Inspectors says Harrogate hospital maternity services ‘requires improvement’

Health inspectors have rated Harrogate District Hospital’s maternity services as ‘requires improvement’.

The Care Quality Commission, which inspects hospitals and health services, published its verdict in a report on Friday after an inspection in November 2022.

The CQC visited the hospital as part of a national inspection of maternity services.

Harrogate District Hospital was previously rated ‘good’ in a 2016 inspection that looked at maternity services and gynaecology. This latest report was the first time maternity services were rated as standalone services.

The four possible outcomes are ‘outstanding’. ‘good’, ‘requires improvement’ and ‘inadequate’.

Jonathan Coulter, chief executive of Harrogate and District NHS Foundation Trust, said it was “difficult to understand” the change in the rating.

The CQC report said “compliance with appropriate safeguarding, life support training and medicines did not meet targets” although it acknowledged “there was a plan in place to recover this position”.

It added that the number of medical staff on hand “were not always sufficient” and there was no clear system in place to “to identify prioritise risks to women in the maternity assessment area”.

Regular checks on life saving equipment “were not always completed”, the report said.

Inspectors said staff at the service “did not always receive and keep up to date” with mandatory training.

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However, the CQC did find the service had enough midwifery staff to care for women and that staff worked well together.

It added:

“Staff had training in key skills, and worked well together for the benefit of women, understood how to protect women from abuse, and managed safety well. The service controlled infection risk well.

“Staff assessed risks to women in most areas, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.”

‘Not a fair reflection’

In response to the report, Mr Coulter said he did not feel that the findings in the report were a reflection of the service at the hospital.

He said:

“With such positive findings in the CQC report it is difficult to understand the resultant rating change and we do not feel it is a fair reflection of the maternity service we provide. The report describes a maternity unit which is fully staffed, with a positive culture, with staff that are competent, listen to women and are always seeking to improve. 

“We are proud of our team for the dedication, professionalism and caring attitude that they show each day whilst supporting those in our care. We are disappointed the rating applied to the service overall and for the safe domain does not appear to reflect the findings in the report.

“Whatever the rating in this report, our response will be to focus on learning and improvement, as it is for any external or internal service review. 

“As part of this focus on continually improving our services, we prioritise listening and learning to ensure we can provide the high quality care that our patients deserve. Listening to people who use our maternity services is so important, as we completely understand that peoples’ experience can differ. 

“This is why, in addition to our own improvement work, we work in partnership with our Maternity Voices Partnership who provide another valuable way for us to hear the needs of those using our services.”

Staffing problems still affecting mental health services for Harrogate district residents

Mental health services for people across the Harrogate district still require improvement, according to the health regulator.

The Care Quality Commission (CQC) found the services provided by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) were below the standards expected.

However, inspectors said there had been some improvements since the last inspection report in December 2021.

At that time, TEWV’s forensic in-patient and secure ward services were found to be inadequate, with the trust ordered to make urgent improvements. Now, the service is rated ‘requires improvement’, though the ‘safe’ aspect of the inspection is still rated ‘inadequate’.

The report said:

“Fifteen patients we spoke to raised concerns regarding there not being enough staff on the wards. Patients told us staff spent a lot of time in the office which sometimes made them feel neglected.

“Two patients told us that they had not received their prescribed medication on the day we arrived due to staffing. Another patient told us they did not know who their key worker was.

“However, most patients said that staff were caring towards them.”

In-patient and secure wards for Harrogate district residents are provided elsewhere in the north-east after the mental health unit at Harrogate District Hospital, the Briary Ward, was closed down in 2020. The CQC inspection of TEWV’s services was carried out at Roseberry Park Hospital in Middlesbrough.

The Briary Unit at Harrogate District Hospital

The Briary Wing, Harrogate District Hospital, which was closed in May 2020.

Inspectors said data provided about staffing levels over an eight-week period suggested the service was regularly understaffed to an unsafe level. However, managers said the data was inaccurate and there was always a nurse and support staff on duty.

The report said:

“Staff were frequently being moved to different wards during their shift based on risk, which meant they were often working in environments and with patients they were unfamiliar with.

“This was impacting on several areas within the service; incident data showed staff were not always able to provide a timely response to incidents. Staff were unable to carry out all clinical duties on time, such as administering medication and completing clinical audits.

