Avon and Wiltshire Mental Health Partnership NHS Trust

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We found that the service was not always safe for patients and staff. Staffing levels were within the trust safe levels during the night. However, when incidents occurred across the site, staff responded from their wards, and therefore, decreased the safe staffing levels across all wards for extended and undetermined amounts of time. The staff we spoke with could not describe the process to follow in the event of emergencies and there was a lack of clarity for staff on the procedures to follow to escalate an emergency. The service used a high level of agency staff on wards which staff and patients told us was poor quality. Patients shared that some staff did not treat them with dignity and respect. We were informed that some staff were anxious about reporting incidents and concerns and using the freedom to speak up process due to high levels of staff disciplinary procedures. We found breaches of regulation in safe staffing and safe care and treatment. Staff lacked the understanding of their roles and associated responsibilities in relation to some of the provider's policies, procedures or guidance to prevent abuse. The provider did not fully assess the staffing levels required to safely meet the needs of the patients during emergencies. Additionally, the provider had not removed blanket restrictions during the night. However, we found evidence that senior leaders did act promptly when they were made aware of information about poor care practices.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We saw evidence that patients were able to raise their concerns through their community meetings. However, the same complaints were raised consistently which indicated that prompt action was not taken by staff to address the concerns that were raised. Most of the relatives we spoke to during the assessment also told us that they did not think their concerns were taken seriously by senior leaders and they felt frustrated raising the same concerns.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We saw records of patients raising concerns about the care provided by some staff. Patients complained about a lack of engagement from staff, especially over weekends when activities are limited, being ignored and spoken to and treated without dignity and respect. Patients said that staff ate their food and sometimes lost their personal property.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff told us that blanket restrictions such as night time curfews for patients, and the locking of internal doors while some patients accessed the garden, had recently been lifted. Staff told us that they were not given time to prepare for these changes by senior leaders which meant that some restrictions remained in place on some wards.

We saw that the wards gardens were poorly lit at night time which reduced visibility of patients subject to observations. We reviewed maintenance records in which most reported problems were dealt with promptly. However, we did not see that poor lighting in ward gardens had been reported as an issue on the service maintenance records.

Nurses said short notice cancellations of shifts was a problem. Nurses in 3 wards said they had no access to daytime rotas for them to arrange cover. For example, there were occasions when staff rostered on early shifts rang to cancel during the night. Nurses told us they often had to ask staff to stay on past their shift to cover short notice absences. We were made aware that staffing levels at night were maintained by agency or bank staff. We were also told that the quality of some agency staff was poor which made work for the permanent staff burdensome.

We observed that there was a lack of oversight of staffing arrangements during night time hours and the deployment of staff on any of the wards when emergencies occurred. The staff we spoke to were unaware of who the unit nurse in charge was, or on which ward they were located. We observed incidents where a unit nurse in charge was needed to direct and deploy staff for potential emergencies. For example, for a patient whose blood sugars had become difficult to stabilise during the day due to dietary decisions. Another patient had self-harmed and needed support from staff across all wards and escorts for a hospital visit. During this period of time staffing levels were reduced across other wards.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.