Learning Disability Today
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Calderstones Partnership NHS Foundation Trust must take urgent action to address serious failings in its services to people with learning disabilities, a Care Quality Commission (CQC) report has concluded.
While the CQC inspection team observed instances of Calderstones staff delivering care in a kind and compassionate manner, there were also a number of failings. These included failure to maintain cleanliness and hygiene on the wards, problems with levels of staffing on some wards, poor medicines management, the frequency with which patients were restrained in the face-down position, and a failure to adequately monitor the use of the Mental Health Act (MHA).
Calderstones is the only NHS trust that provides care exclusively for people with learning disabilities. The CQC noted that all of its patients are cared for in a hospital ward and almost all detained under the MHA. Additionally, more than 40% of Calderstones’ patients have been there for more than five years.
Areas that the trust must improve include:
• Some wards and seclusion rooms that inspectors visited were dirty or unsafe
• Inspectors found deficiencies in infection control procedures on some wards with a lack of infection control audits at ward level, no hand-washing facilities in areas where medicines were dispensed and incorrect labelling and use of sharps containers. The trust must also ensure that it adheres to best practice for food labelling, monitoring of fridge temperatures and the maintenance of equipment
• Nurses frequently used physical restraint to manage the behaviour of patients. On more than 25% of occasions when physical restraint was used in the 6 months prior to the inspection, the patient was held on the floor in a face-down position. This is known to be the least safe method of restraint and its use is contrary to national guidance
• The trust must ensure there are sufficient numbers of suitably qualified, skilled and experienced staff, particularly at night
• The trust has to ensure that there are improvements in practices and adherence to the MHA. For example, inspectors found that wards where information leaflets were out of date and did not incorporate amendments to the MHA made in 2007, certificate of consent to treatment and certificate of second opinion forms that were out of date, incorrectly stored or not followed.
The CQC did note some areas of good practice, such as the patient-led complaints summary being trialled at Gisburn Lodge. The trust had a complaints system which could monitor trends across wards.
Dr Paul Lelliott, CQC’s deputy chief inspector of hospitals, said the trust faces some major challenges. “The trust has difficulty recruiting nursing staff and many posts were vacant. It therefore was relying relied heavily on the use of agency and bank nurses. Although the trust was good at providing and monitoring basic ‘mandatory’ training for its staff, it was less good at providing the training required to meet the care needs that are particular to the specific problems of the patient group admitted to Calderstones.
“The conditions that we found on some of the wards were unacceptable. It should go without saying that a hospital ward should be clean. It is even more troubling when these wards are also, in effect, people’s homes.
“Many of the people admitted to Calderstones have severe mental health problems and have a history of behaviour that has put themselves and/or others at risk. Despite that, we were surprised at the number of occasions when staff had resorted to physical restraint. I would urge the trust to work tirelessly to find alternative ways of helping the people they care for to gain control over their more risky behaviours. The staff at Calderstones must also ensure that when restraint is used it is by the safest means and that there is proper medical back-up to minimise the possibility of harm to the patient.”
Lelliott added that Calderstones’ board has a “substantial task” to bring the quality of care up to modern standards and to address the failings identified. “To do this they will need help from the clinical commissioning groups, local councils and other members of the local health and social care community.”
In response, Mark Hindle, chief executive of Calderstones, said the Trust accepted the inspectors’ concerns about cleanliness and other issues. “Whilst some parts of the Trust show areas of good practice, there are others where standards fell seriously below expectations,” he said. “Since July, we’ve ensured resource, time, money and expertise are in place to address these shortcomings and many have already been put right. In some cases, wards which the report referred to are being closed in the next few weeks. We have employed additional staff and plan to take on more over the coming months as we agree funding with commissioners.
“Although the CQC specifically recognise that we are unique and consequently it is difficult to compare us to other services, we are committed to improving quality in this organisation for our service users. We have agreed with them that further inspections, focussed on the specific areas that required improvement, will take place.”
Meanwhile, a mother whose son has suffered ‘institutional abuse’ while resident at an assessment and treatment unit run by Calderstones has called for her son to be urgently moved out.