Taplow youth psychiatric hospital rated inadequate and placed in special measures

A Taplow youth psychiatric hospital has been rated inadequate and placed in special measures by the care inspection body – which said the service is ‘still not safe’.

Inspectors gave a damning report to Taplow Manor, formerly known as Huntercombe Hospital Maidenhead, which has had problems before.

Taplow Manor is a specialist child and adolescent mental health inpatient service (CAMHS) in Huntercombe Lane South.

It provides specialist mental health services for adolescents and young people from 12 to 18 years of age. It includes treatment for eating disorders and psychiatric intensive care.

The service has come under intense scrutiny before. In December, police began investigating the alleged rape of a patient there.

Last year, the hospital was also the subject of a series of news reports following an investigation by the Independent and Sky News.

The Care Quality Commission's (CQC) last inspection in August also flagged 'serious concerns' surrounding the safety of the young patients.

It was inspected again in December. As a result, the CQC is now demanding improvements to ensure young people are safe.

Its rating has dropped from ‘requires improvement’ to ‘inadequate’ since the last inspection.

But the service has hit back, saying it believes the new rating is ‘a reaction to recent media reports citing unsubstantiated allegations.’

Of its failings, inspectors flagged concerns relating to tranquillisation and the feeding of young people under restraint.

One ward ‘remained unfit for purpose’ which has been ‘a concern in the last three inspections'. There had been little progress to manage the immediate concerns about the ward environment, the CQC said.

This was also unclean. The floors and carpets ‘were heavily stained’ and there was dirt throughout the ward. Bathroom areas and the clinic room were also unclean, the report added.

In some wards, furniture was in a state of disrepair, there was graffiti on the walls and peeling paint.

The specialist eating disorder ward’s layout could be ‘challenging’ for individuals in poor physical health.

The ward was divided over different levels and involved going up and down small sets of stairs to access the different areas of the ward. This increased the risk of trips and falls, said inspectors.

In the hospital’s only seclusion room, young people were required to sleep, eat and be in the same room as the toilet, which ‘compromised their dignity.’

On the positive side, staff ‘made every attempt to avoid using restraint’ by using de-escalation techniques.

They restrained children and young people only when these failed and when necessary to keep the young person or others safe.

If Taplow Manor does not improve, the CQC says it ‘will not hesitate’ to take further action, which could mean ‘removing the registration of the service.’

The inspection body criticised how well-led the service is – something which has got worse since the last time it was inspected.

As before, the service has inadequate safety and requires improvement to be effective, caring and responsive.

The service is now in special measures which means it will be kept under close review. It will be re-inspected to check sufficient improvements have been made.

Deanna Westwood, CQC’s director of operations in the south, said the body ‘still [has] significant concerns’ regarding the care of the children and young people living in this service.

One red flag was the process of feeding young people under restraint – the length of feeding tubes was not recorded, nor where precisely it was inserted.

There was ‘no record’ of clinical basement of the nasal cavity, as is required.

“There was no indication the practice guidance had been followed,” Ms Westwood said. “The recording didn’t have enough detail.”

The CQC also looked at where rapid tranquillisation had been used. 

In three of the records, the young person ‘had only been followed up for physical health observations for the first hour afterwards’ and none after that.

In one record, ‘no physical health observations were recorded’ and the young person was only noted to be sleeping.

“This is not what the national guidance states and has a very high impact in terms of the young person’s safety,” said Ms Westwood.

“Taplow Manor have made some improvements where we identified that they should, however, this has reduced their focus on other areas which means that children and young people are still not safe.

“Also, other improvements that we have been assured would take place are not happening at the pace we want to see, given the seriousness of the concerns.

“The leadership at Taplow Manor have had more than enough time to implement new strategies and improvements on the service. We have already taken enforcement action.

“When we return, if there are no further improvements or we are not satisfied with progress, we will not hesitate to use further action if needed to protect the young people in their care, even if that means removing the registration of the service.”

A spokesperson for Active Care Group, which runs Taplow Manor, said the service is ‘surprised and disappointed’ by the result.

They said: “We do not accept this rating as a fair assessment of Taplow Manor.

“We feel this is a reaction to recent media reports citing unsubstantiated allegations and the rating is disproportionate to the findings and the improvements that have been made.

“Taplow Manor has been under enhanced surveillance by NHS England, the CQC and the Provider Collaborative, who have collaborated on a plan for its improvement.

“Despite the report noting extensive improvements and no warning notices being issued, the CQC has rated the facility down.

“The safety of young people in our care is a top priority and everything is done to deliver this.

“Particular criticism was paid to Tamar Ward in the report and the pace of improvements that need to be made.

“However, no consideration was given to the careful planning required to move a ward, the extensive refurbishment plan and the building plans which require Historic England involvement and the investment in CCTV and other camera safety systems in place in the hospital.

“We note there are improvements to be made but, by rating Taplow Manor Hospital inadequate, this CQC report does not recognise the hard work and dedication of staff who have achieved the extensive list of improvements acknowledged by the CQC.”

The service highlighted that:

•                     Vacancy rates were reducing and the provider was actively recruiting experienced staff

•                     Observation procedures had ‘significantly improved’

•                     Staff understood how to safeguard patients and were compliant with training

•                     The investigation of incidents had improved – incidents were ‘investigated thoroughly’

•                     Staff treated young people with ‘kindness and respect’, supported them and involved their families or carers

•                     Young people and their relatives and carers knew how to raise concerns

•                     Staff morale was ‘improving,’ and the senior management team had implemented a number of initiatives to improve well-being.