The health care regulator took enforcement action against a hospital in Birmingham after uncovering a litany of safety failures that included vulnerable patients being able to swallow screws and batteries.
The Care Quality Commission (CQC) rated the forensic inpatient and secure wards at Brooklands Hospital, which provides care to adults with autism and learning disabilities, as 'inadequate' following an inspection in March. The unannounced visit came after the Commission was alerted to concerns about the quality of services provided at the hospital, which is run by Coventry and Warwickshire Partnership NHS Trust.
Key issues identified by the inspectors included staff shortages and burnout, inadequate supervision of patients, and an unfit for purpose environment.
The service did not adhere to correct long-term segregation and seclusion practice, and staff weren't carrying out observations of people in accordance with their policy and national guidance to protect people from harm, the CQC said.
Following the inspection, the wards were again rated 'inadequate' overall, and for being safe and well-led. The service's rating for being responsive improved from 'inadequate' to 'requires improvement', while the rating for how effective and caring the service was remained as 'requires improvement'.
The CQC served the trust with a warning notice to rapidly make significant improvements, and in July returned to inspect the service. While it found many of the issues identified within the warning notice had been addressed, the trust was issued with a requirement notice to make further improvements.
Staff Shortages and Burnout
Sonia Brooks, CQC deputy director of operations in the Midlands, said: "When we inspected Brooklands Hospital in March, it was concerning to see that the provider hadn't acted upon all recommendations from our previous inspection.
"Staff felt burnt out from working additional hours and carrying out extra tasks due to a shortage of permanent nurses. One nurse told us, senior managers didn't acknowledge or care how being short staffed impacted on their mental health and wellbeing.
"We told the trust this must be addressed as a priority to ensure all staff are given the help and support they need to keep them well and be able to provide the best possible care to people."
During their visit in March, inspectors also found that environmental checks weren't always adequate, and there had been eight recorded incidents in 12 months. Examples included patients managing to eat items such as screws and batteries, putting them at risk of harm. However, these weren't always accurately recorded, which the CQC said must be improved as a matter of urgency so staff could learn from the incidents and help prevent them re-occurring.
"We were told that permanent staff treated people well and were kind," Ms Brooks said. "However, temporary staff didn't care for them in the same way."
The CQC's follow-up inspection in July found some improvements had been made since March. For example, the trust had put in place a comprehensive training programme to increase staff knowledge around security issues, including environmental safety checks. "We also found staffing levels had improved and vacancy rates had reduced," Ms Brooks said. "Additionally, we saw several examples of staff using different ways to communicate with people, including easy read versions of care plans."
The CQC said it would continue to monitor the trust closely and carry out further inspections.
"Working to Improve Services"
Responding to the findings, Mel Coombes, chief executive officer of Coventry and Warwickshire Partnership NHS Trust, said: "We'd like to reassure patients and their families that we're working at pace to improve the quality of our forensic inpatient services for people with a learning disability or autism.
"The Trust has undertaken significant work to address the issues identified in the March 2023 inspection of our learning disabilities and autism forensic inpatient service. We were pleased to see these improvements highlighted in the report from July 2023. Specifically, the CQC found that people in our care said they felt safe and cared for, that staff were approachable and that there were plenty of activities on offer. The CQC also reported improved staffing levels and reduced vacancy rates, improvements in mandatory training levels among staff, that staff said morale was good and spoke highly of the senior management.
"We also took immediate action in July 2023, to address the areas of concern which were raised by the CQC, including reviewing, and confirming the care pathways for individuals mentioned in the report." The Trust has further strengthened its seclusion practice and is undertaking its own assurance audits, he added.
"We are pleased that the CQC and our own audit processes are already seeing considerable improvement in the areas identified in report dated March 2023. We will continue to work with our staff, the CQC, our commissioners, patients and carers and NHS England, to improve the quality of service that we provide."