MindOf

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• 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

We rated effective as Good because:

The service provided safe care. The service had clear systems to keep people safe and safeguarded from abuse.

Staff appropriately assessed and managed risks to patient safety. The service maintained comprehensive patient records and carried out regular clinical audits. The service had reliable systems for appropriate and safe handling of medicines.

Staff assessed and managed risks to patients and themselves well. There were clear processes in place for the service to gather information about a child or young person, to assess their risks and decide whether they could be safely managed within the service.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a good track record on safety. The service recorded and investigated incidents and staff knew how to report them. In the last 12 months, the service had one incident and no serious incidents or near misses. Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so. There was an agenda item for any recent incidents and safety alerts in the weekly governance meetings. Any system wide learning, including from incidents, was discussed in the daily stand-up meetings and weekly governance meetings. Meeting minutes were shared with staff that could not attend the meetings.

There was a system for recording and acting on significant events. The service learned and shared lessons, identified themes and took action to improve safety in the service. For example, the service had changed their postage courier service after there were issues with prescriptions going missing with a different courier service.

The service acted on and learned from external safety events as well as patient and medicine safety alerts. The service received alerts and updates on medication via the Medicines and Healthcare Products Regulatory Agency (MHRA). They also received updates on guidance through the National Institute for Health and Care Excellence (NICE). The service had an effective mechanism in place to disseminate alerts to all members of the team including sessional and agency staff.

The provider was aware of and complied with the requirements of the Duty of Candour and had a policy in place. The provider encouraged a culture of openness and honesty, and parents said that openness and honesty was demonstrated by the staff.

Staff worked with people and relevant external agencies to establish and maintain safe systems of care, in which safety is managed, monitored and assured.

The service had clear acceptance and exclusion criteria. Parents and young people were signposted to other services where it was determined they met an exclusion criteria. For example, if their risks were too high for the service to manage.

Staff assessed and managed risks to patients and themselves well. There were clear processes in place for the service to gather information about a child or young person, to assess their risks and decide whether they could be safely managed within the service. Staff we spoke with could describe this clearly.

The service had a clear scope of practice and only accepted referrals to patients whose needs it could safely meet. Parents and patients were made aware that the service did not offer emergency or crisis support and were provided with information about which services to access for immediate support if needed. Information was provided to parents and patients as to who to contact out of hours. The service did not offer walk in appointments and did not operate on a 24-hour basis.

The staff team discussed new patients in the daily stand-up meeting. Complex patient cases were discussed in a weekly case clinic, where staff used a psychological formulation approach to decide how to best meet that patient’s needs.

Individual care records were written and managed in a way that kept patients safe. The care records we saw showed that information needed to deliver safe care and treatment was available to relevant staff in an accessible way. Patient records were stored securely in an online system. At the time of the inspection, the service was in the process of updating to a new electronic documentation system.

The service had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment. For example, consent was obtained from young people and their parents to share their assessment letters with their GP.

The service had clear systems to keep people safe and safeguarded from abuse.

The service had systems to safeguard children and vulnerable adults from abuse. The service worked with other agencies to support patients and protect them from neglect and abuse. Staff took steps to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect. Staff gave clear examples of where they had escalated potential safeguarding concerns.

All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. The provider and registered manager had both undertaken level three safeguarding training for children and adults.

There were systems to assess, monitor and manage risks to patient safety.

We looked at 3 patient records. Staff assessed patients risks at the point of referral and at each appointment. Care and treatment records detailed any risk discussions that the clinicians had with individual patients. If patients presented with risks that were outside the scope of practice to deal with, the service would signpost or refer them to other services based on their individual needs. For example, for young people with an eating disorder.

The service obtained information on patients’ presenting condition, current and historic risks, medical history, behaviours and information from individual GPs and other healthcare providers. The provider carried out a detailed face to face assessment with the patient and their parent if appropriate.

Identification checks were carried out before any assessments took place to verify the identify of patients. Before treatment, the service asked for photographic identification for children, young people and parents. The service had recognised that this could be further improved and had introduced an electronic digital system to verify patient’s identities.

Staff understood their responsibilities to manage emergencies and to recognise those in need of urgent medical attention. Staff were trained in basic life support training.

There were suitable medicines and equipment to deal with medical emergencies which were stored appropriately and checked regularly.

When there were changes to services or staff the service assessed and monitored the impact on safety.

The premises where patients were seen were safe and clean. The main reception area, waiting rooms, consultant psychiatrist’s room and therapy rooms were well maintained, well-furnished and fit for purpose.

