The Care Quality Commission has told a young person’s mental health service to urgently address ‘serious failings’ in care after inspectors identified a series of concerns over the use of seclusion and restraint on an admissions ward.
CQC inspectors, who visited the Alpha Hospitals’ service in Woking in November and December, failed the unit against five of the six care standards it was assessed against. The CQC issued formal warnings to Alpha Hospitals on three of these standards – safeguarding people from abuse, records management and protecting the care and welfare of people.
Adrian Hughes, regional director for CQC in the south of England, said it was worrying that “serious problems” were still being identified at the service, particularly as some concerns raised at a previous inspection in June 2013 remained unaddressed.
“Our intention was to secure improvement by raising our concerns with the provider. However, as this did not result in the necessary action, we have issued warning notices as urgent action is now needed to tackle the serious failings at this hospital,” said Hughes.
“People are entitled to receive care and treatment in services which are safe, effective, caring, responsive to their needs, and well led. We will continue to monitor the hospital to satisfy ourselves that improvements have been made. If we find the changes have not been made, we will take further action to protect people living there.”
In a statement, Alpha Hospitals said it valued the CQC’s feedback and said it had worked closely with the regulator “to develop an action plan that has been implemented”.
“The welfare of our patients is uppermost to us and we are committed to providing the highest standard of patient care,” the statement said.
The CQC’s inspection report raised a number of concerns over the use of restraint and seclusion at the service’s adolescent admission ward. Specific concerns included:
- A lack of suitable arrangements for the use of control and restraint. Staff had taken people up and down stairs whilst being restrained, in breach of the Alpha Hospital policy. This meant “people were not safeguarded when restraint and seclusion was used”, the CQC found.
- Inspectors saw records which “showed a lack of response from staff when people became unwell whilst in seclusion”.
- Patients told inspectors restraint or seclusion were not always used as a last resort. One said that as soon as anything ‘kicked off’ they were restrained or put in seclusion. Another said “seclusion and inter-muscular injections are regularly used as threats”.
- A patient had been put in seclusion twice because they had been “seen whispering to peers”. The Mental Health Act code of practice states seclusion’s “sole aim is to contain severely disturbed behaviour”.
- The welfare of patients in seclusion was not being adequately monitored. One patient was kept in seclusion for 31 hours without any 8-hourly review (as recommended by the Mental Health Act Code of Practice) taking place.
- There was a lack of monitoring for people after the administration of medication by injection.
CQC inspectors said the concerns identified on the adolescents admission wards had led them to speak to patients on two general adolescent awards. Those patients told inspectors “they felt safe and that they had good positive experiences”.
The inspection also found that the service did meet the required standard for respecting and involving people who use services.
The service is commissioned by NHS England. Julia Dutchman, NHS England’s directory of quality and nursing for Surrey and Sussex, said her organisation had worked closely with Alpha Woking over the past year to ensure the service delivers “safe and effective care”.
“In that time we have seen Alpha make considerable improvements which have been positively reported by both patients and staff. The CQC has highlighted concerns following visits last year, but we recognise that Alpha has worked hard to address these concerns and indicated that the outstanding issues have now been resolved. We are committed to working with Alpha to ensure that all the necessary standards are maintained,” said Dutchman.