The Care Quality Commission (CQC) has published a report following an inspection of forensic inpatient and secure wards run by Greater Manchester Mental Health NHS Foundation Trust.
CQC carried out an unannounced inspection in April and May 2024 to follow up on the progress of improvements they were told to make at their previous inspection, when CQC issued a warning notice.
The inspection took place at the Edenfield Centre, at the trust’s main site in Prestwich, and Wentworth House, in Eccles. The wards inspected include: Rydal, Dovedale, Silverdale, Ferndale, Keswick, Delaney, Isherwood, Borrowdale, Derwent, Buttermere, Newland, and Wentworth.
The ratings for forensic inpatient and secure wards at this inspection have been combined with the ratings from its previous inspection. The service has been re-rated as inadequate overall and for being safe and well-led. Effective, caring, and responsive have been re-rated as requires improvement.
The rating for the trust remains unchanged and is rated as inadequate overall.
Alison Chilton, CQC deputy director of operations in the north, said:
“When we inspected the forensic inpatient and secure wards run by Greater Manchester Mental Health Foundation Trust, we found some improvements had been made since our last inspection, however several areas of concern remained.
“At this inspection we found the trust had made cultural improvements to how it approached learning and safety, as well as its leadership. Leaders told us safeguarding reporting had improved and there were now better relationships with local safeguarding teams. However, some staff said they didn’t feel able to speak up about concerns and weren't confident leaders would act on issues.
“There were significant gaps in some observation records and staff told us the trust’s policy wasn’t always followed. Staff were unclear how they should be completed and told us about occasions where observations were sometimes carried out later than required.
“Some staff said they were expected to carry out observations for several hours without a break and there had been issues with bank staff sleeping during the night shifts. However, leaders told us that previous issues with staff sleeping had reduced due to the use of CCTV.
“The trust’s processes didn’t always ensure the environment was safe for people. We found some wards which carried out 15-minute security checks to keep people safe had gaps and missing signatures in their records.
“In addition, ligature risks hadn’t been identified on two wards and outside areas weren’t included in heat maps for any of the wards. Some of the ligature risk assessments were undated and it was unclear when they’d last been reviewed. We also found blind spots on several wards which weren’t adequately addressed.
“Medicines weren’t always being managed safely, despite managers efforts to audit and monitor them. There were gaps in stock checks, missing signatures for controlled drugs, and expired items in emergency bags. On some wards staff weren’t following the trust’s policy on people self-medicating.
“There was also evidence of restrictive practices across the wards. The service had imposed blanket restrictions without evidence to demonstrate the decision-making behind this, or that these were being kept under close review. For example, there was a blanket policy for nursing staff to supervise all family visits. We were told by carers this happened despite people’s risk assessments showing it wasn’t always necessary for their safety.
“We’ve told the leadership team where improvements are needed and since our last inspection we have engaged with the trust and partner organisations to closely monitor the service so that people receive the safe care and treatment they deserve.”
Inspectors found:
- Staff told inspectors incidents of people smoking on the wards had significantly reduced. However, on one ward staff described ongoing issues with people vaping in communal areas
- The trust had recruited more staff which had led to concerns from managers about the challenges of managing an influx of new staff alongside more experienced staff. Inspectors were told this had led to a cultural divide on some wards and led to isolated complaints of bullying and discrimination
- Cleaning records were incomplete or not available during the inspection
- Some staff told inspectors they didn’t feel engaged with leaders and felt changes had been made without their participation
- People gave mixed feedback about their experiences on the wards. Some told inspectors staff didn’t listen to them when they raised concerns and didn’t speak positively to them. However, during the inspection staff were observed treating people with kindness and compassion
- Fire safety checks were also not always carried out in line with the trust’s policy and not all staff had received a fire induction. There was no evidence fire drills had taken place on some wards
- Care plans reflected people’s individual needs and were personalised, holistic and recovery-based
- The trust held regular community meetings and made improvements based on feedback from people who used the service.
The report will be published on the CQC website in the coming days.