24 and 30 July and 04 August 2020
During an inspection looking at part of the service
We completed this focused inspection based on concerning information received about the alleged abuse of patients. We specifically focused on our safe, caring and well led domains.
We did not rate this inspection.
We identified the following areas of concern:
- Some staff did not protect patients from abuse and improper treatment. We reviewed close circuit television (CCTV) footage which showed staff physically and emotionally abusing a patient. Staff who witnessed the incident did not raise or report their concerns to anyone at the hospital. We reviewed 20 further episodes of CCTV footage, saved between May 2020 and July 2020, which we requested from the hospital. Out of these 20 episodes, we identified in 8 (40%) examples of inappropriate staff behaviour, including physical and emotional abuse. No staff reported or raised concerns about this practice. Staff did not recognise when an incident of seclusion occurred and therefore, the patient did not have access to the appropriate reviews and safeguards outlined in the mental health code of practice.
- Staff did not record incidents accurately. We reviewed all incident records relating to the 20 episodes of CCTV we requested. Forty five percent of the reports did not align with the CCTV footage. Staff did not accurately record the descriptions of the incidents and staff did not record the time of incidents accurately. None of the incident forms recorded inappropriate staff behaviour.
- Managers failed to assess, monitor and mitigate risks relating to the health, safety and wellbeing of patients at the hospital and failed to improve the service. We continued to identify breaches of regulations that we raised at previous inspections. The service remained in special measures and had conditions placed on its registration. Managers did not always act on audit outcomes and did not respond to prompts sent about key performance items such as completing supervision.
- Managers had not ensured they took every step to ensure they recruited and continually assessed people with the right skills, experience and values to work with a vulnerable patient group. Managers did not offer regular and robust supervision. They did not review specific agenda areas such as safeguarding and whistleblowing. Staff responsible for recruiting new staff did not always ask all questions at interview, including questions about when to raise concerns. Scores were not always recorded to demonstrate candidates met the recruitment thresholds.
- Staff contributed to poor culture in the hospital that increased the risk of harm to patients. This included abuse and human rights breaches. Staff did not always report when they witnessed inappropriate behaviour of other staff. When staff did raise concerns, managers did not act on them and take steps to safeguard patients. In one example, where staff raised concerns about practice there was a delay of 509 days before a safeguarding notification was sent to CQC and action was taken to investigate the concerns. Staff described issues with team dynamics, relationships and support from managers. Staff used nicknames for each other that gave weight to a poor culture.
However:
- The hospital acted to suspend staff involved in one incident of abuse and inappropriate behaviour. Managers made appropriate referrals to Police, the Nursing and Midwifery Council and the Disclosure and Barring service. Managers continued to review CCTV footage, after the inspection, to assess additional staff and their treatment of patients. Managers had taken appropriate steps to support patients who were victims, this included offering psychological support. Managers informed families and carers of the incidents.