Baxter Education Centre Northwest

We rated it as inadequate because:

• Safety was not given sufficient priority, making people who used the service at risk of potential harm. This was because staff were not provided with the appropriate level of safeguarding training and did not always understand how to protect patients from abuse. The service did not always control infection risk well. Staff did not always manage medicines well. Staff did not always assess and minimise risks to patients. The service did not manage safety incidents well and did not always learn lessons from them. The service did not always ensure that equipment was safe for use and used in a safe way.
• People were at risk of not receiving effective care or treatment. This was because care and treatment were not always provided in line with national guidance and evidence-based practice. Managers did not monitor the effectiveness of the service and make sure staff were competent. Care and treatment was not always provided with written or verbal consent of the relevant person.
• The service did not always meet people’s needs. We did not see evidence that the service made reasonable adjustments for all people with protected characteristics to access the service. Complaints were not recorded, lessons learned were not always effectively shared and there was limited oversight.
• The delivery of high-quality care was not assured by the leadership and governance. Leaders did not always have the skills and abilities to run the service well. Leaders did not operate effective governance systems and processes to identify, assess and mitigate risks to the health, safety and welfare of people who use the service. Leaders did not assess, monitor and improve the quality and safety of the service they provide. The service did not have a vision for what it wanted to achieve and a strategy to turn it into action

However:

• Staff worked well together for the benefit of patients.
• Staff treated patients with compassion and kindness and respected their privacy and dignity
• People could access the service when they needed it and did not have to wait too long for treatment.

Following this inspection, due to the concerns we found, we told the registered manager they were failing to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served two warning notices under Section 29 of the Health and Social Care Act 2008. The warning notices related to Regulation 12(1) Safe care and treatment and Regulation 17(1) Good governance. We also served one requirement notice in relation to Regulation 11(1) Need for consent.

We are placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.