A MORPETH hospital has been ordered to improve after an unannounced inspection.
The Care Quality Commission (CQC) carried out the inspection at St George’s Park mental health hospital after concerns were raised that standards were not being met.
Now a report from the inspection team shows that action is needed in four out of seven areas of care.
Failings included unsafe or unsuitable premises, not enough qualified, skilled and experienced staff, inappropriate medicine management and problems maintaining accurate records.
Northumberland, Tyne and Wear NHS Foundation Trust, which is responsible for the hospital, said it responded immediately to address the issues raised and additional nursing staff will be recruited.
The hospital provides a full range of mental health facilities, including care for people with learning disabilities and problems with substance misuse, as well as rehabilitation services.
The unannounced inspection took place in November, assessing the Embleton ward, which provides acute male admission and assessment services, and Bluebell Court, which is designed to prepare patients for moving on to independent living.
Concerns had been reported about the layout and security of Embleton and inspectors found that one of two enclosed gardens next to the unit was not being used because the design of the perimeter fence enabled patients to climb over it or gain access to the roof and they could abscond.
The main garden was in use, but there were some blind spots and fencing could be easily scaled, providing access to a single storey roof.
Patients used the garden to smoke, but no shelter was provided.
In the ward itself inspectors reported that it was clean and well decorated, while furniture was robust. However, privacy blinds in bedrooms were nearly all open so anyone walking along the corridor could look in.
While staffing levels were appropriate at Bluebell Court and patients were complimentary about the workers, the CQC team said there were issues in the Embleton ward.
Patients said there were too many changes of doctors and the ward manager confirmed that three locum consultant psychiatrists had been used over five months following the retirement of the previous consultant. Three out of five patients said they did not see their clinician often enough.
The manager said there were difficulties covering staff absence due to numbers, and he backed up patients’ complaints that they didn’t get out because of a lack of escort staff.
Agency staff had been used, but an issue of competency had arisen and this was being reviewed. It was hoped that the use of a bank team across each ward would reduce the need for such staff.
The CQC report states: “In relation to the number of patients on the ward; the number of patients detained under the MHA, the times that authorised patients leave from the ward has been cancelled; the design of the ward and the level of required observations we found there were insufficient numbers of appropriate staff to ensure the health and welfare of patients on Embleton ward.”
On medicine management, inspectors found that some medication kept for emergency use had reached its expiry date, but was still available on clinical units and staff did not know who had responsibility for checking the dates.
The last medicine management audit was dated 2011, despite stating it should be repeated annually, similarly with an audit of drug storage and custody of keys.
However, a medicine management policy had been extensively updated during 2012 and controlled drugs were stored securely and checked daily.
When inspectors examined patients’ records they found errors in completing forms, some of which could lead to patients’ leave being allowed when not authorised.
Standards were met in respecting and involving patients in their care, ensuring patients’ needs were assessed and treatment was delivered in line with their individual care plans, and providing an adequate complaints procedure.
Positive comments were made by patients about respect for their privacy and dignity and involvement in their care, particularly in Bluebell Court, where there was information in each person’s flat about planned activities, mental health issues and the complaints procedure.
In Embleton, patients said staff treated them well, but there were limited things to do. However, at Bluebell Court they said there were services to meet their social needs, such as a club house, community centre and gym.
People were involved in setting their own goals and measuring their progress, and treatment reflected research and guidance.
An information leaflet was available about the complaints procedure in a format to meet patients’ needs and people were aware of the system.
A spokesman for Northumberland, Tyne and Wear NHS Foundation Trust said: “We have over 6,000 staff and as one of the largest mental health and disability organisations in the country we aim to deliver high standards of care consistently well across our organisation. We therefore always welcome the Care Quality Commission’s inspection reports as they help us to assure our compliance with the essential standards of care.
“The Trust has 37 separate inpatient sites registered with CQC, including seven main hospital sites. Since April 2012 CQC has inspected 15 of those sites and reviewed the range of essential standards, amounting to 77 separate outcome reviews. The results of which are published on the CQC website, showing the Trust is complaint with the essential standards across all sites, with the exception of St. George’s Park. The reports also highlight areas of good practice and specific positive quotes from service users and carers on the care and treatment provided by NTW.
“Following the recent inspection of two of our units/wards at our St George’s Park hospital, CQC has reported that we need to do more to meet essential standards on this site. The Trust responded positively to the concerns raised and improvements were made immediately.
“We have highlighted to CQC within an action plan the further enhancements we plan to make, including the recruitment of additional nursing support for the site to be accessed across all wards.
“The quality and safety of care we provide to our patients is always our primary concern and we act immediately if, and when, any of our services are deemed to fall short.”