Coventry and Warwickshire Partnership NHS Trust

Updated 29 February 2024

Our rating of the trust improved. We rated the trust as good because:

• The trust had made a number of improvements since the previous inspection in June 2017. We rated effective, caring, responsive and well-led as good, and safe as requires improvement. Our rating of effective, responsive and well-led had improved from requires improvement to good from the previous inspection in June 2017.
• We rated five of the trust’s seven core services as good and two services as requires improvement that we inspected on this occasion. In rating the trust, we took into account the previous ratings of the seven core services not inspected this time.
• There was improved collective leadership and the trust had worked with and learnt from other NHS trusts to develop a culture of quality improvement. The trust had embedded a number of initiatives since the previous inspection of June 2017 that included; its vision and values, a workforce strategy, an electronic patient records system, and staff recognition and rewards.
• The trust had worked with NHS Improvement and clinical commissioning groups specifically to reduce the waiting lists for some children and young people with mental health problems and plan the upgrade of wards to reduce risk in acute mental health wards for adults of working age.
• The trust had identified three empty wards and had worked with NHS partners to design safer adult mental health wards for adults of working age. The work had started and there were clear plans in place for completion. To make patients safer, the trust and staff had robust risk assessments and care plans in place to reduce the risk of patients tying a ligature and in the use of seclusion.
• For children and young people with mental health problems, the trust had significantly improved triage processes since the previous inspection in June 2017. This meant referrals were reviewed more quickly. The trust was working with partners across local the health and social care economy to reduce the impact on children and families who were waiting for treatment. Systems and processes were in place to monitor assessment and treatment times. However, there was further work to undertake to reduce waiting times for treatment, especially in neurodevelopment services.
• The trust had good awareness of risk and was working collectively to monitor and address the main risks to the trust. Risks included the recruitment and retention of staff, financial sustainability whilst maintaining quality and safety to patients, and the upgrade of existing buildings and wards.
• The trust had improved the way it worked with stakeholders across the health and social care economy of Coventry and Warwickshire. The trust continued to work with the public to design and improve services as part of its equal partners strategy. This had supported the Board’s awareness of local priorities to support care to local people. The trust continued to work with neighbouring mental health NHS trusts to develop new models of care to improve quality and safety.
• The trust had further work to complete to support staff from minority or diverse groups. However, the experience of staff from these groups had shaped the development of specific support groups to black and minatory ethnic staff, LGBT staff and those staff who have a disability.
• The trust had planned and was making effective use of technology to improve quality and safety to patients. There was outstanding use of medically certified technology in older people’s mental health wards and innovative approaches when working with stakeholders across Coventry. The IT department were leading the drive to make access to patient clinical records timely between the trust and GP services.

However:

• There were still problems with medicines management across the trust. Not all areas across the trust stored and administered medicines safely. Although the trust had introduced new processes and equipment since the last inspection in June 2017, not all staff or teams adhered to safe medicines management.
• Some wards did not have enough regular staff to meet the needs of patients. This meant that activities and leave were cancelled and it had an impact on the morale of permanent staff. However, the trust recognised this was a risk and had improved ways to recruit and retain staff.
• We found that further improvements needed to be made to support managers to access information related to training, supervision, risk and audit.

Our full Inspection report summarising what we found and the supporting Evidence appendix containing detailed evidence and data about the trust is available on our website – www.cqc.org.uk/provider/RYG/reports.

Updated 21 December 2018

Our rating of this service went down. We rated it as requires improvement because:

• The service did not have always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. There were high vacancy levels for nursing staff and a dependence on bank and agency staff to cover shifts. However, the trust was aware of the issues and had put strategies in place to try and address this problem
• The service generally had suitable premises but did not always have equipment that was regularly maintained. There were large amounts of equipment used in the community nursing service that were out of date for annual testing. We raised this with the trust who took action to address this.
• Staff understood how to protect patients from abuse and they were aware of the requirement to work well with other agencies to do so. However, not all staff were up to date with training on how to recognise and report abuse.
• The service did not use safety monitoring results well. Although staff collected safety information and shared it with staff, there was limited evidence of how the service used information to improve the service.
• The service did not routinely monitor the effectiveness of care and treatment and generally did not use audit findings or analyse outcomes to improve services. There was not a systematic approach to reviewing patient outcomes. There was some comparison of national audit results with those of other similar services. Audit outcomes were not routinely used to drive improvements.
• Staff generally understood their roles and responsibilities under the Mental Capacity Act 2005. However, there was poor compliance with MCA training within the service.
• There were some services which were unable to meet targets for waiting times due to capacity issues within services.
• There was not a consistent approach to improving the quality of services and safeguarding high standards of care through use of clinical audit systems and clinical outcomes.

However:

• The service provided mandatory training in key skills to all staff and made sure most people completed it and remained up to date.
• The service controlled infection risk well most of the time. Staff generally kept themselves, equipment and the premises clean. They usually used control measures to prevent the spread of infection.
• Staff kept appropriate records of patients’ care and treatment. Records were clear, up-to-date and available to all staff providing care.
• The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
• The service made sure staff were competent for their roles. Managers appraised most staff’s work performance and held supervision meetings with them to provide support and monitor staff progress with personal objectives set at annual performance and development reviews.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
• Staff provided emotional support to patients to minimise their distress.
• Staff involved patients and those close to them in decisions about their care and treatment
• The trust planned and provided services in a way that met the needs of local people.
• The service took account of patients’ individual needs.
• People could usually access services when they needed to. Waiting times from assessment to treatment, were generally in line with good practice.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
• The service generally had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
• The service generally engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively.

