Learning Disability Today
Supporting professionals working in learning disability and autism services

CQC finds learning disability assessment and treatment unit meets no minimum standards

CQC logo A damning report by care regulator the Care Quality Commission (CQC) has found that an assessment and treatment centre in Headington, Oxfordshire, met none of the minimum standards for care.

In total, 10 areas were inspected at Slade House, with the CQC inspection report finding that 6 of the areas required immediate enforcement action to be taken. The remaining 4 were said to have action needed to bring them up to the required standard.

Slade House is operated by Southern Health NHS Foundation Trust and provides services for people with mental health needs, learning disabilities and problems with substance misuse. It comprises two separate units; John Sharich House, an eight bedded assessment and treatment unit for adults over the age of 18 years who require treatment for a period longer than six months; and the 7-bed Short Term Assessment and Treatment Team (STATT) unit.

Numerous failings

The 6 areas that required enforcement action were:

  • Care and welfare of people who use services
  • Cleanliness and infection control
  • Safety and suitability of premises
  • Safety, availability and suitability of equipment
  • Assessing and monitoring the quality of service provision
  • Records.
  • The report said that inspectors spoke with 3 of the 5 people living in the STATT unit. “We asked them about the assessment, treatment, care and support they received. One person told us they felt unsafe and uncared for, another told us they “hated it” there. The third person said “It is okay.”

Inspectors also reported seeing “few social or therapeutic nursing interactions with people who stayed there” over the course of the 2 days they were there. “There appeared to be an impoverished environment with little therapeutic intervention or meaningful activities to do.”

They also spoke to staff about their understanding and practice of safeguarding vulnerable adults. “Staff could describe many types of abuse but did not mention neglect or institutional abuse.”

Other areas of concerns the inspectors highlighted included medicines not always being safely administered, inadequate quality monitoring and the safety of the building.

Southern Health response

Katrina Percy, chief executive of Southern Health NHS Foundation Trust, said: “Southern Health’s primary concern is the safety of our patients. We are an organisation that prides itself on providing high quality, compassionate care. We were most concerned to learn of the issues brought to light by the CQC in a recent visit to Slade House in Oxford. We worked with CQC on the day to put right all the environmental problems that were raised and we have been working hard to rectify the remaining issues. We are concerned the points raised in the report did not come to light sooner and have launched our own internal investigation.

“Over the last 6 months we have received 19 visits from the CQC to our LD, mental health and our social care sites. In the vast majority of cases the visits have proven successful with no significant issues identified. We believe we can make the changes needed at this site to ensure our patients receive the standards of care we and they expect and in the most appropriate environment.

“A senior team of our most experienced staff are working with the units to provide the leadership and knowledge required to ensure best practice is shared and our internal processes are reviewed. Staff are being supported through this and will be given the opportunity to work within our most successful teams to learn what can and should be achieved when providing the right care in the right environment.

“We have taken the findings extremely seriously. The units are both closed to new admissions and will remain so until we can provide assurance that we are able to deliver the best possible care to our patients. As already mentioned, we have rectified all of the essential environmental issues highlighted in the report, including equipment which was not up to standard. A full action plan is now in place to make sure we can resolve all the issues identified. We are waiting for our internal investigation to conclude to understand where our standards fell down and what needs to change to put things right. Any additional findings will be added to our action plan and acted upon robustly.

“This action plan has also been shared with the local authority Safeguarding Board after a referral from the CQC. After sharing the plan the Board noted: ‘We were reassured that the turnaround team is making a difference and that clients currently in STATT are safe. No further safeguarding meetings are required.’

“We are pleased to see our actions and plans are already changing the services provided at Slade House and we look forward to welcoming the CQC back for a further inspection in the coming months.”

The CQC has asked Southern Health to send it a report by December 17, setting out the action they will take to meet the standards. The CQC will check to make sure that this action is taken.

To read the full CQC report, click here.

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