CQC publishes report on mental health services at Bowmere Hospital in Chester

The Care Quality Commission (CQC) has published a report following an inspection of services at the Rosewood ward at Bowmere Hospital in Chester, provided by Cheshire and Wirral Partnership NHS Foundation Trust in August.

CQC carried out an unannounced focused inspection of the Rosewood ward, due to concerns about the safety and quality of services being provided to people.

This inspection only looked at parts of the safe and well-led domains at this service. The rating for safe has gone down from good to requires improvement, well-led was not rated. The overall rating for the service remains as good.

The overall rating for Cheshire and Wirral Partnership NHS Foundation Trust remains as good.

Rosewood ward is an 18-bed high dependency rehabilitation service for men and women. The ward is divided into male and female areas with 10 beds for women and six beds for men. There are two self-contained flats, which patients from the ward may move to before they are discharged into the community.

Brian Cranna, CQC's head of hospital inspection (mental health and community health services), said:

"When we visited the Rosewood ward we found there wasn't always enough staff to meet patient's needs, and there were times when people missed out on being able to have escorted leave due to staffing issues, which is important to help with their recovery.

"We appreciate the trust had been having a difficult time maintaining staffing levels due to COVID-19 and staff leave, and had implemented measures to address these, including using agency staff and taking action to recruit more permanent staff.

"The trust informed us there had been an increase in self-harm incidents, and while this was partly addressed by individual risk assessments, we weren't assured that risk assessments were carried out adequately for the environment that people were being cared in.

"Although care plans included if patients weren't allowed some items due to the risk of self-harm it was concerning that they didn't always explain what these items were, which could result in them being exposed to harm.

"Inspectors did also see some areas of good practice. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Also, incidents were recognised, reported and investigated.

"Due to several changes in leadership recently, staff were still learning how to work together to help improve the culture on the ward and improve the care for patients.

"The trust has started to make improvements and we will continue to monitor them closely to ensure further necessary changes are made to assure us people are receiving safe care."

CQC inspectors found:

• Leaders had the skills, knowledge and experience to perform their roles. However, there had not been stable leadership over the last year.
• Staff assessed and managed risks to patients, however not all patients had an up to date risk assessment. Staff achieved the right balance between maintaining safety and providing the least restrictive environment possible in order to facilitate patients' recovery.
• The service did not always have enough staff, who knew the patients and received basic training and supervision to provide safe and consistent care.
• The ward was clean and maintained. In most instances the ward was designed to reduce the risks to patients, but the environmental risk assessments were not comprehensive. The service effectively operated the trust's governance processes, but risk was not always managed well.

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