St Andrew's Healthcare - Essex

Updated 20 July 2023

St Andrew’s Healthcare Essex location is situated in North Benfleet, Essex, and has been registered with the Care Quality Commission since 11 April 2011. St Andrew’s Healthcare also have locations in Northampton and Birmingham.

This location was most recently inspected in June 2022. The location was rated as inadequate overall. We issued the provider with a warning notice telling the provider they had breaches of regulation in the following areas: no call bells in patient bedrooms for patients to alert staff in an emergency, staff were not complying with completing enhanced patient observations safely or in line with their policy, managers did not ensure a rehabilitation model was embedded on Maldon ward, patients on Maldon ward did not have access to employment and educational opportunities and did not receive regular psychology sessions to support them in their recovery. At the time of inspection Maldon ward had three patients and the provider had plans to close the ward once the three remaining patients had found suitable placements elsewhere.

During this inspection, we found improvements in all areas of the warning notice served in June 2022. However, we still found areas where the provider needed to make improvements.

The following services were visited on this inspection:

Acute wards for adults of working age and psychiatric intensive care units:

We inspected the following wards:

• Audley ward is a male ward with 11 beds.

• Frinton ward is a female ward with 12 beds.

• Benfleet ward is a male acute admission ward with 16 beds.

Forensic inpatient or secure wards:

We inspected the following wards:

• Danbury ward is a low secure male ward with 16 beds.

• Colne ward is a low secure female ward with 6 beds. This ward was due to be closed once patients had been discharged.

Long stay rehabilitation mental health wards for working age adults:

We inspected the following ward:

• Tiptree ward is an all-male ward with 16 beds. Tiptree ward opened on 19 January 2023 and has not previously been inspected by the Care Quality Commission.  

What people who use the service say

We spoke with 16 patients and 5 family members or carers across all of the 3 core services we inspected.

Acute wards for adults of working age and psychiatric intensive care units:

We spoke with 3 patients and 4 carers.

Carers we spoke with told us that they felt very involved in the care of their loved one, the service was responsive and quick to resolve complaints and that there was good communication between the carer and the doctors or other health professionals. They told us staff were very caring and understanding and they felt that wards were safe and met patient’s needs. They also commented on the range of relevant activities, for example, sporting activities.

Patients we spoke with said they liked the food, they knew how to complain, and that staff were nice, although 2 patients said that the wards needed more staff.

Forensic inpatient or secure wards:

We spoke with 7 patients and 1 carer.

Patients told us staff are visible on the wards, but they spent a lot of time in the office, and it was difficult to get staff out of the office to respond to their requests.

Patients told us they have community meetings, but they do not find these meetings effective, mealtimes were not flexible, and they generally did not like the food. They also told us leave sometimes gets cancelled and patients were not always given sufficient notice when appointments were cancelled.

Patients knew how to complain, and most patients knew what medication they were taking and were involved in their medication reviews.

The carer we spoke with told us they believed their relative was safe and they felt able to raise a concern, although when they did raise a concern, it took longer than they thought to be resolved. They had good communication with their relative’s physical health doctor. They said they were particularly impressed with the hospital social worker.

Long stay rehabilitation mental health wards for working age adults:

We spoke with 6 patients.

Patients told us staff were respectful, kind, helpful and friendly and there were always enough staff to talk to. Patients said that the ward was always clean and there was a range of activities to take part in, patients told us their leave or activities had never been cancelled. 

Patients told us the food was good and there was a wide variety. 

Three patients told us they were not aware of any educational or volunteering opportunities, 2 patients told us they were not given an information pack on admission to the ward and 3 patients told us they did not know how long they were expected to stay on the ward.

Updated 20 July 2023

St Andrew’s Healthcare Essex is situated in North Benfleet, Essex.

The registered location at Essex provides men’s services and women’s services. This location consists of 3 core services:

• Acute wards for adults of working age and psychiatric intensive care units

• Long stay rehabilitation mental health wards for working age adults

• Forensic inpatient or secure wards

Our rating of this location ​improved​. We rated it as ​requires improvement​ because:

Danbury ward and all acute wards for adults of working age and psychiatric intensive care units were tired and in need of redecoration.

Managers did not always ensure there were enough staff on shift to meet minimum planned numbers, on long stay rehabilitation mental health wards for working age adults. Training figures on some wards were below what we would expect for a safe service. Some staff were not up to date with mandatory training. 