Updated 12 July 2016

Overall rating for this core service                                                              GOOD 

Overall, we rated the service as good with the service being outstanding for caring and good in the other four areas.

• A caring and effective multidisciplinary and multiagency service was provided for children, young people and their families (CYPF) who required assessment, support and intervention to ensure their wellbeing and development.

• A highly skilled and empathetic workforce using an integrated “one stop” holistic approach across community settings provided services in a confidential and supportive environment.

• Evidenced based practice was evident and there was a strong ethos of audit and research to support the “best practice” of children young people and patients.

• The service had achieved accreditation for the UNICEF Baby Friendly Initiative Stage 3.

• Staff had appropriate skills, knowledge and experience to deliver effective care and treatment, with appraisal rates exceeding 90%.

• Children were truly respected and valued as individuals, encouraged to care for themselves self-care, and were supported to achieve their full potential within the limitations of their clinical condition.

• Children were active partners with the planning of their care whenever possible. Parents were closely involved throughout the assessment, planning and delivery of their child’s care and were kept informed of changes and developments by members of the multidisciplinary team.

• Feedback from parents who used the service and stakeholders were continually positive about the way staff treated people. Parents said “staff went the extra mile” and the care they received exceeded their expectations.

• The service was generally meeting most national performance measures regarding timely access to care and treatment.

• Services were well-led and staff were aware of the wider vision of the trust and service strategy and felt supported in their roles.

• The Integrated Sexual Health Service (ISHS) provided caring and effective multidisciplinary and multiagency sexual health service-to-service users who required a full range of sexual health services.

• Feedback from service users was very positive about the way ISHS staff treated people. Services were well-led at local level.

However, we found that:

• In the integrated sexual health service levels of staff requiring Level 3 safeguarding training were lower than expected in light of the CQC safeguarding review (2015).

• The clinical procedure for the insertion of contraceptive devices did not include inserting the devices in a patient’s home. This was raised with the service lead at the time of the inspection. The relevant patient group directives and risk assessments were in place to mitigate the level of risk.

• The policy for ordering, storing and handling of vaccines (NHS England 2015) was observed but there was no policy for the administration of the vaccine. Information was recorded on the PGD about administration of the vaccine but did not cover the entire process.

• CYPF had a mixture of paper and electronic care records. Copies of each were kept in the child or young person’s home and a copy was stored at the Paybody Building, the organisational hub for children, young people and family services. We noted there were delays with updating some care records in CYPF, which could affect the continuity of care for children and young people. Plans were in place to address this.

• There were difficulties with connectivity in relation to the use of laptops in some areas of the CYPF service.

• There was a high level of demand for the CYPF service, which was affecting waiting times in therapy and autism services.

• Staff raised concerns about the staffing levels in the children’s continuing care service, the learning disabilities respite service for children and young people, and the looked-after children service. There were difficulties recruiting specialist children’s nurses and there were 28 vacancies across the service. The service had taken action to mitigate the risks to children and young people.

• There was a shortage of consultants in ISHS due to retirements and staff sickness. The service had taken actions to mitigate the risks to patients. For example, the use of locum medical staff and the reconfiguration of clinical and support roles in sexual health teams.

• Withdrawal of the trainee doctor’s deanery contract occurred in July 2015. ISHS and Health Education England (HEE) were addressing the issues with plans to reintroduce trainee doctors in August 2016.

• There were clear governance frameworks in place and the outcomes of audits and governance meetings were shared with staff. However, not all risks in the service had been addressed in a timely manner.

Updated 8 November 2017

Overall, we rated the service as good because:

• Staff reported incidents appropriately. Incidents were investigated, shared, and there was evidence of lessons learned.

• Staff understood their safeguarding responsibilities and were aware of the safeguarding policies and procedures. Staff had up to date safeguarding training at the appropriate level.

• Medicines were stored, handled and administered safely.

• Equipment was well maintained and fit for purpose.

• Staffing levels were appropriate and met patients’ needs at the time of inspection.

• Patients’ individual care records were comprehensively written in a way that kept patients safe. Relevant information was recorded appropriately and staff had access to relevant details before providing care.

• Standards of cleanliness and hygiene were generally well maintained.

• Mandatory training was provided for staff and compliance was 100% for most topics. There was an action plan for the one topic, which did not meet the trust target of 95% compliance.

• Staff had the necessary qualifications and skills they needed to carry out their roles effectively. Further training and development opportunities were available for staff.

• Appropriate systems were in place to respond to medical emergencies.

• Patients’ needs were assessed and their care and treatment was delivered following local and national guidance for best practice.

• The service followed effective evidence based care and treatment policies that were based on national guidance.
• There was evidence of good multidisciplinary working with staff. Teams and services worked together to deliver effective care and treatment.

• During the inspection, we saw and were told by patients, that all staff working in the service were kind, caring and compassionate at every stage of their treatment.

• Patients were treated respectfully and their privacy was maintained in person and through the actions of staff to maintain confidentiality and dignity.

