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Staff at Palgrave mental health hospital, St John's House, 'demonstrated elements of abuse' as CQC rates facility inadequate

A Suffolk care home had demonstrated elements of abuse, as well as undermining patients' safety and dignity – according to a new report.

A damning report into practices at St John’s House, in Palgrave – which cares for adults living with learning disabilities and mental health problems – has revealed that staff had unnecessarily physically restrained patients, in some cases leading to injuries, amongst a number of other instances of malpractice.

As a result of the report – which was carried about by the Care Quality Commission (CQC) following an unannounced inspection in December last year – the 49-bed home has been rated as 'inadequate' and placed under special measures.

St John's House in Palgrave - pictured in 2011
St John's House in Palgrave - pictured in 2011

The report claimed that staff had physically restrained patients when they presented a danger to themselves and others, and before other methods of de-escalation had been exhausted. It claimed some instances of restraint were disproportionate and used unauthorised techniques, including when a patient was pushed to the floor.

It also found that the care home has a number of 'blind spots', compromising people at risk of self-harming. This issue was compounded because observations were not always undertaken correctly, including at least five instances captured by closed-circuit television where staff were asleep while they should have been monitoring patients.

The service was also said to be short-staffed, heavily dependent on agency workers, and lacking essential equipment – including for resuscitation.

The Care Quality Commission.
The Care Quality Commission.

Dr Kevin Cleary, CQC deputy chief inspector of hospitals and lead for mental health, said: “Our latest inspection of St John’s House found an unacceptable service where some staff interventions had demonstrated elements of patient abuse.

“Services we regulate must inform us when they identify safeguarding concerns to ensure patient safety. This service’s failure to transparently refer all possible instances of abuse to us and thoroughly investigate concerns has put its patients at prolonged risk of harm.

“The hospital must ensure its patients’ dignity and safety by only using physical restraint as a last resort. It must also ensure that it has enough staff, who have received the right training, so that patients receive the quality of care to which they are entitled.

“Following the inspection, we placed the service in special measures and prevented it from admitting new patients.

“Services in special measures are re-inspected within six months. We will use our enforcement powers further if satisfactory improvements have not made by the time of our next inspection."

The home, which is based in Lion Road, was previously rated 'Good', following an inspection in 2018.

The CQC continues to monitor the hospital closely, including through future inspections, and will use its enforcement powers further if there is insufficient improvement.

Priory Healthcare – who run the home – said they were swiftly taking action in light of the reports.

A spokesperson said: “We do not accept this standard of care in our services and have taken immediate action to deliver improvements at St John’s House.

"Senior management is overseeing the implementation of a comprehensive action plan to address all issues identified in the report, and we have already seen significant improvements in training compliance, the physical environment, upholding patient dignity, incident reporting and care planning.

"We have completed the required actions for 18 of the 24 key areas identified in the report, and are on track to complete the remainder within the timeframe agreed with the CQC.

"The service is now fully compliant with the required infection prevention and control procedures and we are committed to delivering all required improvements as swiftly as possible. Patient safety remains our absolute priority.”

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