Updated 24 March 2023
Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS). It provides specialist mental health services for adolescents and young people from 12 to 18 years of age. The hospital delivers specialised clinical care for young people requiring inpatient CAMHS, including psychiatric intensive care (PICU) and eating disorders. The hospital and its surrounding grounds are within a rural setting and are situated near a town with easy access to transport links and shops. Young people are supported in their education via the hospital school which is rated good by Ofsted. Where appropriate the young people have access to the hospital grounds and local community facilities.
When all the wards are fully open, the hospital has 59 beds. The PICU wards have a cap on admissions and are only able to admit a maximum of 22 young people due to conditions imposed on its registration by CQC at a previous inspection in July 2021. At the time of this inspection, the cap was still in place.
The hospital consists of five wards:
- Kennet ward provides eating disorder services and has 20 beds
- Tamar ward provides tier four CAMHS general adolescent services and has 10 beds
- Juniper ward provides PICU services and has 7 beds
- Holly ward provides PICU services and has 8 beds
- Maple ward provides PICU services and has 7 beds.
There was a registered manager in post at the time of the inspection.
The hospital is registered to provide the following regulated activities:
- Treatment of disease, disorder or injury
- Assessment or medical treatment for persons detained under the 1983 Act
- Diagnostic and screening procedures.
Following the previous inspection in July 2022, we issued a letter of intent under section 31 of the Health and Social Care Act 2008. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. A letter of intent sets out our intention to take urgent action if the provider does not assure us that it will make the required improvements urgently. The provider submitted an action plan to us and assured us they were taking immediate actions to improve the safety of the hospital. As such we did not take further action at that time. As a result of the July 2022 inspection we rated the hospital as requires improvement overall, with a rating of inadequate in the safe domain, requires improvement in the effective, caring and well led domain and good in the responsive domain.
Following the inspection in July 2022 we issued the provider with requirement notices. We told the provider to make the following improvements:
- The service must ensure that all relevant staff are appropriately trained and assessed as competent to carry out observation checks of young people. (Regulation 12)
- The service must ensure that all ward environments are fit for purpose. (Regulation 15: Premises and equipment, (1)(c) and (e))
- The service must ensure that staff receive a debrief and/or reflective practice session following serious incident, including after incidents that involve restraints. (Regulation 12)
- The service must ensure that staff have completed managing medications and immediate life support training. (Regulation 12)
- The service must ensure that young people and the relevant family/carers are involved in care and treatment planning. (Regulation 9)
- The service must ensure that young people have access to the recommended psychological therapy as outlined in best practice guidance and that young people have access to meaningful activities seven days a week. (Regulation 9)
- The service must ensure that there are effective and robust governance procedures in place to ensure that young people always receive safe care and treatment. (Regulation 17)
- The service must ensure that they complete the actions of the action plan following the issue of the letter of intent and embed the improvements to the service. (Regulation 17)
During this inspection we saw that the provider had made improvements in the areas of concerns we had found in July 2022, but had not met all of the requirement notices. We also found new concerns during this inspection relating to governance, the cleanliness of Tamar ward, maintenance issues on Tamar and Kennet wards, the physical observations of young people following the use of rapid tranquilisation and the recording of nasogastric tube insertion and administration of feed lacked detail.
The hospital had improved the process around observations of young people. There was now a daily checklist in place to ensure staff on shift were trained and competent to undertake observations of young people. There were also processes in place to ensure young people’s observations were undertaken as prescribed. The hospital was monitoring observations through regular audits and a standard operating procedure had been implemented to ensure all staff followed the Supportive Engagement and Observation Policy and were competent to use it.
Training compliance rates among staff had improved for managing medications. However, the training rate for Immediate Life Support training was still low. Staff requiring this training had dates booked to complete it by January 2023.
We found some of the ward environments were still unfit for purpose. A feasibility study had been developed and planning permission was being sought to replace Tamar ward with a purpose built ward. Refurbishment of the psychiatric intensive care units had now been completed.
The hospital recognised there were still actions that needed to be completed and work was required to embed the improvements to ensure they would be sustained permanently. The provider had introduced a new governance system and developed a comprehensive site improvement plan to monitor progress against each of the actions contained within it and had detailed oversite of progress.