• Staff were sensitive to the needs of all patients and were skilled in supporting patients and young people with a disability and complex needs. We saw there were systems to ensure that services were able to meet the individual needs, for example, for people living with dementia and a learning disability.

• Staff involved patients and those close to them in aspects of their care and treatment. Information about treatment plans was provided to meet the needs of patients.

• There was an effective system to record concerns and complaints about the service. Complaints were reviewed and actioned appropriately with a view to improving patient care.

• Staff told us that they felt supported by their immediate line managers and that the senior management team were visible within the department.

• There was a very positive and forward looking attitude and culture apparent among the staff we spoke with.

However, we found that:

• Not all staff followed standard infection control precautions at all times.

• Some medical records were not locked away securely, although there was limited public access to this area.

• The service was unable to provide evidence of water quality monitoring and the results of water quality checks.

• Dental staff did not always ensure they followed their own policy on obtaining and recording informed consent.

• There were frequent inappropriate referrals into the service, which led to delays in the provision of treatment for some patients. However, the service had taken steps to reduce these and there was evidence that the number of inappropriate referrals had reduced.

• The newly developed dental strategy covered the period from 2016 to 2020. It was not fully operational as it relied on a dental plan that was incomplete at the time of our inspection. However, staff told us the plan was a work in progress and that it would be completed. The plan did not contain dates when the actions should be allocated, reviewed or completed by.

Updated 21 December 2018

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment.
• The service provided mandatory training in key skills to staff and most staff had completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service-controlled infection risk well. The service prescribed, gave, and recorded medicines well. Staff kept appropriate records of patients’ care and treatment.
• The service managed and reported patient safety incidents well most of the time. Staff recognised most incidents and reported them appropriately.
• The service provided care and treatment based on national guidance and evidenced some areas of its effectiveness. Staff assessed nutrition and hydration and provided advice to meet patients’ needs and improve their health. Pain was assessed appropriately.
• The service made sure staff were competent for their roles. Staff worked together as a team to benefit patients.
• Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff involved patients and those close to them in decisions about their care and treatment.
• Services were planned and delivered to meet the needs of patients and their relatives. The service took account of patients’ individual needs. People could access the service when they needed it.
• The service treated concerns and complaints seriously. Complaints were investigated when received. Lessons learned were shared with all staff.
• The service had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
• There was an effective governance structure in place. Processes and systems of accountability supported the delivery of the end of life care strategy.
• Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. There was a strong sense of culture that was centred on the needs of patients at the end of their life.

However,

• The service had suitable equipment but did not always use the equipment in line with national guidance. For example, syringe drivers were not routinely stored in the plastic lockable cases when in use. The service took action to resolve this when we raised it. Not all incidents identified in relation to syringe drivers had been reported as an incident.
• The quality of records had not been routinely audited.
• The service did not have a clear audit plan in place. The service did not have any mechanisms in place to monitor their results and benchmark against other similar services.
• Post-bereavement services feedback data was slightly worse than the previous year. Some patients’ equipment was delayed due to the specialist palliative care team referring patients to the community nursing teams solely for the ordering of equipment.
• Systems to review risks, planning to eliminate or reduce them, and coping with both the expected and unexpected were in place but risks were not always identified and there was no evidence of risks being discussed.

Updated 17 December 2019

We rated Aspen Centre as good because:

• We found that the ward had improved since the last inspection. The ward provided safe care and the environment was safe and clean. The ward had enough nurses and doctors. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to enable them to work with patients with eating disorders.
• The service worked to a recognised model for eating disorders. It was well led, and the governance processes ensured that ward procedures ran smoothly.
• Staff developed holistic care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a specialist ward for people with eating disorders and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. This included dieticians, occupational therapists and nursing staff. Managers ensured that these staff received training, supervision and appraisal.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service worked to a recognised model for eating disorders. It was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Bank and agency staff did not always fully understand or follow the mealtime routines which were care planned for patients.
• Staff did not always give a full response to concerns raised in community meetings and the responses were not fully recorded.
• Ward staff and the multidisciplinary team referred to themselves as two separate teams rather than as one team working together on patient care.

Updated 21 December 2018

• For children and young people with mental health problems, the trust had significantly improved triage processes since the previous inspection in June 2017 that meant referrals were reviewed quickly. The trust was working with partners across local the health and social care economy to reduce the impact on children and families who were waiting for treatment. Systems and processes were in place to monitor assessment and treatment times. However, there was further work to undertake to reduce waiting times for treatment, especially in neurodevelopment and child and adolescent mental health services.
• Staff received training on an extensive range of therapeutic interventions and provided care in line with National Institute for Health and Care Excellence guidelines.
• Care plans captured the voice of the young person and placed them at the centre of their care. Young people were actively involved in reviewing their progress towards their goals and outcomes.
• Staff reviewed complex cases using a multidisciplinary approach, were able seek support and guidance to ensure risks were appropriately managed. Care records contained up to date individual risk assessments and management plans.
• Staff morale was good and staff felt positive about their teams. The managers promoted a positive culture that supported and valued staff, creating a sense of mutual purpose based on shared values.
• Staff knew how to identify abuse and safeguard young people in line with current recognised guidance and trust policy. Staff followed safeguarding processes and ensured that they highlighted any safeguarding information on the electronic recording system.
• Young people felt that staff listened to them and provided them with appropriate emotional and practical support. Young people described the staff as caring, supportive and non-judgemental.
• Staff reported incidents appropriately and shared lessons learnt from the investigations. The teams had regular and effective multidisciplinary team meetings and worked well with other external organisations.
• The trust demonstrated how it was working to meet the recommendations of the previous inspection and how it was addressing the issues identified. Managers and commissioners were working together to reduce waiting lists and ensure that the service met the needs of children and young people locally.