The provider’s landlord completed appropriate risk assessments for the premises. Appropriate fire safety arrangements were in place and fire exits were clearly marked. An automated external defibrillator (AED) was available in the main reception area in the event of an emergency.

There were no clinic rooms but there were 3 consultation rooms on site. There was appropriate equipment within the consultation room to carry out basic physical checks such as blood pressure, heart rate, weight, and an ECG (electrocardiogram). This enabled staff to undertake the required basic routine monitoring for patients on certain medicines. For more extensive physical examinations patients were referred to their GP or physician.

The provider conducted safety risk assessments. It had appropriate safety policies, which were regularly reviewed. They outlined clearly who to go to for further guidance.

There were enough qualified, skilled and experienced staff, who received effective support, supervision and development to provide safe care that met people’s individual needs.

The provider carried out staff checks at the time of recruitment and on an ongoing basis, where appropriate. The registered manager compiled a checklist for each staff member working within the service. This included oversight of their Disclosure and Barring Service checks (DBS), annual appraisal, induction, training and confirmation of their revalidation with their professional body, such as the General Medical council or Nursing and Midwifery council. This was of particular importance as there were six staff that worked within the service using their practicing privileges. This meant that a medical practitioner is granted permission to work in an independent private clinic that is not their usual place of employment. For example, all of the staff using their practicing privileges were employed by an NHS service but were granted permission to work within this clinic on certain days.

The number of patients on the clinician’s caseloads was well managed to allow enough time to treat each patient. Parents told us they did not have to wait long to get an appointment with a consultant or therapist.

The provider understood the learning needs of staff and provided protected time and training to meet them. Up to date records of skills, qualifications and training were maintained. Staff compliance with mandatory training was 94%. Staff that had not completed their training were either on extended leave or booked on to receive their training. Training covered basic life support for adults and children, safeguarding adults and children, equality and diversity, information governance, infection, prevention and control, risk management and GDPR. Staff had either received or were booked to receive their Oliver McGowan training on people who have a Learning Disability and/or Autism.

The clinicians had access to operational and administrative support from administrators.

There were appropriate indemnity arrangements in place. Indemnity arrangements are insurance to cover the costs associated with something going wrong in the day-to-day undertaking of a professional’s activities.

There was an effective induction system for agency staff tailored to their role, which included a specific induction pack for agency staff. There was one regular agency clinical administrator who covered sickness and annual leave.

There was an effective system to manage infection prevention and control. The service was cleaned daily. Staff used equipment and control measures to protect patients, themselves and others from infection. The service had an infection control policy in place. The building had hand sanitisers at the reception desk and within the clinician’s room.

The service had reliable systems for appropriate and safe handling of medicines.

Staff followed systems and processes to prescribe and administer medicines safely.

Consultant psychiatrists prescribed and supplied medicines to patients and gave advice on medicines in line with legal requirements and current national guidance.

The service carried out regular medicine audits to ensure prescribing was in line with best practice guidelines for safe prescribing. Where needed, the service made changes based on learning from these audits. For example, a recent prescribing audit highlighted that by introducing a drop-down menu to select the drug used would reduce spelling and description inconsistencies in the electronic record system. Any concerns with prescriptions were discussed with the whole team in a daily stand-up meeting.

The service was compliant with managing and storing any controlled drugs. The service had a small controlled drugs cupboard and recorded controlled drugs in a register that staff checked daily and audited. At the time of our visit the service did not have any controlled drugs onsite.

Processes were in place for checking medicines and staff kept accurate records of medicines. The service kept very little amounts of medicine stock on site and these were stored securely.

The service kept prescription stationery securely and monitored its use. FP10 pads were stored securely. Staff uploaded copies of all prescriptions to the patient record, this included controlled drug prescriptions. The serial numbers of all prescription pads were recorded and audited.

The service had a shared care protocol in place for certain patients and their GPs. This was a plan in place for the responsibility for prescribing, administering and monitoring certain medicines being shared between the consultant psychiatrists and the patient’s GP. In practice, the service would usually prescribe a medicine, and a patient or their parent would obtain a repeat prescription from their GP, whilst being under the care of the service.

Verbal and written information on medicines and side effects was provided to all young people and parents where medicines had been prescribed, in line with legal requirements and current national guidance. All parents said that they could raise any concerns about medicines and side-effects with the registered manager who was also a consultant psychiatrist. Where there was a different approach taken from national guidance there was a clear rationale for this that protected patient safety.

There were protocols for verifying the identity of parents, young people and children. The service had identified that this could be further improved through a recent audit. As a result, the service had introduced a digital identification verification system to ensure that this would achieve 100% compliance in the next 6 months.