‘Inadequate staffing’ put mental health patients at risk, CQC warns

CQC inspectors raise series of concerns over care at mental health ward, including staff shortages, breach of the Mental Health Act code of practice and "demeaning" restrictions on patients.

“Inadequate staffing levels” at an acute mental health ward have put patients at risk and seen staff carrying out duties they are not trained for, the Care Quality Commission has found.

The Minterne Ward at the Forston Clinic in Dorset failed to meet all 10 of the “essential standards” of care that it was assessed against, a critical report by CQC inspectors found.

The regulator uncovered a series of staffing issues on the ward, with acting ward managers telling inspectors they felt “unsupported by senior managers” and staff warning of a “restrictive” and “regime orientated” culture.

CQC inspectors observed staff taking on duties they had not been trained to do, including suicide risk assessments and giving medicines to a patient.

Other issues found during unannounced inspections in November and December last year included:

  • Failures to safeguard patients against the risk of abuse, including one case where staff had failed to act appropriately on a patient’s complaint of domestic abuse.

  • A series of shortfalls in information and record keeping, including inaccurate patient information about social workers, out-of-date care plans and incomplete prescription records that exposed Mental Health Act detainees to the risk of being given medicines unlawfully. 

  • “Demeaning” restrictions placed on patients detained under the Mental Health Act, including blanket bans on patients using real cutlery, hairspray or deodorants, that had no basis in risk assessments.

  • Premises were unsuitable for carrying out Mental Health Act assessments and treatment. During one inspection a detained patient was able to push a bedroom window out of its frame and leave.

  • Poor standards of cleanliness and hygiene, with inspectors finding patient toilets were dirty, urine testing was being undertaken in the laundry and patients were not being protected against cross-infection.

  • A lack of activities for patients with lounge areas having “no books, newspapers or games” available. Patients were allowed a 15 minute “fresh air break” once every hour between 8am and midnight.

  • Evidence that the Mental Health Act Code of Practice had been breached in some instances, with incident reports “vague about the circumstances of the control and restraint incident and how it was managed.”

The ward was closed at the end of last year, following the CQC inspections, and is scheduled to reopen in April.

James Barton, director of mental health services at Dorset Healthcare University NHS Foundation Trust, said staffing levels were “being bolstered before the ward reopens” as part of a series of improvement measures put in place following the CQC report.

“We are in the process of recruiting to increase overall staff numbers by 39 per cent. This strengthened team of staff will be further boosted by a robust new leadership structure, consisting of a ward manager, a matron and a full-time consultant,” said Barton.

“We’re confident that, as a Trust, we have responded in a very positive manner to the feedback from the CQC,” he added. 

Ian Biggs, deputy director of CQC, said the concerns raised by inspectors should have been addressed “some time ago”.

“This is not the first time that we have told the trust that it must make improvements at this service. It is a matter of some concern that the trust has failed to address these issues,” Biggs said. 
“Where we have continuing concerns, we have a range of powers we can use to protect the safety and welfare of people who use this service. We will consider further action and publish information about this in due course.”

The CQC inspection report also assessed another ward at the Forston Clinic – Melstock House – which demonstrated high levels of care in a number of inspection areas.

Dorset Healthcare said “CQC inspectors commended the services and care provided on this neighbouring ward”.

The report did raise some issues with Melstock House, including concerns that the acting manager had “raised concerns over staffing levels with the general manager on several occasions”.

is Community Care’s community editor

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