A unit for people with learning disabilities in Cumbria has been given an improved rating by the Care Quality Commission but told it must improve learning from incidents and uptake of key training.
The Edenwood unit at Carleton Clinic in Carlisle was previously rated “inadequate”, but has been moved up to “requires improvement” after an unannounced inspection in October last year.
“The trust must make further improvements to ensure people receive a safe and well-led service”
The service provides six assessment and treatment beds and had 21.8 full-time equivalent substantive staff, as of August 2016, including nurses and nursing assistants.
It was rated good for being effective, caring and responsive but “requires improvement” for whether it was safe and well-led.
Inspectors identified a number of improvements since the unit, run by Cumbria Partnership NHS Foundation Trust, was last visited as part of a comprehensive inspection in November 2015.
The introduction of a “positive behaviour support model” – a way of working with people with learning disabilities to reduce challenging behaviour – had led to better patient care.
There were also improvements in the quality of care plans, communication plans, discharge plans and risk assessment processes.
“Patients felt well supported by staff and staff demonstrated a good understanding of the needs of patients, including their communication needs,” said the CQC’s report.
“We have already been looking at ways to improve the uptake of mandatory staff training”
Between April and September 2016, there were 288 incidents of violence and aggression on the ward. During the same period, there were 88 episodes of patients being restrained by staff.
However, CQC inspectors found there was no clear process to review and learn from incidents and staff did not feel they got “any constructive feedback” from management following incidents.
This was one of the key areas the trust was told it must improve, alongside staff understanding of the duty or candour and take-up of mandatory training.
The proportion of staff who had done mandatory training was below the trust target of 80% for several key topics, including infection prevention and control, rapid tranquilisation and clinical record keeping.
Only half had undertaken mandatory training on mental health legislation. Meanwhile, only one member of staff was able to explain what was meant by the duty of candour.
Dr Paul Lelliott
“Although we found staff to be caring, the trust must make further improvements to ensure people receive a safe and well-led service,” said Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health.
“We have told the trust where they must make improvements, and we will return to check on their progress in due course,” he added.
Clare Parker, interim director of quality and nursing at Cumbria Partnership, said the CQC report reflected “a positive change in direction for Edenwood”.
“We know there are still areas we need to improve further on and we have plans in place to support this,” she said.
“We have already been looking at ways to improve the uptake of mandatory staff training and are hopeful this can be improved by monitoring of training and staff supervision,” she noted.
She added: “Learning from incidents will also be addressed further through staff discussions and learning reviews and we have already implemented a monthly bulletin for staff which shares the learning.”