A Birmingham hospital for patients with mental health conditions has been downgraded from 'outstanding' to 'inadequate' and placed in special measures by the Care Quality Commission (CQC).
The move followed a February inspection of Montague Court in Edgbaston, after the CQC received "information of concern regarding training compliance, staff supervision, and lack of opportunity for staff and people using the service to give feedback about the hospital".
As a result of the inspection, the CQC said it had taken enforcement action and "served the provider with a warning notice" requiring it to make immediate improvements. The service, which is provided and run by Options for Care Limited, is now in special measures, which means it will be kept under close review by the CQC and re-inspected to check on the progress of improvements.
Complex Care Needs
Montague Court is an 18-bed mental health long-term complex care locked rehabilitation hospital for men aged 25 to70 with complex needs. It is registered to provide care and treatment to people detained under the Mental Health Act. The facility was last rated as 'oustanding' in September 2018 following a routine CQC inspection.
During the most recent inspection, there were 16 people in residence in the hospital.
Specific points of contention in the CQC's inspection included:
- Multiple ligature points for which risk mitigation actions had not been followed by staff
- Insufficient alarms to keep staff, visitors, and people safe
- Staff did not routinely check medical equipment, with blood glucose monitoring machines not routinely checked or calibrated
- Staff did not follow General Data Protection Regulations to keep people’s information confidential
- Governance systems were not sufficient to identify potential risks
- Significant risks that were identified by the CQC had not been recognised, assessed, monitored, and mitigated by the hospital, which was not aware of the level of risk posed by multiple issues
- Staff did not receive regular supervision and annual appraisals
'People Weren’t Safe'
Amanda Lyndon, CQC interim deputy director of operations in the Midlands, said: "During our inspection of Montague Court, we found the standards of care had significantly deteriorated since our previous visit; people weren’t safe and were at risk of avoidable harm.
"The hospital didn’t provide an environment that was clean, well maintained or fit for purpose. We found staff couldn’t observe people in all parts of the hospital; we saw multiple blind spots, which weren’t mitigated by any mirrors or individual risk assessments. Also, the standards of cleanliness were well below what people should be able to expect. It was visibly dirty with food on both the furniture and floor, which is totally unacceptable, and nobody should have to live in these conditions.
"Staff didn’t always develop care plans that were holistic and recovery-orientated or record the person's involvement in developing their plan. Also, they didn’t regularly review and update care plans, which could result in people not receiving appropriate care to meet their individual needs."
On the good side, the inspection found that staff had used a full range of rooms and equipment to support treatment and care. There was a dedicated activity centre with a therapy kitchen, as well as an IT suite and games room, quiet areas, and a room where people could meet with visitors in private, including a dedicated family room. Residents had access to their own mobile phones.
Decline in Standards 'Not Good Enough'
Ms Lyndon noted: "However, throughout the inspection we did see staff treating people with respect, and they offered people a choice of food and drinks. People told us they were offered a variety of good quality food.
"The overall decline in these standards isn’t good enough and we’ve told the provider what they must do to improve, as nobody should ever have to live in a service which is unsafe.
Ms Lyndon said that the CQC will continue to monitor Montague Court closely to ensure "the necessary improvements are made urgently to keep people safe and free from harm".
"If we are not assured people are receiving safe care, we will not hesitate to take further enforcement action, even if this results in closure of the service," she said.