The Care Quality Commission (CQC) has rated a Shropshire private hospital inadequate and placed it in special measures following an investigation which found people using the service were at risk of harm.
The CQC revealed it had inspected Eldertree Lodge in Market Drayton, which provides specialist inpatient treatment and rehabilitation services for adults with a learning disability or autism, due to serious concerns raised about the care being provided.
These related to inappropriate patient handling techniques, poor staff behaviour, unsafe staffing levels and a lack of visible leadership.
Some of these concerns had been raised by Coveberry – the service’s new provider which had taken over the hospital four months before the March inspection.
During the inspection, concerns were identified that showed patients were at risk of harm because systems to monitor the quality of care were either not in place, or not operating effectively.
These included:
- Not all patients were treated with dignity and respect. Patients were not always happy with the care and treatment provided.
- Leadership was poor and staff did not always feel supported, valued or respected by senior leaders.
- The ward environments were not safe and clean. Staff did not always adhere to COVID-19 national guidance, putting staff and patients at risk.
- Not all staff were trained in the same restrictive techniques to ensure patients remained safe.
- Not all staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging. Staff were slow to deploy de-escalation techniques to prevent patients’ further distress.
- Risk to patients was not always managed well. Incidents were not investigated thoroughly, and associated learning was not adequately shared among staff.
- Governance processes did not always operate effectively at ward level and performance and risk were not managed well. Managers said they were working to rectify several concerns since they took over the service, but many identified and unidentified issues remained.
‘Widespread significant shortfalls’
Following the inspection, the provider was ordered to submit an action plan within 24 hours that described how it was addressing the concerns found.
The CQC found the response did not provide enough assurance so took immediate enforcement action to restrict the hospital from admitting any new patients without written agreement from CQC.
Eldertree Lodge was also rated inadequate and placed in special measures meaning it is subject to close monitoring to help it improve its care and ensure patient safety. A follow-up inspection was carried out in May to check on progress and the CQC expects to publish the inspection findings soon.
CQC deputy chief inspector of hospitals and lead for mental health Dr Kevin Cleary, said: “When we inspected Eldertree Lodge, we found widespread and significant shortfalls in the way in which the service was led.
“We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity and independence that most people take for granted.
“We were concerned there had been incidents where patients had self-harmed while living at the service. There were not enough staff to safely provide nursing observations and all wards used a high number of agency staff many of who could not describe the needs of the patients in their care,” Cleary added.
The regulator also noted that wards were not safe, clean, well-equipped or fit for purpose and staff did not follow the provider’s Covid-19 infection control policy or national guidance.
“Throughout the inspection we saw staff not wearing face masks appropriately,” Cleary continued.
“This is why we took the decision to restrict admissions to the service until improvements are made. We will continue to monitor the service closely and have since returned to check on progress.
“We will not hesitate to take further enforcement action if necessary.”
Coveberry response
In response, a spokesperson for Coveberry said in a statement: “Coveberry is aware of the findings of a recent inspection report published by the Care Quality Commission regarding Eldertree Lodge, a high-dependency rehabilitation service. Eldertree Lodge recently came under Coveberry’s control as part of a wider acquisition completed in December 2020.
“Upon taking control at Eldertree, Coveberry, alongside other stakeholders, recognised the need for improvements at the site and initiated an action plan to upgrade the standard of services, facilities and the environment as well as enhance training support for staff. New leadership has also been put in place.
“Anticipated timelines for implementing these improvements have been extended by the Covid-19 outbreak, which has impacted the service. We acknowledge that further work is needed but we are confident that progress is being made under the continuing programme of work and investment.
“Coveberry is working closely with CQC and commissioners to address all of the issues raised in the recent report. We are confident that the action we are taking will ensure the necessary improvements are made at Eldertree Lodge.”