The July 2O14 CQC announced inspection report stated..
Care and welfare of people who use services FAILED
Safeguarding people who use services from abuse FAILED
“Some of our findings highlighted that seclusion was used as a way of managing the ward environment rather than as a response to the violent or disturbed behaviour of individuals. An example of this was that we were told by staff that one person was in seclusion because the person's behaviour was difficult to manage. We spoke with the person's consultant and other health professionals involved in their care and found arrangements were not adequate to ensure the person received safe and appropriate care. For example; we saw periods of days where the person's behaviour was stable and they showed nonthreatening behaviour. We spoke with the person in seclusion and they told us they were unclear what they had to do to leave seclusion room and that none of the staff had explained this to them. However following our inspection the provider sent us information demonstrating the person had been appropriately informed. Considering all the information available, it was not clear what 'severely disturbed behaviour' had triggered the episode of long term-seclusion. This is not in line with the Mental Health Act Code of Practice, Paragraph 15.43, which states: "Its [seclusion] sole aim is to contain severely disturbed behaviour which is likely to cause harm to others. We looked at examples of three other people who had occupied rooms for seclusion that were not designated seclusion rooms, (these were referred to as quiet rooms) and found that people often spent long periods of time in the rooms without adequate reviews having taken place and without appropriate facilities being available. For example one person was told to urinate in a bowl when they required to use the toilet as there were no toilet facilities the person could use. Failing to ensure people were adequately reviewed during seclusion periods and not providing adequate facilities meant that people were not protected from the risks of receiving inappropriate care. We also looked at the risk assessments regarding the use of non-seclusion rooms and found these were not adequate. They did not address the privacy and dignity of people using the rooms during the time of seclusion due to lack of toilet facilities and also the fact the rooms could be overlooked by other parts of the hospital. We found that the hospital did not always treat people in the least restrictive manner and often enforced boundaries with punitive actions. For example staff told us that spitting and hitting staff was regarded as physical assault and would lead to a person having their leave cancelled. We saw an example in one person's care where they had seven days leave cancelled and 72 hours internal leave cancelled due to spitting at a member of staff. This meant they were unable to leave the ward. The situation had not been analysed prior to imposing such a restrictive measure. We found examining the information available that the incident had escalated due to the staff member's behaviour towards the person. There was little consideration of people's learning disabilities, challenging behaviours and levels of functional analysis when enforcing these levels of restrictions. This meant people were placed at risk of receiving inappropriate care. We looked at other areas of restrictive practices and found most people had restrictions in place regarding the use of telephones and family visits which often meant people were supervised during phone calls and visits. We looked at the risk assessments in place and found they were not adequate. They lacked detail on the risks to demonstrate why people required supervision. There was no forward plan detailing under what circumstances this could cease. People we spoke with told us they did not know why they were being supervised for phone calls and visits and did not understand their rights regarding privacy and restrictions. People told us about their meal time experience and said that if they did not turn up for meals on time they were not offered a hot meal and would be given a sandwich. Staff told us this was due to food hygiene regulations. However; we found the practice restrictive as the rules did not take into account people's complex behaviours that may mean they were unable to attend lunch /dinner or if they were attending visits or other appointments that meant they were not able to attend the mealtime. However we also found that people did not always have their care planned in a way which meant it was safe and effective and people were not always treated in a way where their human rights were protected. We provided a summary of feedback to the managers of the service during our inspection and expressed our concerns in relation to the way some people were cared for. People were placed in seclusion for often long periods of time where their behaviour did not amount to seriously disturbed behaviour which presented risks to themselves and others, and was used to manage often complex difficult behaviours without appropriate reviews from doctors taking place. The majority of staff we spoke with were not aware that it was the local authority safeguarding team that co-ordinated investigations and reviews into safeguarding adults cases, or that they could contact the safeguarding team directly if they were concerned that someone was being abused. Staff were not able to identify that restrictive practices such as cancelling people's leave and failing to analyse incidents in full detail, taking into account people's functional analysis, behaviours and learning disabilities, meant that people were subject to practices that may potentially have been abusive. We saw examples of where people had contacted external services to complain about leave being cancelled and to also complain about the way they were treated by some staff. People who used the service were not protected against the risk of unlawful or excessive physical restraint because the provider had not made suitable arrangements. We saw an example within records where people were restrained in rooms (quiet rooms) for long periods of time where they did not have access to appropriate facilities such as toilets. Staff told us due to people's presentation during restraint it was often difficult to move people to the hospital seclusion rooms safely. We also found where people had seclusion plans in place they were not allowed to come out from seclusion until the time stipulated in seclusion plans had lapsed, regardless if their behaviour had decreased. This meant that people were in seclusion for potentially longer periods than necessary. Incident reports did not include analysing excessive use of seclusion and also providing care in the least restrictive manner. Overall, we did find examples of care practices where the restrictions imposed did not protect people from the risk of abuse. We also found arrangements in relation to the use of seclusion were inadequate and did not protect people from the risks of receiving care where restraint was potentially excessive and unlawful. We met with managers of the service during our inspection and expressed our concern relating to how people were treated and are seeking assurances from the service to ensure standards are improved.” (Selected extracts with some editing from the CQC inspection report into Roseberry Park hospital, July 2014).
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