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Agency nurses 'unsafely' left in charge at recently axed hospital

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An independent children’s mental health hospital that put patients at risk by leaving agency nurses “without relevant knowledge or experience” in charge of shifts has been shut down.

Four Seasons Health Care Group made the decision to close Meadow Lodge, in Chudleigh, Newton Abbot, this month after safety concerns were raised by the Care Quality Commission.

“There was a disconnect between the nursing team and the local management team”

CQC report 

However, a spokeswoman for the company insisted the closure was the result of a restructure of children’s mental health services by NHS England and was unrelated to the CQC’s findings.

She also said that the announcement today that Four Seasons Health Care Group was going into administration was unconnected with the issues at Meadow Lodge.

The other hospital and care home services in the group’s portfolio would continue to run as normal under their current leadership teams, the spokeswoman added.

Meadow Lodge was led by the Huntercombe Group, a subsidiary company of the Four Seasons.

The service was inspected by the CQC in February 2019 after previous concerns over safety lead to provider voluntarily stopping admissions in November last year.

Despite the closure, the CQC published the findings of its inspection on Friday. The hospital was rated “inadequate” overall and would have been placed under special measures if it had not been shut down.

The report revealed how on seven occasions over a six-week period, registered general nurses from an agency were unsafely left in charge of shifts, despite measures put in place to stop this happening after the first occurrence.

“These nurses had little knowledge of mental health or child and adolescent mental health and had no experience of working in these areas so could not safely take charge of shifts,” it said.

“Following the first occurrence, the provider identified an action to put in place a safer system of work but this action wasn’t taken and RGNs, without relevant knowledge or experience were left in charge of six subsequent shifts,” said the report, noting that these were not recorded by the hospital as incidents.

“Meadow Lodge was subject to enhanced monitoring”

Paul Lelliott

The CQC’s report said staff were unclear about who they should contact in the event of an emergency.

There were also health professionals working shifts who had not undertaken the training required to do their role “effectively and safely”, it added.

The CQC highlighted serious problems with leadership at the hospital due to a high turnover of local managers.

“Due to the instability of the local management team and pressures within the service there was conflict in the team at all levels,” noted the document.

It uncovered a “disconnect” between managers and the nursing team, noting how nurses were excluded from key clinical meetings.

“Nursing staff said they did not have the opportunity to contribute to discussions about the strategy for their service,” the report said.

“In the six months prior to the inspection nursing staff were present at only two of the six held monthly clinical governance meetings,” it added.

“There was a disconnect between the nursing team and the local management team,” stated the report.

The hospital also failed to inform the Nursing and Midwifery Council when nurses displayed poor practice or acted outside of the regulator’s code of practice, the CQC revealed.

However, the watchdog said staff did go “above and beyond” to protect young people, even putting themselves in danger to do so.

“Had the service remained viable, we would have continued that improvement work”

The Huntercombe Group spokeswoman

“We saw CCTV footage showing staff putting themselves in harm’s way to prevent a young person from injuring themselves,” said the report.

Staff had “good rapport” with patients and only used restraint as a last resort, added the document.

The latest CQC inspection followed a period of intense scrutiny on the hospital. The service had been under “enhanced multi-agency surveillance” since September 2018 after issues were raised by whistle-blowers.

In November last year, the hospital voluntarily stopped taking admissions after it was issued a warning notice by the CQC. The watchdog found the service was not providing young people with safe care and treatment, and staff were not following their requirements under the duty of candour.

Dr Paul Lelliott, the CQC’s deputy chief inspector for hospitals and lead for mental health, said: “CQC has worked closely with NHS England along with other stakeholders.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

“Meadow Lodge was subject to enhanced monitoring from these groups to ensure young people using services were safe since concerns were first raised last year,” said Dr Lelliott.

“Our latest inspection of Meadow Lodge identified issues that were a matter of some concern and that although some improvements had been made the service was not managed in a way that ensured safe care was delivered,” he added.

A spokeswoman for the Huntercombe Group and Four Seasons said a consultation was being held with staff at Meadow Lodge about their future positions. 

“Earlier this month we made the decision to close Meadow Lodge following an NHS England review to re-organise capacity of Child and Adolescent Mental Health Services in the South region, which determined that Meadow Lodge was no longer required,” said the spokesman. 

“Staff are undertaking a consultation process where we will try to support them in their individual options for the future,” she added.

“The CQC’s report acknowledges progress that had been made,” she said. “Had the service remained viable, we would have continued that improvement work.”

The spokeswoman said two patients who were admitted to Meadow Lodge when it closed were “relocated”.

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