restraint significantly increased since the last comprehensive inspection across the forensic service. Staff told us that rapid tranquillisation medication was administered most days. [1] After the election, the composition of the council was: Liberal Democrat 34. Staff had not escalated these issues to estates management, leading to an unpleasant environment for patients. We found gaps in observation records. Inspection Report published 29 December 2012 for St Andrew's Healthcare - Womens Service - PDF - (opens in new window), Published It was also revealed that four patients had died on one ward between October 2010 and May 2011 and that all had been prescribed Clozapine. Peoples quality of life was enhanced by the services culture of improvement and inclusivity. How many of them have died in St Andrews? In three services, governance processes in place did not always ensure checks and audits were effective enough to ensure care delivery was improved. Managers had not effectively managed the change to the ward profile. People had clear plans in place to support them to return home or move to a community setting. At Spring Hill House, we saw that refurbishments were taking place to the shower and bathing facilities. Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance. The provider as part of a national pilot, had developed a new clinical model (co-produced with staff and patients), which was a blended approach including low and medium security. The providers governance processes had not addressed staff failures to follow the providers procedures on enhanced observations, handovers and safety checks. The provider had removed 26 blanket restrictions following our last inspection. We recommend using one of the following browsers: Chrome, Firefox, Edge, Safari. The provider invested in a programme of support to promote staff well-being. Staff did not always follow National Institute for Health and Care Excellence guidance for the use of rapid tranquillisation on Sunley ward. We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. Managers dealt effectively with poor practice and the provider had made significant improvement in following policy and procedure to deal with outcomes of investigations. Teams held regular and effective multidisciplinary meetings. Staff did not always keep patients safe from avoidable harm whilst on enhanced observations on the forensic wards and on the psychiatric intensive care unit. Patients told us that they felt the wards could be cleaner and the furniture in places was damaged and not replaced. Therapy provision on wards for people with a learning disability was below establishment and affected the delivery of therapeutic activity. Acorn ward (formerly Bayley) is a ten bed medium secure forensic service for boys with autistic spectrum conditions and / or learning disabilities. Neurobehavioural Rapid Response -We have one male bed available today. There was little evidence that patients or their carers were actively involved in writing or reviewing their care plans on the learning disability wards. And are detained under the Mental Health Act 1983. Boardman ward is a low secure inpatient ward that can accommodate up to 11 children and adolescent females with complex mental health needs. Patients that have received a positive result can end their isolation before the 10 days if they have 2 consecutive negative LFT results 24 hours apart. Staff told us they knew the whistleblowing policy and felt they could raise concerns without fear of victimisation. Hotel and Leisure. Two services did not make timely repairs to the environment when issues were raised. Staff throughout the organisation were aware of how to report incidents and we saw good examples of staff learning from the investigation of adverse events. Northampton, Environments on wards for people with a learning disability or autism wards were not always maintained due to untimely responses to complete repairs and manage estates issues. For family visiting our Northampton site, St Andrew's are able to offer accommodation locally to aid your support of a loved on in our crisis services. The provider had recently implemented a new system for calculating the right numbers of staff required, based on the acuity of patient need. There was no evidence that the provider undertook regular and effective audits of these issues. The provider told us they were going to fit a safe diffuser over all of the ducts to try to diffuse the cool air over a larger area. We told the provider they must not admit any new patients until further notice; that wards must be staffed with the required numbers of suitably skilled staff to meet patients needs and to undertake patients observations as prescribed; that staff undertaking patient observations must do so in line with the providers engagement and observation policy and protocol and the provider must ensure there is clear documentation to inform staff of the current observation level of all patients. There was a need toassess and treat patients based on individual risk and identified needs, rather than placing emphasis on generic, restrictive risk management processes. The teams included or had access to the full range of specialists required to meet the needs of patients on the ward. On Oak ward, we found water stains in bathrooms and showers where water had been left to dry, because the drainage was not sufficient enough to allow the water to flow away. Not all wards had a seclusion facility available for use. at Northampton are the Adolescents services, men's services, women's services and acquired brain injury . Recommendations from external bodies were not always taken on board and these decisions were not always justified. Not all ward areas at the long stay rehabilitation service and learning disability and autism service were safe, clean and well maintained. Click here for our dedicated Neuro Rapid Response service page. Multidisciplinary teams worked well together to provide the planned care. John Reader 09 Jan 1822 Terrington St Clement, Norfolk, England - 08 Feb 1899 managed by James LaLone . . Please discuss this with the ward to arrange. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Download full inspection report for St Andrew's Healthcare - Womens Service - PDF - (opens in new window), Published Managers had not notified CQC about seven out of eight safeguarding incidents and had not referred one to the local authority safeguarding team. Patients and carers reported that managers were dismissive of concerns raised. Staff told us that the chief executive officer visited regularly. Staff did not always create care plans for physical healthcare conditions. Published Staff had not always recorded patients vital signs (in line with the National Institute for Health and Care Excellence (NICE guidance) when using rapid tranquilisation. There had been an overall decline in the use of agency staff over the preceding 12 months. the service isn't performing as well as it should and we have told the service how it must improve. We found some expired medicines in the clinic rooms on the wards, and that staff did not act on previous audits where this was found. Fairbairn Ward management informed us the electronic system did not allow them to specify staff trained in British Sign Language. Any other browser may experience partial or no support. Governance, CQC ratings and Annual reports, Child and Adolescent Mental Health (CAMHS), Information for family, friends and carers, LightBulb Mental Wellness for Schools Program, Centre for Developmental and Complex Trauma. The clinic rooms were fully equipped and resuscitation equipment was checked regularly and recorded however not all wards had equipment. Wards had adequate space for delivering care and treatment of patients, with appropriate seclusion rooms, low stimulus rooms, and extra care suites for patient use. Contact Research Funding Support Walter Bower House Guardbridge St Andrews Fife KY16 0US Scotland, United Kingdom Tel: Contacting the team Documents RBDC Team Structure (PowerPoint, 45 KB) A patient is assessed as posing a significant risk of suicide and the patient is unresponsive to preventative measures available, Absconding patients who are detained under the MHA 1983, for whom the consequences of persistent absconding are serious enough to warrant treatment in the PICU, Unpredictably patients, potentially posinga significant risk to self or others and requiring further assessment. We rate most services according to how safe, effective, caring, responsive and well-led they are, using four levels: Outstanding In the learning disability services there was not a clear and effective system for comprehensive handovers between nursing staff due to the set nursing shifts. This meant staff may not be clear what behaviour was expected in certain situation. Staff and patients spoke highly of the new manager and we observed that positive changes had been made on our second visit. Peoples care, treatment and support plans, reflected their sensory, cognitive and functioning needs. Medical staff told us clinical decisions were made at a senior level without any evidence based rationale or consultation at a clinical level. The inspection team consisted of one CQC compliance inspector and a mental health specialist advisor. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.