However:

• Although we found that staff received regular supervision, the trust did not have a consistent and effective system for collating and monitoring supervision data.

Updated 29 February 2024

We carried out this announced focused inspection because this core service was last inspected in 2017 and rated requires improvement for the responsive key question. The inspection was announced to the trust the day before to ensure people using the service and staff were available to speak with us.

We visited all five locations of the community learning disability teams and both adult learning disability respite services.

The community team locations inspected were:

• The North Warwickshire team based at the Loft in Nuneaton.
• The Coventry and Rugby team based at Windmill Point in Coventry and the Railings in Rugby.
• The Solihull team based at Brooklands Hospital in Solihull.
• The South Warwickshire team based at Whitnash Lodge, Leamington.

The adult learning disability respite locations inspected were:

• Ashby House in Nuneaton.
• Shirley House in Solihull.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Our overall rating of this service went down. We rated them as requires improvement because:

• Governance processes did not always operate effectively, and performance and risk were not always managed well. Services were not always assessed, monitored and improved in relation to the quality of people’s experience.
• Not all staff kept up to date and accurate care records for all people using the service.
• People’s privacy was at risk due to the lack of soundproofing in interview rooms.
• Managers did not ensure the community teams met their referral to assessment and treatment targets or have plans in place to address this.
• While managers had systems and processes in place to monitor and manage staff absences. It was not always possible for managers to make arrangements to cover staff sickness and absence. This impacted on staff workloads and people waiting to access the service.
• Managers did not ensure all staff were up to date with basic life support training and appraisals.

However:

• People’s care and support was provided in safe, clean, well equipped, well-furnished and well-maintained environments which met people's sensory and physical needs.
• People were protected from abuse and poor care. The service had sufficient, appropriately skilled staff to meet people’s needs and keep them safe.
• People were supported to be independent and had control over their own lives. Their human rights were upheld.
• People received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. People had their communication needs met and information was shared in a way that could be understood.
• People received care, support and treatment that met their needs and aspirations. Care focused on people’s quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• The service provided care, support and treatment from trained staff and specialists able to meet people’s needs.
• People and those important to them were actively involved in planning their care. Multidisciplinary teams worked well together to provide the planned care.
• Since our inspection the trust have told us they have made a number of further improvements.

How we carried out the inspection

We looked at all 5 key questions: safe, effective, caring, responsive and well-led.

The inspection team consisted of 2 CQC inspectors, 2 specialist advisors and 1 expert by experience.

During the inspection visit, the inspection team:

• visited 5 community team locations and 2 respite services.
• looked at the quality of the environments and observed how staff were caring for people.
• observed 5 clinical review meetings.
• observed 5 episodes of care.
• spoke with 6 people who were using the service.
• spoke with 10 carers of people who were using the service.
• interviewed 7 managers, including team managers and one senior manager.
• spoke with 31 other staff members; including learning disability nurses, consultants, doctors, occupational therapists, psychologists, art therapists, speech and language therapists, physiotherapists and student nurses.
• looked at 22 care and treatment records of people using the service.
• looked at a range of policies, procedures and other documents relating to the running of the service.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

We spoke with 6 people using the service and 10 carers of people who were using the service. Feedback was mostly positive with people and their carers telling us staff were compassionate, kind and helpful. Carers described staff as going the extra mile and providing a life changing service. People and their carers told us that staff involved them and fitted the service around them to meet their needs. People and their carers told us that staff communication was good, and teams would ensure they communicated using the persons preferred methods. A carer at the North Warwickshire team told us staff consider the family as a whole and “as a family I don’t feel we could have asked for more.” A carer at Ashby House told us, “Staff moved heaven and earth, our family member gets so much out of her time here. Staff are incredibly responsive.”

One person supported by the Rugby team provided written feedback stating “- x (nurse) is really nice and I can speak freely to her and everyone else. My confidence has grown. “TOP BANANA!!!.”

