Suffolk mental health hospital closes after staff caught sleeping again

Inspectors revisited the hospital to see if any improvements had been made.

Author: Abi SimpsonPublished 17th Sep 2021

A mental health hospital in Suffolk has decided to close permanently after inspectors found no improvement had been made on a previous 'inadequate' inspection.

The Care Quality Commission was forced to take further action after a visit to St John's House in Palgrave in July, to check on progress from its previous visit which saw the hospital placed under special measures.

The 49-bed hospital is run by Partnerships in Care, part of the Priory Group and cares for adults with learning disabilities and associated mental health issues.

The CQC says during the most recent inspection, further concerns were highlighted that showed unacceptable care, and insufficient progress had been made regarding patient safety, staffing, risk management and adherence to patient care and risk needs.

Due to the serious level of concerns found, previous conditions CQC placed on the provider remained in place, including restricting admissions to the hospital and further urgent conditions were imposed to prevent harm and to protect patients.

Following this, the provider decided to close this location and they are working to find alternative care services for patients.

Stuart Dunn, CQC head of inspection for mental health and community services, said: “Our latest inspection of St John’s House found an unacceptable service where insufficient improvements had been made to protect patients from harm and abuse and the number of safety incidents remained high.

“Staff weren’t responding appropriately to patients who were self-harming, with one patient not being sent to hospital quickly enough after swallowing a foreign object, despite complaining of abdominal pain.

“We reviewed CCTV footage and found staff were sometimes asleep when they should have been observing patients to make sure they were safe.

"This was all the more concerning as we identified this as a concern during the previous two inspections of this service, demonstrating a lack of improvement to keep patients safe.

“Incidents of restraint remained high and not all staff had the right training to carry it out safely. In addition, staff were not following hospital policy when using soft handcuffs with patients during safety incidents.

“Services must inform CQC and other statutory bodies when they identify safeguarding concerns such as these to ensure patient safety. This service’s continued failure to refer all instances of abuse and thoroughly investigate concerns has put its patients at prolonged risk of harm.

“Following our inspection where additional enforcement action was taken, the provider made the decision to close this service.”

The CQC said the service was short-staffed and heavily dependent on agency workers, many of whom were not adequately trained or experienced. Permanent staff had completed their mandatory training, but reported they were concerned about working with agency workers as they were not always competent.

Staffing levels were below the number needed to consistently maintain patient observation levels and male staff were often placed on female patient observations due to a shortage of female staff.

This led to a potential self-harm incident when a female patient was left alone in a bathroom due to the male staff member not being able to enter. This posed a significant risk to the patient as there was a delayed response in assisting them.

A spokesman for the hospital said: “Following discussion with NHSEI, we notified the CQC on 23rd July 2021 that we had taken the decision to close St John’s House. This step has not been taken lightly but we consider that, given the wholly exceptional circumstances, it is the most appropriate course of action.

"Despite our best efforts and substantial investment, St John’s House continued to suffer from significant recruitment difficulties stemming from the nationwide shortage of specialist nursing staff for learning disability services.

"As such, it had become increasingly challenging to meet the needs of the people we look after and over the last 2 months we have worked diligently with all stakeholders to find appropriate alternative provision for service users.

"There are now only 2 service users remaining at the service and we expect alternative provision to be found for them later this month.

"We fully support the transforming care initiative, which enables more people with a learning disability to live in the community with the right support and close to home. In line with this approach, we will continue to work with NHSEI to change the way we deliver our learning disability services in order to provide the most appropriate form of care for the people we look after.”

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