Patients on Tiptree ward were not accessing and participating in, education and work opportunities in the wider community.

The service had not reviewed its recovery model of care, expected length of stay and did not have clear discharge pathways for patients at admission.

Staff did not always record observations in line with the providers policy. We reviewed 16 observation records during inspection, 12 of the observation records we reviewed had delays in the time of the observation being uploaded on to the providers electronic recording system.

Patients from Benfleet ward requiring seclusion were taken to Tiptree ward through the ward area to access seclusion, potentially not maintaining privacy and dignity.

However:

The ward environments were safe. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.

Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

Patients had access to a nurse call system, so patients could summon help if required.

Observations were being completed at unpredictable intervals which was an improvement from the last inspection and staff were following policies and procedures. The hospital had installed a new observations system for staff to record observations in real time and managers had oversight.

Following this inspection, requirement notices were issued for:

• Regulation 9 HSCA (RA) Regulations 2014 Person-centred care
• Regulation 12 HSCA (RA) Regulations 2014 Safe care and treatment
• Regulation 15 HSCA (RA) Regulations 2014 Premises and equipment

At St Andrew’s Healthcare Essex, the services provided include patient centered care for both men and women with a personality disorder and/or mental health issues in both a low secure and locked environment.

St Andrew’s Healthcare Essex location has been inspected 8 times.

The location has a registered manager and a controlled drugs accountable officer.

St Andrew’s Healthcare Essex location 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.

Updated 20 July 2023

Our rating of this service ​improved​. We rated it as ​good because:

• Danbury ward was not clean when we visited, and patients told us that the ward was not clean.
• Training figures were below what we would expect for a safe service. Fifty seven percent of staff on Danbury ward had completed immediate life support and 56% had completed safety intervention training. The hospital target was 100%.
• On Danbury ward there was a cold drinks dispenser which was empty at the time of inspection and did not appear to be in use.
• On Danbury ward there were maintenance issues; a clothes dryer was not working, 4 showers were not working, the patient computer was being repaired and there was poor décor and graffiti on 2 pictures on the ward.
• Staff struggled to name the 5 principles of the Mental Capacity Act, although they showed a good understanding of how the Mental Capacity Act was applied in practice.

However;

• Patients had access to a nurse call system, so patients could summon help if required.
• Maldon ward was clean. Neither ward had an unpleasant smell.
• Staff maintained patient confidentiality on the wards.
• Observations were being completed at unpredictable intervals which was an improvement from the last inspection and staff were following policies and procedures. The hospital had installed a new observations system for staff to record observations in real time and managers had oversight.
• The seclusion room on Danbury ward had a functioning monitor. The seclusion room had not been used since the ward opened in January 2023.
• Patients were given feedback following complaints.

Updated 20 July 2023

Tiptree ward had not previously been inspected. We rated it as ​requires improvement​ because: 

• Staff did not always complete observation charts fully or in a timely manner. 
• Patients could not freely access the kitchen for drinks or snacks. 
• Managers did not always ensure there were enough staff on shift to meet minimum planned numbers. 
• Staff were not up to date with mandatory training. 
• There was a seclusion room on the ward, this had a potential negative impact on the therapeutic environment. 
• Staff did not ensure that patients accessed and participated in educational or work opportunities in the wider community. 
• The service did not work to an expected length of stay and some patients did not know how long they were expected to stay on the ward.  
• Not all patients had a discharge pathway from admission, and some discharge plans lacked detail. 

However: 

• The ward environments were safe and clean. Staff assessed and managed risk well. They managed medicines safely and followed good practice with respect to safeguarding. 
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and patient involvement. They provided a range of treatments and activities on the ward suitable to the needs of the patients cared for in a mental health rehabilitation ward. 
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received regular supervision and appraisal.  
• The ward staff worked well together as a multidisciplinary team. There was clear input from occupational health and psychology teams.  
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. 
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients in care decisions. 
• Both staff and patients spoke positively about the ward. 

Updated 20 July 2023

Our rating of this location ​improved​. We rated it as ​good​ because:

• The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
• Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision, and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
• The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

• Wards were tired and in need of redecoration. The provider had a hospital wide renovation plan, which showed the timescales for all ward areas to undergo redecoration and renovation. Renovations were due to start in April 2023.
• Patients from Benfleet ward requiring seclusion were taken to Tiptree ward through the ward area to access seclusion, potentially not maintaining privacy and dignity.
• Staff did not always carry out observations in line with the providers policy.