However, one carer of a person at the North Warwickshire team told us they were “left out of the loop” after the psychiatrist left. They reported communication was not as good after the psychiatrist left.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• There were sufficient staff to meet the needs of patients; to assess, diagnose, treat and support them in a timely manner. Monitoring and reviews took place in a timely manner, and changes and concerns were responded to promptly. Patient and carer feedback about the approach and support of staff was consistently positive.
• Staff showed a good understanding of how to support people in making decisions, when support was needed, and the appropriate steps to take when decisions were made for people.
• Patients and carers were fully involved in comprehensive assessments which were patient focused and took account of physical health, mental well-being, their environment and all other relevant factors. Patients were well supported through assessment and diagnosis by skilled and sensitive staff, who re-assured patients and conveyed information effectively. Information and advice was made available to help patients and carers live with dementia and assist patients to access opportunities in the wider community.
• Teams had a wide range of skills, qualifications and experience, and worked together well to ensure any delays or deficits were minimal. Teams worked well with other agencies to ensure good support was available when needed.
• The service addressed the wide range of needs in the diverse communities they served.
• Staff and managers all worked together well and positively and flexibly to ensure that the service worked effectively under pressure to meet patient need. Staff were confident and were positive about their experience within the teams.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• We rated effective, caring, responsive and well-led as good and safe as requires improvement.
• The service kept people safe from avoidable harm by ensuring sufficient staff with the right training, supervision, knowledge and skills. Risk assessments were thorough and staff planned patient care around their needs. Staff had good awareness of safeguarding issues, followed the trust lone working policy, incidents were reported, and lessons learnt were cascaded to staff.
• Staff used best practice and national guidance to complete comprehensive assessments of their patients, and communicated their needs within the multidisciplinary team, the wider trust and with their external partners to ensure patients received effective and consistent care and treatment.
• Patients told us staff treated them respectfully and they were involved in their own care. They felt they were listened to and both patients and carers were provided with relevant information and support to manage their condition.
• The teams responded to patients quickly and managed their caseload effectively to ensure they could provide care when the patient required it. Teams were meeting their targets and dealt with complaints effectively.
• There were good governance arrangements in place and experienced managers and staff monitored the quality of the service they provided through the use of audits, patient feedback, incidents and complaints and key performance indicators. Staff were positive about the trust and their managers.

However:

• We found that processes and procedures for medicines management were not in place to adequately safeguard against abuse, ensure they were safe to use so patients were protected against harm.
• Staff could not easily identify when patients had been involved within their care plan and had received a copy, however patients and carers we spoke with felt they had sufficient information about their plan of care and treatment.

Updated 8 November 2017

We rated the inpatient wards for people with a learning disability or autism as good because:

• During this most recent inspection, we found that the services had made improvements and addressed most issues that had caused us to rate the inpatient wards for people with a learning disability or autism as requires improvement following the April 2016 inspection.

• Staffing levels on all wards were sufficient and ensured safe clinical practice. Ward managers ensured a balance of staff skills and gender mix across all wards. Wards had enough staff to meet needs of patients and provide therapeutic time for patients. All patients had up-to-date risk assessments that informed risk management plans.

• We saw many improvements to the awareness of environmental risks. Staff undertook assessments of ligature points and, where these were identified, took adequate action to mitigate the risk. Staff were made aware of both the ligature risk assessment and the mitigation plan for each ward.

• There were low rates of restraints and prone restraints. The trust had adopted robust effective systems to review and learn from incidents.

• Staff demonstrated good knowledge of the Mental Health Act, Mental Capacity Act and Gillick competency.

• Staff were receiving regular clinical supervision and were appraised in line with the trust policy and procedures. Staff had access to a range of specialist training that was directly linked to the needs of patients. This included additional training for nursing staff in physical health care and monitoring.

• Staff delivered treatment in a respectful and caring way and demonstrated an advanced understanding of patient needs. Patient and carers spoke very highly of staff and the quality of care received.

• Staff were passionate about their work and spoke with pride about the wards they worked on.

• Patients had easy access to information on advocacy, complaints, treatments, and legal rights. Patients had access to community (patients) meetings where they could raise issues and concerns. Patients knew how to make complaints, and received outcomes from their complaints.

However:

• The wards did not adhere to all safeguards relating to long-term segregation, in accordance with the Mental Health Act Code of Practice, for the patients nursed in long-term segregation. There was no evidence of external three monthly reviews taking place.

• Medical reviews in seclusion records were not consistent. One of those seclusions lasted five hours with no medical reviews taking place and no clear justification why the doctor did not attend.

• Patients and visitors could see confidential patient information on the patient information boards in the staff offices.

• On Jade and Amber wards, there was no unified approach to records consolidation. Patient notes were stored in four different files. This meant records were not easily accessible to staff and there was a risk that records could be misfiled.

Updated 21 September 2023

We carried out this unannounced focused inspection because we had concerns about the quality of services.

The service

Brooklands hospital is a specialised hospital site which provides inpatient care and treatment to adults and children with a learning disability or autism. The hospital is part of the learning disability and autism services delivered by Coventry and Warwickshire Partnership NHS Trust. There are 4 forensic inpatient wards based at Brooklands Hospital.

The forensic inpatient service is made up of:

• The Janet Shaw Clinic, a medium secure unit for adult men,
• Eden ward, a low secure ward for adult women,
• Malvern ward, a low secure ward for adult men, and
• Rainbow ward, a low secure ward consisting of 3 individual apartments for men with a diagnosis of autism.

During our inspection, we visited Janet Shaw, Eden, Malvern and Rainbow.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, Right care, Right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

What we found

At an inspection in March 2022 the service was rated inadequate overall and following that inspection we served 6 requirement notices for breaches in regulation.

At that time, we rated safe, responsive and well led as inadequate, and effective and caring as requires improvement.

As a result of this inspection on 28 March 2023 the overall rating of this service stayed the same. Due to the seriousness of our concerns following our site visits, we used our powers under Section 29A of the Health and Social Care Act 2008 to issue a warning notice to the trust. We use Section 29A warning notices with NHS Trusts when it appears that the quality of health care provided by the trust requires “significant improvement”. The notice provided the trust with a deadline by which they were required to make significant improvement to the areas identified in the notice. Details of the notice can be found at the end of the report.

