St Andrews Healthcare Northampton

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff did not always receive regular supervision. At the time of our inspection only 59% of clinical staff were up to date with their supervision requirements on Sycamore ward and 72% on Hawkins ward. Not all staff were up to date with mandatory training and there were a number of areas with low compliance and that did not meet the providers target. We found that basic life support had a compliance of 30% on Hawkins ward and 36% on Sycamore ward, with a number of other areas under 75% compliance. The service did not always have enough permanent staff to fulfil shift requirements and relied on the use of bank and agency staff. There were restrictive practices in place on Hawkins ward in relation to vape times and we issued an action plan request for regulation 12 due to this. However staff assessed risk well and followed good practice with respect to safeguarding. Staff developed holistic, recovery-orientated care plans informed by comprehensive assessment. Patients told us they were involved in planning their care. Ward environments were well-maintained and fit for purpose.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients on Hawkins ward said staff made them feel safe on the ward, although not when there were a lot of incidents. Patients on Sycamore ward did not always feel safe. One patient said that agency staff were slow to respond to safeguarding incidents and did not always adhere to patients care plans. They gave examples of when staff had not observed them properly or had been asleep. One patient said she had to wait to shower or go to the toilet when male staff were observing her. At times she felt uncomfortable with male observing staff who were agency and she did not know. However, patients said staff listened to them when they wanted to make a complaint.

Staff demonstrated that they had a good understanding of the safeguarding process and were confident in identifying various forms of abuse and reporting on these. Staff gave examples of safeguarding concerns and knew how to make referrals if they suspected someone was at risk of harm. Staff gave an example of multidisciplinary decision making to ensure a patient was kept safe from harm and abuse from another patient and working collaboratively to make positive changes to keep people safe. Safeguarding was discussed within handovers, multidisciplinary team meetings and by managers with oversight of the learning disability division. Staff stated patients approached them with issues and concerns and they were listened to, with information received being acted on. All staff spoken with told us immediate risks were removed from situations where safeguarding concerns were identified. Staff worked collaboratively and protection plans were put in place at the point of an incident. Serious safeguarding concerns were raised with partner agencies within a timely manner. Staff told us that capacity was reviewed in accordance with the Mental Capacity Act when necessary. However, we were not able to find all decision making recorded in relation to a patient with suicidal ideation but full multidisciplinary discussions had taken place. Leaders were involved in daily huddles to discuss all types of incidents, including safeguarding. Leaders acknowledged that training compliance might appear to be low in data, but staff were aware of risks and how to report any safeguarding concerns. Leaders were aware of recent safeguarding incidents and spoke confidently about actions being taken, including close liaison with local authorities and advocates.

Posters were displayed on the wards with information on raising safeguarding concerns. We observed positive and supportive interactions with patients. Items of risk, such as vapes were managed carefully and vigilantly by staff during vape times due to the identified risk for some patients.

Systems were in place to record and flag safeguarding incidents. However, not all incidents had been initially identified as a safeguarding concern, although the service had independently rectified these and made appropriate safeguarding referrals where necessary. Managers and safeguarding practitioners met weekly to review new and ongoing safeguarding concerns. Investigations were completed internally and recorded within individual records in the provider’s incident reporting system. Staff helped patients understand their treatment and care. Best interests assessments were completed for specific actions or tasks. Detailed PBS plans were in place which recorded patient need and risk and provided clear guidance to staff on how to respond to behaviour and escalating risk. Information regarding patients legal status was recorded and advocacy and Independent Mental Health Act services were accessible on the wards. Daily progress notes demonstrated at relevant points where patients were supported to understand their rights and restrictions that were in place. The provider had a detailed safeguarding log in place. From 23rd January 2024 to 24 April 2024 there had been 17 safeguarding referrals made for Hawkins ward and 21 for Sycamore ward. The provider had a safeguarding incident investigation and reporting process for adults guidance document in place. This highlights the processes to be taken in relation to different circumstances such as patient to patient harm and allegations against members of staff working with vulnerable adults. This document is supported by flowcharts to clearly demonstrate the correct process for staff to follow.

