Patients at Broadmoor hospital and its sister units are being subjected to an alarming degree of face-down restraint despite Government attempts to curtail the practice, the NHS watchdog reveals today.

A “very high” level of about 30 cases a month were reported at Broadmoor, the country’s most famous high-security unit, and medium- and low-security facilities for men, including St Bernard’s hospital in Southall.

Broadmoor and the West London Forensic Service were today rated “inadequate” by the Care Quality Commission, while their parent organisation, West London Mental Health NHS Trust, “requires improvement” overall.

According to the CQC, patients were physically restrained on 432 occasions between last July and December – though the true total is higher as some staff failed to record arm restraint of elderly patients.

Of the 432 most serious cases, 179 involved use of the potentially dangerous “prone position”, which involves trapping a patient face-down on the floor. At least 31 patients required “rapid tranquilisation” to bring them under control, though this was also “under-reported”.

Several months earlier, the Department of Health published a two-year plan limiting the use of “outdated” face-down restraint as part of an overhaul of the treatment of people with mental illness.

Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals, said: “We were concerned at the apparent overuse of physical restraint, and the failure to keep proper records.

“Staff must use restraint only as a last resort, and minimise the use of restraint in the prone (face-down) position. They must also make the necessary physical health observations to ensure the safety of patients who have been given an injection to manage disturbed or distressed behaviour.”

A total of 113 serious incidents were recorded between March 2014 and February this year. A quarter involved a patient attacking another inpatient. Between April 2014 and April this year, there were three patient deaths, including two at Broadmoor. A further 17 community patients died in apparent suicides.

The CQC inspection, over five days in June, involved a team of 75 inspectors and spoke to 381 patients and relatives. The trust was found to have a “substantial” problem with staff recruitment and retention, with to few to guarantee safety and quality in high-security and forensic services and in the community.

Some staff complained of poor morale and a bullying culture. But inspectors praised staff at Broadmoor for showing a “real concern” for patients and a desire to help them progress towards recovery. A redeveloped site at Broadmoor, in Berkshire, is due to open in 2017. It has about 240 inpatients, of which 37 were in long-term segregation at the time of the inspection.