Running the service

• staff had the skills to develop detailed positive behaviour support plans and risk assessments,
• care plans were individualised and met people’s needs, people had a copy of their care plan and could attend their weekly ward review,
• people received a range of treatments in line with national guidance for best practice. These were delivered in group and individual sessions,
• vacant occupational therapy posts had been recruited to.

However,

• the service did not ensure there were enough staff within the service trained to deliver safe, person-centred care suitable for a secure environment,
• the service did not ensure the secure environment was fit for purpose and meeting the needs for people. Staff did not complete thorough environmental checklists to protect people from harm,
• staff did not have easy access to clinical information,

• blanket restrictions for the service were disproportionate to individual risk. People said they could only have a hot drink at certain times in the day. The patient information booklet on Rainbow stated people could only access leave once they had completed daily tasks and were looking clean, smart, and tidy. The provider told us they have reviewed their use of ward rules and this no longer applies.
• the service did not adhere to the Mental Health Act Code of Practice in relation to long term segregation and seclusion practice, including timeliness of reviews.

How we judged the service

We judged the service as inadequate overall. The service did not meet the principles of Right support, right care, right culture because:

• the service did not provide safe care,
• people did not have an individualised timetable and could not shape their own meaningful activities, independence, and quality of life. People said activities were often cancelled and did not happen on evenings or at weekends,
• people did not always have expected discharge dates and were delayed in their discharge from hospital, so were kept in hospital longer than necessary.

The provider had not ensured:

• staff were carrying out observations of people in accordance with their policy and the National Institute for Health and Care Excellence (NICE) guidance to protect people from harm,
• their quality improvement plan and audits of the service were effective in mitigating risk and improving quality for the people in their care,
• staff were receiving supervision in line with trust policy, staff nurses said they felt burnt out,
• people did not have access to contraband items, this led to subsequent incidents,
• staff were completing accurate records when people were secluded,
• people felt safe with bank and agency staff.

Updated 29 February 2024

We carried out this announced focused inspection because this core service was last inspected in 2017 and rated requires improvement for the responsive key question.

At our last inspection, in June 2017, we rated the trust overall as Good. Long Stay Rehabilitation Mental Health wards for working age adult services was rated Good overall.

Coventry and Warwickshire Partnership NHS trust provides 2 Long Stay Rehabilitation mental health wards for working age adults.

Hawkesbury lodge is a locked recovery inpatient rehabilitation service in Longford, Coventry. It provides care and treatment for 20 males and females. There are 8 male beds, 8 female beds and four female step-down beds. At the time of the inspection there were 15 patients of which 7 were female and 8 were male.

Hazelwood Ward is a locked, inpatient rehabilitation ward at St Michael’s hospital in Warwick. It provides care and treatment for 12 males.

At the time of the inspection Hazelwood Ward was temporarily based on Rosewood Ward due to the renovations across most of the wards at St. Michaels Hospital. There were 10 male patients on the ward.

Patients are either informal or formally detained under the Mental Health Act 1983 and have severe and enduring mental health problems. Patients may also have additional challenging behaviour, substance misuse use problems, social support needs and physical health needs.

Our overall rating of this service went down. We rated it as requires improvement because:

• Staff did not keep patient care records, including care plans up to date.
• There were no updated recovery and well-being journey skills pack for patients in care records. There was limited evidence of patient involvement documented in relation to activities, assessment and recovery.
• There was no occupational therapist or psychologist on Hawkesbury Lodge at the time of the inspection.
• Managers did not ensure staff on Hazelwood ward received regular supervisions and appraisals.

However:

• The service provided safe care. The ward environments were visibly safe and clean. The wards had enough nurses and doctors. Staff assessed and managed individual patient risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff provided a range of treatments suitable to the needs of the patients cared for in a mental health rehabilitation ward and in line with national guidance about best practice.
• The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients.
• All patients spoken with were very positive, happy and had no complaints.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
• The service worked to a recognised model of mental health rehabilitation.
• There was positive feedback from staff about induction, leadership and support.
• Overall, the service had a positive culture and were keen to improve.
• Since our inspection the trust have told us they have made a number of further improvements.

How we carried out the inspection

This was an unannounced inspection and we looked at all 5 key questions: safe, effective, caring, responsive and well-led.

The inspection team consisted of 2 CQC inspectors on site, 1 expert by experience and 1 specialist advisor. 2 locations or wards Hawkesbury Lodge and Hazelwood Ward were inspected. We also carried out interviews with carers or families.

During the inspection visit, the inspection team:

• Spoke with 13 patients who were being cared for at either Hazelwood ward or Hawkesbury Lodge.
• Observed staff’s interaction with patients.
• Observed a morning safety huddle meeting.
• Interviewed 14 members of staff including nurses, health care assistants, a senior support worker, occupational therapist, ward managers and deputies including the junior doctor and the clinical lead.
• Reviewed the environment of the wards and reviewed 2 tours Hawkesbury Lodge and Hazelwood Ward.
• Reviewed 12 patient care records which included physical health records.
• Reviewed 16 medication charts.
• Reviewed 11 incidents.
• Reviewed a range of documents and policies in relation to the running of the long stay and rehab services across both sites.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

We spoke with 13 patients who were receiving care in the long stay and rehabilitation services and we also spoke with 4 carers or families.

