In a CQC report published today, it was announced that Thors Park, which provides support for up to 14 men with learning disabilities and complex needs, has been rated ‘inadequate’ overall, following an inspection in February.
“It is unacceptable that staff have failed to take the necessary steps to keep patients safe”
Dr Paul Lelliott
The latest rating comes just over a year after the Danshell Group hospital was rated ‘good’ overall in January 2018.
According to the health watchdog, a series of further focused inspections had been carried out in October and November 2018 because of safeguarding concerns.
Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, said Thors Park was under investigation by safeguarding teams due to allegations of abuse by staff towards patients and “a number of incidents related to unexplained injuries of patients”.
As a result of the most recent inspection, the CQC issued the organisation warnings in relation to safety, governance and staffing.
Today’s report explained that staff at the Thorrington based hospital, had not managed risks to people who used the services and had “missed opportunities to prevent or minimise harm”.
At the time of inspection, 11 men were receiving care and treatment at the hospital.
In its report, the CQC flagged up that staff had not intervened in situations of challenging behaviour towards staff, and that restraint records were “not accurate” and personal alarms were “faulty”.
It was also found that staff were not up-to-date on mandatory training and that staff had not managed medication properly.
In addition, the CQC reported that the provider had not ensured that the clinic room door has been repaired. During its inspection, a patient managed to forcibly access the room as the door was faulty, and no temporary solution had been put in place.
Concerns were also raised about the cleanliness of the hospital.
As a result of the inspection, the hospital is now rated as ‘inadequate’ for being safe, responsive and well-led, ‘requires improvement’ for being effective and ‘good’ for being caring.
“We are already implementing a comprehensive action plan”
The CQC today set out a list of improvements for the service to implement. As part of this, the health watchdog called on Thors Park to ensure staff received regular appraisals, supervision and were up-to-date with all mandatory training.
It also asked that physical restraints used during incidents were recorded, that action was taken to manage significant issues that occur, and that the clinic room, equipment and medication was safely managed.
Dr Lelliott explained that the service currently had no registered manager and that the turn over of managers in recent year had been high.
“It must be asked whether these factors have contributed to the deterioration in the service since our last comprehensive inspection in January 2018 – at which time we rated the hospital as ’good’,” he said.
Dr Lelliott described the situation at Thors Park as “troubling”.
Dr Paul Lelliott
“It is unacceptable that staff have failed to take the necessary steps to keep patients safe or to keep the ward in a clean and well-maintained condition,” he added.
“The local safeguarding team is currently undertaking a safeguarding investigation triggered by allegations of abuse by staff towards patients and a number of incidents related to unexplained injuries of patients,” he said.
The CQC would monitor Thors Park closely and if necessary take further action to keep patients safe, Dr Lelliott added.
The service will be inspected again within six months.
A spokesman for Cygnet Health Care, the parent organisation of Danshell Group, said it had only recently acquired the group and that it was currently undertaking an in-depth review of the facilities.
Cygnet was working to address the concerns raised by the CQC, he added.
“Immediately following the CQC’s inspection and ahead of the publication of the report, we began taking steps to address the concerns raised,” the spokesman said.
“We are already implementing a comprehensive action plan to address the issues referenced in the CQC report,” he added.