Read the full report on why a Mansfield mental health hospital was put in special measures

St Andrew’s Healthcare Nottinghamshire, Sherwood Avenue, Mansfield, is an independent hospital for men detained under the Mental Health Act.

Following an inspection by the Care Quality Commission health watchdog, it has been placed into special measures after being rated as inadequate overall.

The ratings broken down

Are services safe?​

Found to be inadequate

What did the CQC find?

Staff did not protect patients from avoidable harm or abuse. Managers had not ensured safe care environments. Inspectors identified potential ligature anchor points on Newstead ward that were not included in the ward ligature risk assessment.

Staff were not compliant with the Mental Health Act Code of Practice, with respect to the use of seclusion. Staff permitted patients on Thoresby ward to vote on whether to end other patients’ seclusion. Senior managers told inspectors that this was normal practice as part of the therapeutic community model. Staff were keeping patients in seclusion for longer than required.

Staff did not always adhere to infection control principles. On Wollaton ward, inspectors saw takeaway boxes disposed of in a clinical waste bag; staff had incorrectly put general laundry and a mop head in a contaminated waste bag; contaminated laundry had not been put in a contaminated waste bag and had been left in an untied bag.

Staff were assessing and managing risks for individuals. Inspectors examined 24 patient records, all showed that staff undertook a risk assessment of every patient on admission and updated this regularly and after every incident.

Ninety three percent of staff completed safeguarding training and made safeguarding alerts when appropriate.

Managers shared learning from incidents. Managers held daily morning meetings to discuss any serious incidents from overnight or the previous day.

Are services effective?​

Requires improvement

What did the CQC find?

Staff did not always receive specialist training. Managers had not ensured staff on Thoresby ward had completed training in therapeutic communities. According to data from the provider only four staff on Thoresby ward had completed this training. The Royal College of Psychiatrists’ service standards for therapeutic communities’ states that “all staff receive training in therapeutic communities for a minimum of two days per year”.

Staff did not always adhere to the Mental Capacity Act. Inspectors reviewed 24 patient records and staff had not demonstrated that they had assessed capacity in ten records, where appropriate, to patients’ consent to treatment.

Staff assessed patients’ needs and planned their care.

The provider had the full range of disciplines needed to deliver care. This included autism specialists, nurses, occupational therapists, clinical psychologists, social workers, healthcare assistants and activities coordinators.

Are services caring?​

Inadequate

What did the CQC find?

Staff did not always treat patients with kindness or respect when providing care and treatment or during other interactions. Inspectors observed a patient being ‘pat down’ searched in front of other patients in the communal area on Thoresby ward. This was not in line with the provider’s search policy. Inspectors reviewed 16 records of patients in seclusion. Staff were not responding to patients' requests in four records reviewed. This included requests to go to the toilet, to use the shower, for food, medicines and for blankets. In one record, the patient had requested to use the toilet at 21:45. The patient repeated this request three times and at 22:30 soiled themselves. The staff records of this incident were disrespectful and used inappropriate language. A patient told inspectors that they had witnessed a member of staff ignoring a request from a patient in seclusion for a drink.

Patients on Wollaton ward told inspectors that staff were sometimes punitive in their approach, would ignore them if they were settled, could be disrespectful and had breached confidentiality at times. On Thoresby ward, we observed a senior staff member ignore a patient, who called out to them three times.

Patients told inspectors that some staff were friendly, approachable, caring, nice, helped them to progress, were good listeners, supportive and patient focused.

Patients told inspectors they were actively involved in care planning and risk assessment and this was evident in care plans.

Are services responsive?​

Good

What did the CQC find?

The provider ensured that facilities promoted recovery and dignity. Patients had their own bedroom with en suite facilities. The provider supported patients to personalise their bedrooms on all wards. Staff had individually risk assessed this to allow patients access to technology such as games consoles in their rooms.

The provider had a full range of rooms and equipment to support treatment and care and help patients build skills to support them when they moved on from services. The provider had a range of activity and therapy rooms, including a music room, information technology suite, therapy kitchens, gyms and arts and crafts rooms.

The provider had a RACE (race, culture and ethnicity) group who looked at ways that patients from different ethnic backgrounds could be supported, for example, providing different meals from around the world.

The provider actively reviewed complaints and involved patients and staff in how they were resolved and responded to.

Are services well-led?

Inadequate

What did the CQC find?

Leaders and governance arrangements had not assured the delivery of high quality care. The provider’s governance processes had not ensured that staff followed best practice in the care and treatment of patients. Managers had not ensured that all staff worked within the legal frameworks of the Mental Health Act and Mental Capacity Act.

Leaders did not ensure that services worked towards recognised standards. Thoresby ward did not meet the service standards required to be accredited by the Royal college of Psychiatrists for therapeutic communities.

Staff knew and agreed with the organisation’s vision: to transform lives together. Managers ensured team objectives reflected the organisation’s vision and values. Managers displayed their wards values on the walls in patient areas.

Staff told inspectors they knew how to use whistleblowing process and felt able to raise concerns without fear of victimisation.

What the chief inspector said

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), said:“Our return to St Andrew’s Nottinghamshire showed there had been a real deterioration in the service being delivered and that significant and urgent improvements were needed.

“Inspectors highlighted a number of serious issues. These included that people were not protected from the risks of harm. We found a number of potential ligature points and the ligature risk assessments some staff referred to were out of date.

“Staff did not always adhere to the Mental Health Act Code of Practice when using seclusion. There were gaps in seclusion reviews, staff did not end seclusion at the earliest opportunity or complete observations correctly.

“Staff did not always respect people’s dignity and privacy or respond promptly to their needs. This included requests to go to the toilet, to use the shower, for food, medicines and for blankets. This resulted in distress and embarrassment for patients. Staff used inappropriate and disrespectful language in a patient's record.

“While some patients said that staff were friendly and approachable, others told us that staff ignored them, took a punitive approach and spoke to them in a disrespectful way.

“These findings are troubling. We have told St Andrew’s Healthcare that they must take immediate action to address the problems that our inspectors identified.

“We will continue to monitor the service closely and this will include further inspections.”

What St Andrew’s Healthcare said

A spokesperson for St Andrew’s Healthcare, responds to the CQC’s recent inspection of its hospital in Mansfield, Nottinghamshire “The CQC has rated our Mansfield hospital as Inadequate and consequently it has been placed in ‘special measures’.

“We deeply regret that in a number of instances the care provided to patients at Mansfield fell below our expected standards. As soon as the CQC raised concerns we acted decisively, closing the hospital to new admissions. We are now undertaking a clinical review and strengthening operational

oversight under new management.

"The CQC’s main concerns relate to the care and monitoring of those in seclusion – a measure that we very much consider to be a last resort. We regret that in a small number of cases, care of those in seclusion fell short of the high standards we strive for.

“The CQC also noted some specific issues around safety, privacy and respect. However, any instance where we have let patients down is one too many and unacceptable.

“While we were pleased that the CQC praised the involvement of patients in the care planning and rated Mansfield as ‘Good’ with regards to responsiveness to patients’ needs, clearly we must make significant improvements in a few key areas.

“We will continue to work with staff and patients, patients’ families and carers, as well as the CQC, to promptly address these concerns. We will welcome the CQC back to Mansfield to review improvements within the next six months and are confident this will result in an improved rating for the hospital.”