We rated St Neots Hospital as requires improvement because:

• There were some gaps in the updating of risk assessments and care and treatment plans particularly with regards to physical health care. Staff had not received falls prevention training and body maps for patients were not consistently completed. Care plans to manage the risk of pressure sores and falls prevention where relevant lacked detail. Only 69% of staff had current training in the prevention and management of violence and aggression.
• Two items were found to be missing from the emergency grab bags. One from the first floor and one from the ground floor. One item had been missing for a month and not been replaced. The other had been signed as present but was not there. There were no clear reports of physical observations post rapid tranquilisation. Patient decisions to decline physical observations post rapid tranquilisation were not clearly documented. Discrepancies were identified in the administration and recording of ‘as required’ medicines.
• Clinical audits carried out by staff had not identified the concerns we found during this inspection.
• The hospital provided occupational therapy three days per week since August 2018. Until this point the hospital did not provide sufficient occupational therapy input to provide thorough assessments for all patients.

However:

• The provider had addressed the requirements issued by the Care Quality Commission following the last comprehensive inspection which took place on 10 and 11 August 2017.
• The provider had a monthly ward to board electronic dashboard that enabled the unit manager to see an overview of their service’s performance. This made reference to the Commission’s five domains and any actions arising were identified.
• The hospital shared learning from incidents, complaints and feedback at monthly clinical governance meetings and monthly corporate governance meetings. This was confirmed by those minutes seen.
• The provider reported that 85% of staff had received supervision in July 2018. This was confirmed by those staff spoken with and those records seen. These records confirmed that 94% of eligible staff had received an annual appraisal.
• Front line staff had received specialist training in Huntington’s disease. This had been provided by the Huntington’s Disease Association. Nutrition and dysphagia training had been delivered by the speech and language therapist and dietician.
• Staff monitored patients’ daily nutrition and hydration intake as required and recorded this. We noted that actions had been subsequently recorded as to how to address low fluid and food intake.
• Ongoing recruitment was taking place to address the existing staff vacancies.
• Staff attendance at mandatory training was 87%. Staff had been booked onto further training course where necessary.