All of the carers or family members we spoke with told us staff were polite and respectful. There was good communication between carers and the service and the service was responsive.

Carers expressed they have been given information about care and treatment and this made them feel involved in the patient’s care.

All carers and families including patients, told us the environment was clean, comfortable and well-maintained. They could also see the patients making good progress.

Patients, families and carers told us they could access a doctor in a timely way and that their medicines were reviewed regularly.

All patients we spoke with did not have any complaints about the care or the staff and said they were friendly, kind, caring and compassionate. The staff would also have discussions with patients about education and work opportunities such as online courses and one-to-one sessions. Two patients found this very useful.

Most patients told us there were activities during the week such as cinema trips, picnics, swimming, going to the gym, cooking, walks and beach trips were arranged too. However, 4 patients on Hawkesbury Lodge told us there were not many activities in the evening and sometimes they would not be interested in the ones during the day. On Hazelwood ward, patients told us there was a limit to the use of the car to take them on excursions or planned activities.

All patients told us their dietary requirements were met and the quality of the food and choice was good. They were all encouraged to self-prepare if they could or supported if required. The mealtimes were flexible as well.

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

• Patients had thorough assessments covering both their mental and physical health. Staff reviewed and updated risk assessments and care plans in a timely manner. Patients and relatives were positive about the quality of care and treatment that staff delivered. Vacancies remained high in the nursing teams across the service but managers filled most posts with regular temporary staff who were known to the service. There were sufficient staff of the right grades and professions to assess, treat and support patients.
• Patient care was delivered by a multi-disciplinary team involving a wide range of professionals who worked well together. Patients had access to good support to identify and manage physical health problems. Patients could access the right care at the right time.
• Patients and relatives told us that staff were kind, treating them with dignity and respect. Staff encouraged patients to give feedback about the service they delivered. They tailored these opportunities to meet patients’ communication abilities.
• Patients did not experience delays in their discharge. Any delays were outside of the control this service. Most patients who experienced delays were waiting for a community support package or new housing.
• Ward managers led their service well. They carried out regular audits to provide assurance about the quality of care provided by the service. Middle managers involved staff in service development. Staff received regular supervision and appraisals. They had opportunities for career development and good access to specialist training. Senior managers made visits to the wards so they were visible to staff. Staff knew how to contact senior managers if they wanted to raise concerns. The service was working toward accreditation with the Royal College of Psychiatrists’ Quality Network for Older Adults Mental Health Services and the Triangle of Care.

However:

• Room temperatures where medicines were stored regularly exceed the recommended range on three out of the four wards. The trust had supplied some wards with air-conditioning units and these were being used correctly. Staff had to wait six weeks for a faulty medicines fridge to be replaced on Pembleton ward. Not all wards had personal emergency evacuations plans for patients who needed them. Staff on Pembleton ward had not followed trust policy or best practice when covertly administering medicines for a patient.
• Staff routinely completed mental capacity assessments when they needed to, but did not always use trust documents to evidence the assessments. Patients on Pembleton and Stanley wards had limited access to psychological assessment and formulation because the trust had struggled to recruit a psychologist.
• There was nowhere other than the daily records for staff to record that they had offered patients a copy of their care plan.
• Morale amongst some of the nursing teams was poor due to rumours about the future of the service and the number of vacant posts within the service.

Updated 29 February 2024

We carried out this focused inspection because this core service was last inspected in 2018 and rated requires improvement for the safe and well led key questions. The inspection was unannounced.

At the last inspection we raised concerns in a number of areas. We found that:

The trust must ensure that changes are made to the seclusion room to prevent the risk of injury to patients and staff. At this inspection we found that the work had been undertaken and risks had been eliminated.

The trust must ensure all staff that require it are trained in the Mental Health Act and Mental Capacity Act to support them in their roles. We found that mandatory training levels in these areas had improved, and the trust was compliant with its own target rates for Mental Health Act and Mental Capacity Act training.

The trust must ensure they have effective systems in place to check that all issues relating to the management of medication including room, fridge temperatures and the administering of medications is safe. At this inspection we found that processes had been put in place to ensure that checks were undertaken.

The trust must ensure that all Mental Health Act paperwork is completed correctly and in line with the guidance given in the code of practice. At this inspection we looked at Mental Health Act paperwork and did not identify any issues.

The acute and PICU service at Coventry and Warwick Partnership NHS Foundation trust, is made up of 9 wards based across two separate locations in Coventry and Warwick. The Caludon Centre is in Coventry and St Micheals Hospital is in Warwick.

The Caludon Centre houses a male psychiatric intensive care unit (PICU), Sherbourne ward, and a female PICU, Edgwick ward. It also houses 5 acute mental health wards comprising of Westwood, Beechwood, Spencer, Hearshall and Swanswell wards.

St Michaels Hospital houses two acute wards, the Larches and Willowvale.

For this inspection we visited 6 of the 9 wards that make up this service.