Patients were involved in discussions about risks and their care plans and were offered copies. We observed good interactions with patients and how staff managed risk with patients in a positive and productive way. Patients on Hawkins ward did not like the restrictive times when they could vape, and told us staff were not flexible. For example, one patient was asleep at one of the vape times so had to wait for the next session. Patients on Hawkins ward said staff responded to, and de-escalated incidents quickly. Patients said they had good access to an advocate when they needed one to help them express their needs.

Staff completed risks assessments for each patient on admission and regularly reviewed risk management plans following incidents. Staff told us care plans and risk assessments were personalised to meet patient’s needs and were updated regularly through multidisciplinary discussion. Patients had positive behavioural support plans in place and patients on Hawkins ward had individual safety plans in place. Both were available in grab sheets at a quick glance for staff. Staff knew about risks for each patient and acted to prevent and reduce risks. Risk was reviewed and discussed daily and shared during handovers. Staff and patients were de-briefed following an incident, and staff attended lessons learned reviews. Staff demonstrated good knowledge of de-escalation techniques and stated physical restraint was only used as a last resort. Staff told us restrictions were in place on Hawkins ward regarding patients having access to their personal vapes. Assessments of patient capacity in relation to their vape use had not been completed, and restrictions had been implemented to manage the risk of 3 patients who were also no longer able to vape. This was a blanket restriction. The provider informed us that this was put in place to safely manage the risks patients were presenting with. However, some patients told us they were not happy with these restrictions. Steps were taken to mitigate risk and manage situations where there was patient on patient conflict. We were told there were some instances where patients were being nursed in Long Term Segregation due to incidents that had occurred, to ensure other patients safety. Leaders were aware of risks presented by patients and discussed restrictions that had been implemented to maintain safety. Leaders said that these restrictions were temporary but could not be removed until patients stopped verbalising their intent to harm themselves.

Managers on Sycamore ward had implemented handover grab cards, which included information about diagnosis, risks, restrictions and patient likes and dislikes. They were easily accessible for all staff. However, there had been an increase in serious incidents on both wards, and some patients had been able to put themselves at risk of significant self-harm. Despite care plans being in place, we were not assured that staff had followed them. Staff demonstrated good knowledge around restrictive practice and patients had individualised care plans detailing items of risk and restrictions in place. However, on Hawkins ward blanket restrictions were in place to reduce individual risk. This included 5 specific times when patients could vape, and the door was locked to the courtyard. Staff told us that to safely manage the risk of specific patients who were at risk of swallowing vapes, restrictions had been put in place. Previous plans to restrict the specific patients at risk had not been successful, therefore the blanket restriction had been implemented. Managers told us this would be in place until the individual risks had reduced and restrictions were reviewed regularly. The provider have implemented the Patient Safety Incident Response Framework (PSIRF) and have a clear policy in place to follow this. The provider had a clear incident management and reporting policy and enhanced support policy and enhanced support procedure in place. Sycamore ward have implemented a support framework for each patient that is individualised to each patient on the ward. This has been trialled initially with 1 patient and has been reported to work with good effect and significant risk reduction. The support framework reviews risk behaviours and patient incidents. It has 6 phases ranging from self-managed and independent to crisis and incorporates risk, leave, bedroom access and observations.

Patient we spoke with did not have any concerns about the ward environments.

Staff said that they had the facilities, equipment, and technology in place to provide effective care which they strived to deliver as safely as possible. Staff said that the handheld devices used for completing observations did not always work well, therefore, when required and when safe to do so observations were completed in paper format. Staff said that they completed a check of the environment each shift to maintain safety, any concerns raised were reported and addressed. Leaders of the service demonstrated awareness of safety concerns. Ligature and blind spot audits were regularly completed and reviewed. Care plans included individual risks. Leaders monitor all ward environments and replace any unsuitable furniture without delay. Leaders used their own data and assurance processes to rate both wards as ‘wards of concern’, immediate steps included increased allocation of staff and management support.

Ward environments were clean, well maintained and fit for purpose. Both wards had an extra care suite and a seclusion area. They were appropriately furnished. The seclusion rooms allowed clear observation, although there was not a hatch in the door on Hawkins ward to pass items through safely. Some patients had decorated their bedrooms. Some patients had specific items or parts of the environment restricted for their own safety. For example, the en-suite bathrooms had been restricted for 2 patients on Hawkins ward. Remote controls for the TV were locked away for patients assessed as being at risk to swallowing batteries. CCTV was available on Sycamore ward but not Hawkins ward, apart from in the seclusion suite.

