Freedom from Torture Also known as Freedom from Torture

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection in June 2017, we rated this key question Requires Improvement. At that inspection, the service was in breach of regulation 12 (safe care and treatment) and regulation 18 (Notification of other incidents).

At this assessment the rating has changed to Good: This meant people were safe and protected from avoidable harm.

Staff now risk assessed all patients that had a mental health condition and included information in the risk management plans for patients on what to do in the event of a crisis. Arrangements were now in place to monitor patient’s change in risk when they were waiting to be seen at intake panel or initial assessment. Staff reviewed the needs of people on the waiting list at the weekly team meeting.

The service now had arrangements in place to ensure that notifiable incidents were reported to the CQC.

The service was safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service managed patient safety incidents well.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service had not had any serious incidents in the last 12 months.

Patients said they felt confident to raise concerns, and staff consistently demonstrated compassion and understanding. Leaders encouraged staff to speak up when things went wrong, promoting openness and accountability.

Staff understood what incidents should be reported and were knowledgeable about how to report them using the organisation’s electronic incident reporting system. Staff reported incidents appropriately, and records demonstrated that incidents were reviewed and investigated where required.

Lessons learned from incidents were identified, shared and used to improve practice. Staff told us that learning was communicated through team meetings and email updates to ensure it was disseminated across the service. For example, following an incident in which a patient experienced harassment from a member of the public while leaving the premises, the service reviewed and strengthened its security arrangements to enhance patient safety. This demonstrated that the service responded proactively to incidents and used learning opportunities to reduce the risk of recurrence and improve the patient experience.

Staff said that both staff and patients received a debrief after an incident. Records we viewed confirmed this.

Staff discussed incidents and lessons learnt in a number of forums, including supervision, daily morning and team meetings. Staff were debriefed after incidents by managers and psychologists, and an employee helpline was available for additional support.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all relevant information about each patient was obtained and reviewed before acceptance. This enabled staff to assess whether the service could safely and appropriately meet the patient’s needs and provide the required level of care and support. Patients told us that they were provided with information about the service and how clinicians were matched to clinical need.

Staff worked collaboratively with all relevant health and social care services to ensure patients received safe, coordinated, and continuous care throughout their treatment and following discharge. This included liaison with social care teams, housing departments, GPs, and specialist placement services where required, helping to ensure patients' ongoing health, wellbeing, and support needs were met.

The service provided support and treatment to children and young people who had survived torture or were impacted by family members who were survivors of torture. It accepted referrals for young people up to the age of 23 years. All children and young people receiving treatment through the service had access to a social worker to support their care and safeguarding needs.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The service worked with people to understand what being safe meant to them as well as partners on the best way to achieve this. The service concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Patients we spoke with told us they felt safe.

Staff understood how to protect people from abuse and the service worked well with other agencies to do so. Staff were aware of and followed safeguarding policies, there was a designated safeguarding lead, and staff accessed advice and support when needed. Staff recognised, reported and escalated safeguarding concerns appropriately.

Staff demonstrated how they protected people from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff felt confident that if they did raise concerns, they would be listened to and action taken.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. All staff were trained in level 2, and all clinical staff were trained in level 3. The safeguarding lead for the service and was trained to Level 5 in safeguarding vulnerable adults and children. The safeguarding lead maintained comprehensive adult and children’s safeguarding trackers, which recorded all safeguarding concerns, actions taken, and outcomes for individual patients. This provided effective oversight of safeguarding activity and ensured that concerns were appropriately monitored and managed.

Security arrangements protected people from unauthorised access to the service and supported safeguarding. For example, reception staff-controlled visitor access by requiring visitors to report to the main reception and confirm who they were visiting.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies, for example the service worked with the Local Authority Designated Officers (LADO) teams.

At our last inspection the service had not notified CQC of two notifiable incidents. At this inspection the service now had arrangements in place to ensure that notifiable incidents were reported to the CQC.

100% of staff had had training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles. Staff took all practical steps to enable patients to make their own decisions

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well.

Patients told us that staff made them feel safe.

The service worked with people to understand and manage risks by thinking holistically so that care met their needs in a way that was safe and supportive and enabled them to do the things that matter to them.

Patients told us they were involved in managing risk and contributed to their risk management plans. They told us they had a crisis plan and knew who to contact in a crisis.

The provider had made improvements to risk assessment management since our last inspection. We reviewed 3 care plans, risk assessments and 4 health risk assessments.

At our previous inspection, we found that staff did not consistently assess risks for patients with mental health conditions or provide patients with information about what to do in the event of a mental health crisis. At this inspection, we found improvements. We reviewed 7 patient records and saw that mental health conditions, including the risk of self-harm, had been thoroughly assessed. In addition, personalised crisis plans were clearly documented, providing patients with guidance and support should they experience a mental health crisis.

At our previous inspection, we found that staff did not assess risks to patients who were on the waiting list. At this inspection we found improvements. The service monitored patients on the waiting list during the morning meeting, panel meeting and at the weekly team meeting. The service now operated a duty system and any concerns regarding a deterioration in a patient’s mental health condition were escalated appropriately. This demonstrated that staff were taking a more proactive and structured approach to assessing and managing mental health risks. The service was no longer in breach of regulation.

Staff involved patients in care planning and risk assessment. Patients we spoke with told us they were active partners in their care and were aware of their plan of care.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. The service had two in – house interpreters and access to a full interpreting service for patients using the service.

Staff enabled patients to give feedback on the service they received. For example, via feedback to their key worker or in the service user meetings held by the service engagement lead.

Staff ensured that patients could access advocacy.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the care environment to ensure it was safe and appropriate to support service users.

Staff had easy access to alarms. Alarm call points were available on each floor and checked monthly to ensure they worked. Staff could also carry a personal alarm if required.

The medical assessment room was equipped with the necessary equipment to carry out physical examinations. This included an examination couch, a blood pressure machine, stethoscope and weighing scales. Equipment was checked and calibrated in line with manufacturers guidance.

First aid kits were available and easily accessible on each floor of the building. All were in date. An automated external defibrillator was fixed in the main entrance and in date of servicing.

The service had closed-circuit television (CCTV) in all communal areas and corridor areas.

Fire safety arrangements were in place. 100% of eligible staff were up to date with their fire safety training. Fire escapes were clearly signposted on each floor. Fire equipment was regularly checked to ensure it was fit for purpose.