13 December 2022 14 December 2022
During an inspection looking at part of the service
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.
Our rating of this location went down. This inspection rated Taplow Manor as inadequate and placed them into special measures.
We rated it as inadequate because:
- Tamar ward remained unfit for purpose. This had been a concern in the last 3 inspections. The provider had developed a feasibility study and were submitting a planning application so a new purpose built ward could replace it. However, there had been little progress to mitigate the immediate concerns about the ward environment and it was not well maintained.
- Tamar ward was unclean. Floors and carpets were heavily stained and there was dirt throughout the ward. Bathroom areas and the clinic room were unclean.
- Not all of the wards at the hospital were well maintained. Ward furniture was in a state of disrepair, there was graffiti on the walls and peeling paint.
- Staff training compliance with immediate life support training was still low.
- Physical health observations after the use of rapid tranquilisation were not always being undertaken.
- The recording of nasogastric tube insertion and administration of feed lacked detail and was not in line with guidance.
- Treatment programmes and activities for young people across the hospital were starting to improve. However, this work required further embedding across the hospital.
- Care plans did not demonstrate that children and young people had been involved in their development and represented their voice and views. There was little evidence that young people had been offered a copy of their care plans.
- Supervision rates for staff across the hospital were variable.
- We saw evidence the hospital had better oversight of governance processes and were progressing with the site improvement plan. However, some of the improvements were still in their infancy and further work was required to embed and sustain changes. There were also concerns found during the inspection which the hospital’s governance processes had not identified or mitigated against.
However:
- Vacancy rates were reducing, and the provider was actively recruiting international staff.
- Observation procedures had significantly improved across the hospital. Staff were trained in observations and processes were in place to establish competency with the observation policy.
- Staff understood how to safeguard patients and were compliant with safeguarding training.
- The investigation of incidents had improved since the last inspection. Incidents were investigated thoroughly and staff were provided with a debrief. The hospital learned lessons from incidents and shared these.
- Positive Behaviour Support plans were in place for all young people. Young people had been involved in their development and staff had received training.
- Managers used audits to make improvements. The hospital had recently implemented a new audit schedule across the hospital.
- Staff treated young people with kindness and respect. Staff supported young people and involved their families or carers.
- Young people and their relatives and carers knew how to complain or raise concerns.
- Staff morale was improving and the senior management team had implemented a number of initiatives to improve engagement with staff and improve well-being and morale.
- Leaders at the hospital had shown a commitment to making the improvements required following the last inspection. A site wide improvement plan was in place to measure progress and the actions required.
What people who use the service say
We received mixed feedback from young people across the hospital.
Young people said staff treated them with respect and dignity and ensured that their needs were met.
They were sometimes bored outside of school hours or if not in school as there were no other activity programmes during this time. Mobile phones and television programmes on streaming services were not available during school hours, even if they were not at school.
Young people told us they weren’t always involved in their care plans or received copies of their care plan.
Some young people said that the food was good, while others said it could be better.
Young people on Kennet ward said new staff or staff who cover from other wards as well as agency staff will sometimes say and do inappropriate things as they don’t understand eating disorders.
Some young people said it could take time for staff to respond to requests when the wards were busy.