Stringent security measures were in place for visitors attending the wards. Restricted items that were stored outside the ward space, and staff ensured they were vigilant to items visitors had before entering patient areas. There were regularly updated environmental risk assessments in place for both wards, highlighting appropriate risks with control measures in place. Both wards had an up-to-date ligature risk assessment in place. There were no high risks identified and an action plan was in place. Mitigation was identified through patient access, observation and staff placement.

Patients told us that there was a high level of agency staff that did not always engage with them; one patient raised an issue that staff just leave at the end of the shift. Patients on both wards did not think there were enough staff. One patient on Sycamore ward did not think there were enough female staff on the ward. This meant that patients did not always feel safe.

Staff told us shifts were short staffed on a regular basis and they had to use cover from other wards or bank or agency staff, which felt unsafe at times. Staff stated due to short staffing levels patients often failed to have planned leave from the ward, and felt frustrated because they couldn’t have regular meaningful 1:1 time with patients. Staff told us wards relied upon agency staff to cover qualified and unqualified shifts. As much as possible they tried to block book in a bid to reduce new and unfamiliar agency staff attending the wards. Some staff stated language barriers of some agency staff impacted on their ability to fully understand patients’ needs, for example, following Positive Behavioral Support plans, or nursing observation instructions, potentially putting patients at risk. However, we saw evidence from the provider that they had put additional measures in place to further aid handover and communication, via grab sheets. One staff member told us they had been unable to continue with a professional development qualification due to staffing issues and had withdrawn from the course. However, staff across both wards said staffing levels had improved recently which impacted positively upon how safeguarding concerns and incidents were identified and handled. Staff received mandatory training but this was not always completed on time due to safe staffing levels. Sycamore ward had recently introduced a ward trainer, to support and facilitate unqualified staff learning needs and ensure they had the knowledge and skills to confidently understand patient needs. Some staff told us their knowledge to nurse patients with dysphagia was limited. Dysphagia training had been arranged but there were not always enough appropriately trained staff to support patients during mealtimes. The provider told us staff have access to information within the red folder. Leaders recognised that bank and agency staff had been used to ensure safe staffing levels were maintained.

Staff placed themselves within communal areas and interacted with patients. There were enough staff to ensure the ward was safe. However, we did not observe much interaction between patients and staff in the communal area on Hawkins ward.

At the time of the assessment, the service had a number of vacancies. On Hawkins ward there was 1 full time equivalent (FTE) registered nurse vacancies and 4.1 FTE unqualified vacancies. There were 0.4 FTE nurse vacancies and 7.7 FTE unqualified vacancies on Sycamore ward. We reviewed bank and agency staff usage for both qualified and unqualified staff from 22nd January 2024 to 22nd April 2024. Hawkins ward used agency staff on 66% of shifts and bank staff on 51% of shifts. For the same period, Sycamore ward used agency staff on 47% of shifts and bank staff on 53% of shifts. Staff received management and clinical supervision and annual appraisals. At 4th December 2023, 87% of Sycamore ward staff and 100% of Hawkins ward staff had received management supervision. In April 2024, 59% of Sycamore staff and 72% of Hawkins ward staff had received clinical supervision. At 18th April 2024, 96% of Sycamore ward staff and 100% of Hawkins ward staff had received an annual appraisal. Staff sickness was high on both wards with a rate of 13.5% on Hawkins ward and 13.8% on Sycamore ward in March 2024. Staff turnover was low on both wards with a turnover rate of 2.5% on Hawkins ward and 0% on Sycamore ward in March 2024. Staff completed mandatory training which was relevant to their role, however compliance was low. Mandatory training compliance for Hawkins ward was 73% overall. There were areas of low compliance and beneath the provider target of 90%. Basic life support was 30%, safety intervention training was 45%, MHA, MCA & DoLS was 64%, Information governance 68%, Infection control 68% and fire safety 71%. Mandatory training compliance for Sycamore ward was 77%. Basic life support was 36%, safety intervention training was 40%, MHA, MCA & DoLS was 70%, infection control was 77%, information governance was 78%, fire safety was 78%. Both wards completed the Oliver McGowan training.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.