Archived: Huntercombe Hospital - Maidenhead

Updated 17 February 2021

Huntercombe Hospital - Maidenhead is a specialist child and adolescent mental health inpatient service (CAMHS). It is a 60 bed independent hospital. It provides specialist mental health services for adolescents and young people from 12 to 25 years of age and is registered to treat young people who are detained under the Mental Health Act 1983. It also treats young people who are admitted informally. Huntercombe delivers specialised clinical care for young people of all genders requiring CAMHS, including eating disorders.

The hospital and its surrounding grounds are within a rural setting and are situated near a town with easy access to transport links and shops. Young people are supported in their education via the hospital school. Where appropriate the young people have access to the hospital grounds and local community facilities.

 The hospital consists of four wards.  

 • Kennet ward provided eating disorder services and had 20 beds. 

• Tamar ward provided tier four CAMHS general adolescent services and had 11 beds. 

• Thames ward had 14 beds and provided psychiatric intensive care services (PICU). 

• Severn ward had 15 beds and provided psychiatric intensive care services (PICU). 

We undertook an unannounced, focussed inspection of Huntercombe Hospital, Maidenhead because we had received information which raised concerns about the safety and quality of the service. These concerns included the frequency of incidents of deliberate self-harm, staff whistleblowing about working practices, and complaints from parents of young people at the hospital about the quality of the care and communication with the staff.

The hospital was previously inspected in June 2019 and rated as Good overall. We rated the effective key question as requires improvement, all other key questions were rated as Good. Following the 2019 inspection, we told the provider that they must take the following action:

• The provider must ensure that training levels for all staff in the Mental Health Act exceeds 75%. This had been achieved.
• The provider must ensure that the Paediatric Early Warning System (PEWS) is used correctly and consistently across the wards, to monitor changes to young people’s physical health. This had not been achieved, although we noted some improvement in the three wards that we inspected.
• The provider must ensure that a positive behaviour support approach is embedded across the hospital, to enable an effective response to young people whose behaviour poses a challenge to the service. This had not been achieved at this inspection

Updated 17 February 2021

Huntercombe Hospital - Maidenhead provides specialist child and adolescent mental health inpatient service (CAMHS), including psychiatric intensive care for young people.

Following this inspection, we served the provider with a letter of intent under Section 31 of the Health and Social Care Act 2008, to warn them of possible urgent enforcement action. We told the provider that we were considering whether to use our powers to urgently suspend, impose variation or remove their registration. The effect of using Section 31 powers is serious and immediate. The provider was told to submit an action plan within 5 days to address concerns about poor care and treatment on two of the wards.

We also issued a Warning Notice under Section 29 of the Health and Social Care Act 2008, telling the provider they must ensure that a Positive Behaviour Support (PBS) approach is embedded across the hospital, to enable an effective response to young people whose behaviour poses a challenge and risk to themselves, others and service, and that this must be achieved by 31 January 2020.

We have rated the service as inadequate overall and placed it in special measures. This means that the provider must make the required improvements otherwise we will take further enforcement action. The service will be subject to close scrutiny and monitoring.

Our rating of this service went down. We rated it as inadequate because:

• On two of the three wards we inspected (Severn and Thames), young people did not receive safe care that met their individual needs. We found young people did not receive person centred care. We found minimal evidence of clinical formulations being made, despite some young people experiencing long and highly restrictive admissions. Staff did not appear to be using a Positive Behaviour Support (‘PBS’) informed approach, despite us telling the provider it must use these at the previous inspection in 2019. PBS is an evidence based and person-centred approach to supporting patients who behave in ways which pose risk and challenges to themselves and others.
• On Severn and Thames wards, staff did not follow safe systems and processes to prescribe, administer, record and store medicines. Prescribing was not always in line with national guidance. Staff did not record the reasons why some medicines were prescribed for some young people outside of licensed or best practice guidance, and the hospital lacked the required peer review process to review these prescribing practices. Young people did not have personalised care plans to support them or staff to manage agitation or distress without the use of medicines. Staff appeared to use medicines to manage young people’s agitation and distress, without ensuring that less restrictive and more therapeutic options were consistently provided. We observed several young people on Seven and Thames ward that appeared over sedated due to effects of prescribed medication.
• Staff did not robustly assess young people’s mental capacity or Gillick competency which is the legal framework used to decide whether a child, under 16 years of age, is able to consent to their own treatment. We were unable to find evidence that staff routinely reviewed consent during a young person’s admission. We found incomplete or contradictory Mental Health Act 1983 consent to treatment paperwork. We found incidents where staff had administered medicines without young people’s consent or legal authorisation in place. We found young people were not regularly referred to the second opinion appointed doctor (SOAD) service, who safeguard the rights of patients detained under the Mental Health Act who either refuse the treatment prescribed to them or are deemed incapable of consenting.
• Staff did not effectively monitor young people’s physical health. Staff did not consistently follow the providers policy, or best practice guidance, when monitoring young people’s physical health following giving rapid tranquilisation. paediatric early warning (PEWS) charts used by staff to assess and monitor young people’s physical health had been introduced but had not been used correctly. At the last inspection we told the hospital it must use nationally recognised early warning assessment and monitoring methods (e.g. PEWs) for all young people. Staff reviewed the effects of regular medications on each patient’s physical health but did not always record the effects of rapid tranquilisation for a minimum of two hours as required by national guidance and service policy.
• On Thames and Seven ward young people and their families were not involved in care planning or risk assessment. Care plans lacked personalisation. Young people did not have copies of their care plans. Parents told us they felt their knowledge of their child’s needs and risks, and their views, were ignored by staff. Parents told us they felt concerned this had led to less effective and potentially harmful care being provided to their child.
• Risk assessments were not up to date or sufficiently detailed. Patients did not have risk management plans. On Thames and Seven ward records showed staff relied on restrictive interventions such as sedating medications, increased nursing observations, and restricted access to items within the ward environment, without evidence of considering person-centred or less restrictive alternatives.
• Although a new senior team had been appointed, governance processes had not been operating effectively, which prevented the issues we found in care and treatment from been identified or addressed by the provider organisation. Issues of concern raised at the previous inspection, that we told the provider they must address, had not improved. The hospital lacked robust governance and assurances processes to ensure risk assessments, risk management plans and care plans were consistently completed, sufficiently detailed, and were regularly updated and reviewed across the wards. Issues with the safe storage and management of medication in clinic rooms on the PICU wards had not been identified by the hospital governance systems.
• There was a lack of robust oversight and assurance by Huntercombe senior leaders. Therefore, they had not picked up poor care at the hospital and acted to make improvements in a timely manner.

However:

• The provider had recently recruited a new Hospital Director, Head of Nursing, Head of Quality and Quality Manager. The new managers had the skills, knowledge and experience needed to perform their roles, and had identified the need for improvements at ward level. In response to the concerns which were identified during this inspection, the new management team developed a comprehensive action plan with clear timescales to address our concerns about patient safety and wellbeing.
• The new managers showed a good understanding of the service they managed and were visible in the service and approachable for patients and staff.
• While a significant number of the registered nursing staff were from agencies, all agency staff received the same induction, training and supervision as permanent employees, and most were on long term agreements.

Updated 17 February 2021

Our rating of this service went down. We rated it as inadequate because: