Mental health staff falsified records and assaulted patients - CQC

A mental health trust has been ordered to make urgent improvements after inspectors uncovered a series of safety failings.

The Care Quality Commission (CQC) found examples of staff falsifying records and assaulting patients at Nottinghamshire Healthcare NHS Foundation Trust.

It inspected the trust's acute adult and older people wards last year.

The trust has now apologised "unreservedly".

Inspection reports published on Friday unveiled a catalogue of failings across the two services, causing both to have their overall ratings dropped to "inadequate".

The CQC visited acute adult mental health wards at Highbury Hospital, in Nottingham, and Sherwood Oaks, in Mansfield, as part of the inspection.

The report on these visits highlights a number of concerns, including an inconsistent approach to recording patient's details when they accessed leave at both hospitals and incidents of assaults on patients by staff members at Sherwood Oaks.

It also details occasions in which staff were found to have falsified records at Highbury Hospital - two of which were uncovered before the CQC's inspection following the deaths of two patients and after the police became involved.

The CQC also observed an example of staff falsifying records while visiting Redwood 2 - a ward at Highbury Hospital.

A patient who had been assessed as requiring 10-minute observations due to the risk of harm to themselves was found in their bathroom with a ligature.

Observations were noted on the electronic patient record but the CQC found there were two occasions when the patient was not checked, however staff recorded that they had been.

The time of the incident was also recorded incorrectly.

"A trust investigation of CCTV found that these staff had falsified care records to show that observations had been done when by hadn't," said Greg Rielly, the CQC's deputy director of operations in the Midlands.

"Our inspectors also reviewed CCTV footage in the acute wards for adults of working age and psychiatric intensive care units and found staff had assaulted people causing physical harm.

"There had been four occasions where two people had been physically assaulted on Elm ward. The staff involved had been suspended and the trust have investigated the incidents.

"This is totally unacceptable behaviour and must be addressed by the trust as a priority."

Inspectors also found shortcomings when they visited the trust's wards for older people at Highbury Hospital and Millbrook Mental Health Unit in Mansfield.

They found examples where a patient's sedative medication had been administered against the prescribed dose and against medical advice, as well as missing signatures on patient cards.

The report also notes that there was "no clear signage on the wards to support people living with dementia" and the signs that were in place "did not comply with best practice".

The inspections of the two services took place on dates in October, November and December last year.

The CQC noted that the acute adult wards were clean and patient records were comprehensive, while staff working on the wards for older people felt supported.

Mr Rielly said: "Since the inspection, we have told the trust where we need to see rapid and widespread improvements and we have issued requirement notices, so they know where they need to focus their attention.

"We will continue to monitor the trust closely whilst these improvements are being made to keep people safe.

"If we're not assured improvements have been made and embedded, we will not hesitate to use further enforcement powers to keep people safe."

Ifti Majid, chief executive of Nottinghamshire Healthcare NHS Foundation Trust, said: "I absolutely accept that these inspections found care that was not of the standard of quality that it should have been and I apologise unreservedly that we have let down patients who have not received the level of care they deserve.

"I recognise that we have to do better, to make changes in the way we deliver care so we can help those who need us and reassure the public of Nottingham and Nottinghamshire that it is a good thing to seek care and support from us.

"We have responded quickly to start that improvement journey."

He said the trust had implemented a number of changes since the inspections, including enhanced daily checks on records of patients' leave, a review of all observations and increased medicines management training.

It was reported in January that more than 30 members of staff from across the organisation had been suspended amid an investigation into conduct.

Nottinghamshire Healthcare also runs services at Rampton Hospital, which was criticised by inspectors in January after the watchdog found understaffing had caused patients to be locked in their rooms for extended periods.

The health secretary also commissioned the CQC to conduct a rapid review into mental health services provided by the trust following the sentencing of triple killer Valdo Calocane.

The review - which was ordered earlier this year and is separate to inspections covered in the new reports - will investigate the trust's contact with him prior to the Nottingham attacks in June last year.

The CQC is expected to complete the review by the end of March.

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