CQC tells Tees, Esk and Wear Valleys NHS Foundation Trust to make improvements to wards for people with a learning disability or autistic people
The trust provides care to adults with learning disabilities and/or autistic people at Lanchester Road Hospital in Durham and Bankfields Court in Middlesbrough.
A focused inspection took place across both sites over three weeks in May and June. This was in response to whistleblowing concerns around staffing levels at Lanchester Road. However, due to further issues found, this was extended to a full comprehensive inspection of the service.
Following this inspection, the rating for wards for people with a learning disability or autistic people has dropped from good to inadequate overall and for being effective and well-led. Safe has dropped from requires improvement to inadequate. Caring and responsive has declined from good to requires improvement.
The trust’s overall rating remains rated as requires improvement.
Karen Knapton, CQC head of hospital inspection, said:
“When we visited Tees, Esk and Wear Valleys NHS Foundation Trust, we found a significant deterioration in standards of care at Lanchester Road, as well as some concerns at Bankfields Court, since our last inspection in 2019.
“We found some people didn’t have the opportunity to lead inclusive and empowered lives due to overly restrictive practice on both sites, which must be addressed as a priority to keep people safe.
“At Bankfields Court, we were concerned that managers didn’t always recognise the restrictive practice being used. Also, it wasn’t always recorded, and staff didn’t learn from incidents to reduce the levels of restrictions in place for some people.
“It was concerning that Lanchester Road had insufficient, appropriately skilled staff to meet people’s needs, due to high levels of vacancies and staff sickness. This meant people didn’t receive consistent care from staff who knew them well and could care for their individual needs.
“Additionally, at this site staff didn’t always understand how to protect people from poor care and abuse. Three people had been injured during restraints, and 32 incidents of injury had been reported for healthcare assistants, some requiring treatment. This is unacceptable and measures must be put in place to keep patients and staff safe.
“We have told the trust what improvements must be made, and we will continue to monitor the service closely, returning to check on progress to ensure people using the service are receiving the care they should be able to expect.”
Inspectors found the following during this inspection:
- The service did not meet all the principles of ‘Right support, right care and right culture’.
- Staff did not receive the right training to ensure they had the skills and knowledge to meet people’s needs. Training in learning disabilities, autism and alternative communication methods was not mandatory for non-registered staff and a low proportion of staff had completed training in these areas. Several mandatory training courses and overall rates of supervision and appraisals fell below the trust target.
- Staff didn’t always provide kind and compassionate care or protect and respect people’s privacy and dignity or always understand each person’s individual needs.
- People’s risks were not always assessed regularly and managed safely. People were not always supported and involved in managing their own risks.
- For six people, staff applied restrictions which were not proportionate to the level of risk. There was no clear rationale or plans to end these restrictions. In some instances, managers had failed to recognise the restrictions and reviews were not in place to try and reduce the use of these practices.
- The use of restrictive practice including restraint, and seclusion was high. There was limited evidence of learning from incidents and multi-disciplinary team discussions about reducing people’s restrictions.
- Some people were staying in hospital for too long with no clear plans in place to support them to return home or move to a community setting. Staff attempted to work with services to ensure people received the right care and support, but the lack of community provision from other providers delayed this.
- People did not always receive care, support and treatment that met their needs and aspirations. People’s care and treatment did not always focus on good quality of life or follow best practice. Staff did not routinely use clinical and quality audits to evaluate the quality of care.
- Staff did not always understand their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983 and the Mental Capacity Act 2005.
However:
- Some people made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
- Some people’s care, treatment and support plans, reflected their sensory and functioning needs.
- At Bankfields Court most people were actively involved with a multidisciplinary team in planning their care.
- People’s care and support was provided in a clean, well equipped, well-furnished and well-maintained environment which mostly met people's sensory and physical needs.
The full report can be downloaded below.
