A mental health trust has been served with warning notices to improve after inspectors found not enough staff were caring for patients amid a range of safety concerns.
The Care Quality Commission (CQC) carried out focused inspections at Greater Manchester Mental Health NHS Foundation Trust, some prompted by whistleblowers raising serious concerns about quality of care.
The trust hit the headlines earlier this year when undercover footage broadcast on the BBC Panorama programme showed staff bullying, humiliating and mocking patients at the Edenfield Centre in Prestwich, Bury.
In October, a minister apologised to patients saying the allegations could be subject to a public inquiry.
The trust has also been under scrutiny after three young people died within nine months, with families saying staff needed to be held to account.
An inquest in October ruled that communication failures “probably caused or contributed to” the death of Rowan Thompson at the trust’s medium secure Gardener Unit in Prestwich.
The 18-year-old, who identified as non-binary, was being held while on remand awaiting trial accused of murdering mother Joanna Thompson, in July 2019.
An inquest heard that five members of staff working that day had either wrongly signed records saying Rowan Thompson had been observed or failed to carry out the duty.
The CQC report said inspections over the summer found problems with the assessment of suicide risk, the way medicines were managed, cleanliness, consent to treatment and the safety of patients.
There were too few staff, a lack of proper oversight and scrutiny by the trust’s board, inadequate fire safety and poor maintenance, with dated wards.
The CQC took enforcement action against the trust after the inspections, saying the quality of care in some areas requires “significant improvement”.
The warning notices set out a legally set timescale for the trust to improve.
NHS England has also put the trust into its Recovery Support Programme and will commission an independent review into the failings identified within the trust’s services.
The CQC report said: “The trust did not provide safe care. The ward environments were not all safe, clean, maintained or well presented.
“We had significant concerns about fire safety in the acute wards. Ligature audits were poor because they did not identify all risks or effectively mitigate these.
“The service did not have enough registered nurses and healthcare assistants to ensure that patients got the care and treatment they needed.
“Staff frequently worked under the minimum staffing establishment levels, wards had unfilled shifts and there was not always a registered nurse present.”
The CQC also raised concerns about mixed-sex wards and the “sexual safety” of patients.
It added: “Services were not always caring, some patients told us that wards were noisy and chaotic, and that they did not always feel safe.
“The trust did not provide responsive care in all services. Bed occupancy often exceeded 100% and patients did not always have a bed when they returned from leave.
“The acute wards regularly used rooms designed for other purposes as patient bedrooms.”
Patients also told inspectors there were not a lot of activities on the wards “other than television”, while “food portions were small” and patients thought “the food was unpleasant”.
After the inspections, the CQC said the overall rating for acute wards for adults and intensive care had deteriorated from good to inadequate.
The safe and well-led areas for acute wards for adults and intensive care also dropped to inadequate, while ratings for effective, caring and responsive moved from good to requires improvement.
The overall rating for forensic inpatient and secure wards also dropped from good to inadequate, as did the safe and well-led ratings.
How effective, caring and responsive the service was declined from good to requires improvement.
Ann Ford, the CQC’s director of operations network north, said: “Our inspections of Greater Manchester Mental Health NHS Foundation Trust in June and July were prompted by information of concern and we took enforcement action as a result.
“Since our inspections in June and July, we’ve been contacted by whistleblowers and additional serious concerns have emerged.
“We have carried out further inspections in other services run by the trust in response to those concerns and found further breaches of regulation which the trust must address as a matter of urgency.
“We expect to see leaders make rapid and widespread improvements and will continue to closely monitor this progress.
“We will return to carry out further inspections to ensure action has been taken and the quality and safety of services has improved.”
In its letter to the trust, NHS England said the independent review “follows concerns raised by patients, their families, and staff, some of which have been presented through the media.
“The intention is that the review’s work will bring some clarity and reassurance to patients, their families, and staff, as well as the broader public, in respect of the ongoing safety of services that the trust delivers.”
A spokesman for Greater Manchester Mental Health NHS Foundation Trust said: “We accept the findings of the CQC’s recent inspections at our trust and are committed to making the changes and improvements that our service users deserve.
“Work is already under way in order to build better and more sustainable services. Our Single Improvement Plan incorporates a range of immediate actions identified in recent weeks, alongside various longer-term ambitions.
“Furthermore, our enrolment in the NHS England Recovery Support Programme will provide us with access to additional expertise and resource to ensure that sustainable improvements are made as quickly as possible.
“We are pleased that the CQC did find that a number of our key services, including our mental health crisis services and health-based places of safety, demonstrate good care and management. Going forward, we are determined to build upon these areas of best practice.”