“Staff were regularly unable to take their breaks off the ward. Patient’s hospital ground leave, Section 17 leave (permission to leave the hospital) and visits from friends and family were being cancelled daily at short notice.

“Patients told us they felt neglected and did not have enough time with staff. Carers we spoke to highlighted staffing pressures as a concern and felt it was impacting on patient’s continuity of care and their ability to visit their loved ones.”

Areas for improvement

The CQC set out 12 areas where the service must be improved in order to meet legal requirements, including adequate staffing levels, cleaning all wards, ensuring staff have up-to-date training, and reporting all incidents quickly and accurately

Naomi Lonergan, care group director of the secure inpatient services at TEWV, said:

“We have been working hard to improve the service since the previous Care Quality Commission inspection in June 2021 and we are encouraged by the improvement in the rating.

“We have recruited 70 health care assistants since the last inspection and we are working with local universities to support the recruitment of registered nurses. This is in addition to developing an international recruitment strategy which is already making a difference.

“We have set up a health care assistant council and one for nurses to improve how colleagues contribute to the quality of care within our trust.

“We are also focused on creating a community on our wards, through the work we do with our recovery and outcomes team who put on events and activities for people in our care that help their recovery.

“We recognise that there is more to be done. This includes an unrelenting focus on patient safety with our absolute priority being on safe staffing and safeguarding our patients. We continue to prioritise the experience of our patients, their carers and colleagues to make the improvements we need to and we are confident the service is making these changes and will continue to do so.”

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Children’s mental health services ‘requires improvement’

Meanwhile, TEWV’s specialist community mental health services for children and young people which were rated ‘inadequate’ in the ‘safe’ category last year have now been rated ‘requires improvement’.

In a report published in September, following inspections over the summer, the CQC said:

“Although staffing levels, caseloads and waiting times for treatment had improved since the last inspection, the service did not always have enough nursing and support staff to keep patients safe. Vacancy rates varied by team…

“Caseload sizes had reduced across the community teams. Most of the staff told us there had been significant improvements to caseload sizes and caseloads were more manageable. Only two of the staff we spoke with raised concerns about staffing levels and caseload sizes.”

Inspectors said a recruitment drive meant two new matrons were about to begin work, with a focus on managing staff caseloads.

The average waiting time for treatment had reduced to 104 days, compared to 371 days in 2021, and the number of children waiting more than 12 months had reduced to 275 from more than 1,000 in the same time period.

The CQC, which inspected six teams within the community mental health service for children, said TEWV must adequately staff its service and continue to work to reduce waiting times.

Brent Kilmurray, chief executive of Tees, Esk and Wear Valleys NHS Foundation Trust, said:

“We are pleased that the CQC have raised the rating for our community children and adolescent mental health service (CAMHS) in the safe category.

“The CQC report acknowledges improvements that have been made, including how quickly we responded to address the issues identified at the previous inspection. It also recognises that we are achieving our targets of maintaining contact with children and young people on waiting lists.

“This is a step in the right direction, and a testament to the hard work from our CAMHS community teams across the trust.

“We know there is still work to do and more opportunities to improve the service. We will now focus on embedding the recommendations from the report to ensure that we provide the best care to the young people in our communities.”

‘Rodent dropping’ Harrogate care home no longer registered

The Harrogate care home where rodent droppings were found is no longer registered by the Care Quality Commission.

Government inspectors put Mary Fisher House in special measures this year after discovering rodent droppings in the kitchen and finding some medicine practices to be “unsafe”.

The CQC report detailing the findings, which also said bedrooms “smelt strongly of urine”, was published in April.

The health and social care regulator subsequently said it had “taken action to protect the safety and welfare of people living at the home” by moving them them to other homes.

But it added its legal processes did not allow it to go into further detail at the time because care provider Svivekcaregroup Limited could appeal its findings.

An updated version of the report, released this month after the appeal deadline passed, revealed the CQC had issued notice of a proposal to cancel the home’s registration.

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A CQC spokeswoman told the Stray Ferret enforcement action “did not proceed to the final stage”. When the Stray Ferret asked why not, the spokeswoman said:

“The service is now closed, and no longer active on the CQC’s register. No one is living on site, and as far as CQC is concerned the matter is concluded.”

In June, Svivekcaregroup indicated the home, which catered for up to 24 residents on Cold Bath Road, was likely to reopen.