This included Sherbourne which was the male PICU ward at The Caludon Centre and three acute wards for adults of working age comprised of Westwood, Beechwood and Spencer Wards. We also visited The Larches and Willowvale at St Michaels Hospital.

Our overall rating of this service stayed the same. We rated them as requires improvement because:

• The service was not responding to safeguarding alerts in line with its own organisational policy. We found cases where safeguarding reviews had not taken place and examples where safeguarding reviews had not been reviewed by managers as per trust policy.
• We found that there was high usage of locum doctors across the service and the organisation did not have systems in place to monitor the training and development of locum doctors who were working within the service for extended periods.
• The service did not have safe systems in place to monitor restricted items on wards.

However

• Risk assessments and care plans were complete and had been reviewed regularly in line with trust guidance. Care plans also included complete physical health assessments on admission and ongoing plans for care of identified physical health conditions where appropriate.
• We saw staff engaging with patients and offering emotional support. Patients told us that they felt supported. We also saw staff supporting patients to move on to new placements. This involved high levels of emotional support and encouragement.
• Staff were supported to undertake developmental training and consider their own personal development though regular appraisals. We saw examples where staff had been able to move into new roles as a result of personal development and training.
• Since our inspection the trust have told us they have made a number of further improvements.

How we carried out the inspection

We looked at all 5 key questions: safe, effective, caring, responsive and well-led.

The inspection team consisted of 2 CQC inspectors, 2 specialist advisors and 1 expert by experience.

During the inspection visit, the inspection team:

• looked at the quality of the environments and observed how staff were caring for patients.
• spoke with 10 patients.
• observed 3 meetings.
• interviewed 8 managers, including ward managers and one senior manager.
• spoke with 23 other staff members: including nurses, healthcare assistants, consultants, doctors, occupational therapists,
• looked at 17 care and treatment records of people using the service.
• Looked at the electronic prescribing and medicines administration (EPMA) system in relation to the medical records of 24 patients across the 6 wards we inspected.
• looked at a range of policies, procedures and other documents relating to the running of the service.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the services say

Patients we interviewed were positive about the service. They told us they felt they were getting the care they required, and staff were motivated and helpful.

Updated 8 November 2017

We rated the community-based mental health services for adults of working age as good because :

• During the most recent inspection, we found that the service had addressed the issues that led us to rate community-based mental health services for adults of working age as requires improvement following the April 2016 inspection.
• At our last inspection, we had found that clinical areas did not contain emergency equipment. The trust confirmed that its emergency response for community mental health teams was limited to the administration of basic life support, the use of automated external defibrillators, and a call to emergency services. Each community mental health team base had adrenalin pens, automated emergency defibrillators and additional safety equipment such as spill kits and resuscitation masks to support the administration of basic life support.
• At our last inspection, we were unable to locate legal documents associated with Ministry of Justice orders and community treatment orders. We also found that staff had not incorporated the conditions into risk assessments and care plans. At this inspection, we found that staff stored scanned copies of legal documentation in patients’ electronic records, and that they incorporated the conditions into risk assessments and care plans.
• Since our last inspection, we found that staff received and were up-to-date with mandatory training that included safeguarding, infection prevention, personal safety, and basic life support. Care plans were holistic, person-centred and recovery-oriented. Records showed that staff offered patients copies of their care plans. Staff in all teams considered patients’ physical healthcare needs and offered them support.
• At this inspection, we found that teams had sufficient staffing levels to cover shifts, and good duty arrangements to respond promptly to patients when they contacted by telephone.
• Staff received regular supervision and had access to weekly team meetings, monthly business meetings, peer group meetings and reflective practice sessions.
• Staff had good, collaborative working relationships with their patients. They showed dignity and respect towards patients and their carers/relatives in their interactions with them.
• All community teams took active steps to prevent non-attendance at appointments and work with patients who found it difficult to engage with services.
• Staff showed compassion and respect, and demonstrated genuine commitment to working together and achieving excellence.
• Staff morale was high across all teams we inspected. Staff experienced a strong sense of job satisfaction and empowerment in their roles, and benefited from good team working and mutual support.
• Community teams participated in a range of quality improvement and research projects.

However:

• The wellbeing teams had waiting times of between four to 12 weeks for a team assessment and long waiting lists for allocation of a care coordinator. Most teams had waiting times of up to five months for psychology services.
• Coventry wellbeing team staff found it difficult to access their team’s psychiatrists urgently, and at times had to request medical support from crisis services.
• Clinic room temperatures at the Nuneaton base used by the North Warwickshire teams exceeded the maximum level on 11 occasions in the month to 28 June 2017.
• Some teams did not have enough suitable, lockable bags for the safe and secure transport of medicines.
• Four medication charts at the Coventry wellbeing team did not have consent to treatment forms attached to them.
• Staff had not yet migrated all patients’ records onto the trust’s new electronic care records system. Not all information was stored consistently on the new system.
• Not all staff had received their annual appraisals.
• Staff in the Coventry wellbeing team found it difficult to find available interview rooms onsite or in other premises, which meant that occasionally, they changed face-to-face appointments to telephone calls.
• Staff did not always inform the trust’s complaints departments of the complaints they had dealt with, for the trust’s records.
• Few staff knew about the duty of candour and the trust’s policy.
• Some teams did not have administrative support in their teams and the trust’s administrative hub did not meet their teams’ needs effectively.