The Stray Ferret has attempted to contact Svivekcaregroup to ask if it still planned to re-open Mary Fisher House or had other plans for the building but has not received a response.

Harrogate-based care provider receives top inspection ratings

A Harrogate-based care provider has had all three of branches rated “outstanding” by health inspectors.

The Care Quality Commission gave the highest rating for Carefound Home Care and described it as “being a role model to other services”. 

The care provider was founded in Harrogate in 2011 by Oliver Stirk and has branches in Bishop Thornton, Nottingham and Cheshire.

It currently employs more than 130 people.

Oliver Stirk, Managing Director of Carefound Home Care, said:

“It’s an incredible achievement for all of our branches to be rated Outstanding by the CQC and makes us unique in the UK.

“We are so proud of the brilliant people we employ across our teams and this recognition is testament to their compassion, hard work and dedication.”

The company is set to expand its branches to York with a new branch and is also investing in development of the service including in areas such as staff development, digital health monitoring and complex care.

Mr Stirk added:

“We’re incredibly excited as we continue to invest in growing and improving our service at Carefound Home Care, so that we can enable more older people to live a better quality of life at home.”

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Harrogate care home where rodent droppings were found plans to reopen

A Harrogate care home that closed after a highly critical report by government inspectors has indicated it plans to reopen after refurbishment.

Mary Fisher House, on Cold Bath Road, was rated inadequate and put into special measures in April by health and social care regulator the Care Quality Commission.

The CQC report, which followed an inspection in February, found evidence of rodent droppings in the kitchen, said some bedrooms smelled of urine, described medicines practices as unsafe and said there were insufficient staff to safely support people.

Residents were subsequently moved out of the four-storey home, which is run by private care provider Svivekcaregroup Care Group Limited.

The final residents left just over a week ago and the home closed.

But a statement by solicitors acting on behalf of Svivekcaregroup indicated the home, which caters for up to 24 residents, is likely to reopen.

The statement said the company was “naturally very disappointed with the CQC report”, adding:

“We have, however, used this as an opportunity to begin implementing a wide-ranging series of improvements and environmental upgrades at the home.

“Regrettably, the pace of the improvements was not as we had envisaged and we have therefore taken the difficult decision to close the home.

“This will enable a full refurbishment to take place and the new systems and processes in development to be completed.

“While we acknowledge and are sorry for the upset this will cause our residents and their families, we feel that this is the most responsible route to ensuring that we are able to deliver safe, good quality care in a welcoming and modern environment.”

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The Stray Ferret asked why the slow pace of the refurbishment had prompted the home’s closure and when it might reopen but we have not received a response.

After the home’s recent closure, Rachel Bowes, North Yorkshire County Council’s assistant director for care and support, said it had been “been working alongside NHS North Yorkshire Clinical Commissioning Group with the home’s owner to try to secure improvements”.

A CQC spokesperson, said it had “taken action to protect the safety and welfare of people living at the home” and its “legal processes do not allow us to go into further detail at this time”.

 

Residents moved from Harrogate care home with rodent droppings

Residents at a Harrogate care home where rodent droppings were found and rooms smelled of urine have been moved to other homes.

Mary Fisher House was rated inadequate and put into special measures in April by the Care Quality Commission, which regulates health and social care.

The CQC report in April, which was based on an inspection in February, found evidence of rodent droppings in the kitchen.

It said some bedrooms smelled of urine, described medicines practices as unsafe and said there were insufficient staff to safely support people.

The four-storey home on Cold Bath Road, which caters for up to 24 residents, relied heavily on agency staff who weren’t properly inducted, it added.

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Claire Harris-Winstanley, manager of the home on Cold Bath Road, confirmed it was closed when the Stray Ferret visited today. However, she said it was not clear yet whether the closure would be permanent and declined to comment further at this stage.

Rachel Bowes, North Yorkshire County Council’s assistant director for care and support, said in a statement today:

“We have taken swift action to find new accommodation for 12 residents of Mary Fisher House following a decision by the owner to close for refurbishment.

“This situation has arisen following a recent Care Quality Commission inspection of the home, which identified problems which needed attention.

“Since then we have been working alongside NHS North Yorkshire Clinical Commissioning Group with the home’s owner to try to secure improvements.”

“The owner has decided the best way forwards is to refurbish the premises and to do so without residents in place. As a consequence we are finding alternative accommodation for the 12 residents the county council has responsibility for.

“We understand the situation may be distressing for those involved and we are working diligently to ensure the process causes the minimum disruption to the residents involved. Our absolute priority is the welfare of those affected by this situation and we have been keeping residents, along with their relatives and representatives, fully informed of developments.”

Safety action

One woman, who had a relative at the £600-a-week home until recently, said she was given nine days to find alternative arrangements.

According to the CQC, the home is run by Svivekcaregroup Limited.

The Stray Ferret has tried to contact the provider but has yet to receive a response.

A CQC spokesperson, said:

 “The CQC carried out an inspection at Mary Fisher House in Harrogate in February 2022.

“As a result we have taken action to protect the safety and welfare of people living at the home.

“Our legal processes do not allow us to go into further detail at this time. All CQC’s action is open to appeal.”

Ripon care home set to close in December

A Ripon care home is to close at the end of the year.

Skell Lodge, which is owned by the Maria Mallaband Care Group, operates from a listed Victorian building on South Crescent.

The care provider told the Stray Ferret the building would “shortly no longer meet appropriate building regulations”.

North Yorkshire County Council and the Care Quality Commission are working with Maria Mallaband to find new homes for residents and staff.

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The company also owns a larger care home in Ripon called The Moors.

The nature of the building problems and when they were discovered is unclear at present.

A spokesperson for Maria Mallaband said

“It is with deep regret that we have taken the difficult decision to close Skell Lodge care home.

“We understand that residents and relatives will be concerned and worried by this decision. So we are working closely with the local authorities and commissioners.

“We would like to assure people that we will do our best to provide as much assistance as possible to help with finding alternative placements.”

Richard Webb, corporate director of health and adult services at North Yorkshire County Council, said:

“We are sorry to hear the decision about Skell Lodge. The future of the residents and the staff is our paramount concern.

“We are working with the care provider and the CQC and will be working with residents and their families to try to ensure the smoothest possible transition for people.”

Will compulsory care home vaccines cause staff shortages in Harrogate district?

The Harrogate district has a third of the 235 care homes in North Yorkshire, so government plans to make it compulsory for all care home staff to be vaccinated could have a significant impact locally. Tracey Holroyd, chair of care home group Warmest Welcome, which employs 230 staff and operates The Crest in Harrogate and Westfield House in Killinghall, writes about the issue and the wider challenges of running a care home in the pandemic.

There has been considerable debate recently about the issue of vaccinating staff in care homes. There are concerns some staff won’t agree to have the jab and consequently there could be staff shortages.

I’ve asked all the managers in our group and none of them say they are anticipating a problem as the take-up of the vaccine in our group has been good. We now establish that all new employees should be prepared to have the vaccine before we offer them a job as well.

I have colleagues in some geographical areas where staff of different ethnic backgrounds appear to be less happy about having the vaccine. For those homes it could be a big problem, as it’s already very difficult to recruit staff without making more barriers. But I don’t foresee it being a problem for us.

As far as I’m aware, only a couple of the 230 staff in our group don’t want it. One of them is terrified of injections. We’ve tried distracting her, promising her cake/alcohol but she nearly fainted when she saw the needle, so I don’t actually think that her refusal is anything to do with covid at all. The others are actively trying to become pregnant and so who can blame them? All the staff at Westfield in Killinghall are now vaccinated and happy to be so.

More to the point, why does this only apply to care home staff? Why doesn’t it also apply to NHS and domiciliary care staff? I don’t understand the logic behind this, if indeed there is any.

Recruitment problems

It’s already difficult to recruit in the care sector. The issue of vaccinations is not the problem; it’s a general lack of interest in people wanting to work in a care home. This is a national issue, rather than a local one, and if you want to recruit a qualified nurse it’s even harder

Another problem looming is that the Care Quality Commission, which regulates health and social care in England, is now due to release care home names and numbers of covid deaths.

The care home community is not happy about this — especially homes that put themselves forward as covid units, as their figures will naturally be very high. The numbers will also be higher for nursing homes than they are for residential homes, as their clients are much more poorly to start with, so are likely to have higher death rates.

The NHS is also asking us to encourage staff to take holidays now as they’re anticipating a spike in covid in September, which also makes me nervous, but we will see, I suppose it’s not guaranteed to happen. Being a care home operator in a global pandemic is exhausting and stressful!