3 The Beeches

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on the best available evidence.

At our last inspection we rated this key question as requires improvement. The service was in breach of Regulation 18 in relation to staff supervision. The service had made improvements and addressed this breach with regards to staff supervision. Staff now had regularly documented supervision. 

At this inspection the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Staff assessed the physical and mental health of all patients. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Staff provided a range of treatment and care for patients based on national guidance and best practice. The staff team included or had access to the specialists required to meet the needs of patients. 

We have not awarded this service a score for Effective.

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

We scored the service as 3. The evidence showed a good standard. The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a detailed assessment of the patient in a timely manner. Managers told us the service received 40 to 50 enquiries each day. The first step was to complete a free screening tool, which helped to determine if a detailed assessment would be helpful. People could then speak with administration staff, or sometimes a clinician before coming in for an assessment. Staff told us the threshold for assessing people was high, as it was a long process. For example, the women’s assessment included 30 forms, so a lot of information was gathered. When children and young people were assessed, their school was asked to complete a feedback form. The next step was a diagnostic interview, which was usually carried out remotely, and some further online tests. The final assessment and consultation was usually face to face with the patient, where the outcome of the assessment and their diagnosis was discussed. After this, the patient received a report that included next steps and helped the patient have a better understanding of their condition. 

The service had an active treatment dashboard which showed what stage each patient’s assessment or treatment was up to. At the time of our inspection there were 146 in active treatment with a review due in the next 4 weeks, and a further 35 people in active treatment who were due a later review, such as their next annual review. There were approximately 2 adults for every child in treatment. The dashboard was routinely monitored to follow-up on any gaps or delays. 

We reviewed 10 care records during this inspection. All care records were computer-based. Staff developed a plan of care that met the needs identified during the assessment and were personalised and holistic. The plan of care was detailed in the ongoing care record, and not in a separate care plan. Care records were detailed with a comprehensive assessment and appropriate ongoing treatment for attention deficit hyperactivity disorder (ADHD) in accordance with National Institute for Health and Care Excellence (NICE) guidelines and other recognised guidance. Appropriate risk assessments were in place which included ongoing assurance around physical health to continue to prescribe, as well as possible mental health risks. The efficacy of the treatment was reviewed during patient appointments and adjustments were made. Patient reviews were documented, but it was not always clear who had attended these meetings, particularly for children’s appointments. 

The provider carried out autistic spectrum disorder (ASD) assessments, but did not provide further treatment. As such this is not regulated by CQC.  

We scored the service as 3. The evidence showed a good standard. The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. 

Staff provided a range of care and treatment interventions suitable for the patient group. The interventions were delivered in accordance with guidance from the National Institute for Health and Care Excellence (NICE) and other recognised guidance. The provider had developed a “Brain Health” model, which was a holistic approach that built on NICE guidance and included sleep, stress, hormonal, mood and emotions, behavioural and physical health. The provider listed the evidence base and research articles that it had used to develop this model. The model used a number of rating tools and outcome measures to assess patients to determine if they could be diagnosed with attention deficit hyperactivity disorder (ADHD) and to provide monitoring and support for ongoing treatment. 

The provider was trialling the use of wearable technology with patients, such as monitoring sleep patterns and disturbances. The provider had a post-diagnosis education platform, that patients could access to get lots of information. This can be audited to see how often people are accessing the platform, which can show if the information is of interest to people, and if it can be better tailored to them. The provider was developing a 12-week education programme called ‘Menopause Brain’, which focused on the specific needs of women with ADHD who were experiencing the menopause. 

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group. This included doctors, nurses, non-medical prescribers and a psychologist. 

Staff received appropriate support. Managers provided new staff with an induction. All staff had had an appraisal in the last 12 months. All staff now had regular supervision which was documented; this was usually monthly for clinical staff and every 2 months for administration staff. Supervision had a standard agenda, that reflected the clinical governance agenda.

We scored the service as 3. The evidence showed a good standard. The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff held a multidisciplinary team meeting once a week. This was primarily attended by the lead permanent staff, but other staff, including sessional staff, could attend to discuss specific patients or raise clinical or other risks or concerns. Staff had opportunities outside the team meetings to discuss patients and concerns. 

The teams had effective working relationships with teams outside the organisation, such as local authorities, school and GPs. Information was required from a patient’s GP as part of the pre-screening process. Staff would not carry out an assessment until this was provided. The service had provided training about ADHD for primary care services in the local area. The service encouraged a shared care model for prescribing ADHD medicines once a patient’s treatment had been stabilised. Managers told us that this usually worked well, but there had been a recent reduction in GPs agreeing to take on shared care responsibilities. 

We scored the service as 3. The evidence showed a good standard. The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. The model of care started with a detailed assessment of the person which included their physical and mental health. Following diagnosis, a plan of treatment was developed that not only focussed on ADHD directly, but on other aspects of the person’s health and lifestyle that impacted on this. This included offering sleep monitoring, dealing with stress, psychological interventions and, for a small number of clients, working on addiction. The provider offered women-specific assessments and support for women. 

We scored the service as 3. The evidence showed a good standard. The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff used recognised rating scales to assess and record severity and outcomes. They used a number of rating scales and outcome measures as part of the assessment process. Staff used a range of evidence-based tools to support their diagnosis of ADHD and to monitor impact of symptoms and the person’s response to medicines. 

The service had recently appointed a psychologist, who was in the early stages of creating a new psychology pathway. 

Staff used technology to support patients effectively. The service had an established tool for monitoring patients’ sleep using wearable devices and apps. Staff were developing other approaches to using patient’s physiological information to help support their care and management of symptoms. 

We scored the service as 2. The evidence showed some shortfalls. The service did not always record or document clearly when it told people about their rights around consent. The service respected people’s rights when delivering care and treatment.

The provider had policies and procedures to ensure that patients or their parents could give informed consent, and where applicable, followed the Mental Capacity Act. Staff were aware of these policies and procedures. Staff recorded capacity and consent in the care records. Administration staff were aware that consent was a part of the assessment process, and that patients must provide this before any treatment goes ahead.

Staff took all practical steps to enable patients to make their own decisions. Before medicines were issued, staff went through a detailed consent process with the patient. After assessment, patients were sent a copy of the assessment and given access to an online ‘course’. The course provided them with information about their treatment including medicines used, potential effects and side effects, and what to expect from titration, monitoring and review. Staff could track if patients had accessed elements of the course, and this could help focus discussions. Staff would then discuss the information with patients to ensure their understanding and consent before treatment started. 

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis, usually in relation to medicines. There had been situations when there had been potential safeguarding concerns, for example if it was suspected that medicines were being diverted (given to someone else). 

If a patient lacked capacity or was too young to make decisions for themselves the staff would work with others in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. 

Children and young people were always required to have a parent or guardian with them, including 16 and 17 year olds. The clinician usually met with just the child or young person at the beginning or end of each session, so that they had the opportunity to talk away from their parents. Where possible, the service aimed to get consent from both parents, as they may not always be in agreement. Patients or their parents signed a consent form, but for children and young people it was not always printed or clear who the signature belonged to. When children or young people were assessed, it was not always clear who attended the meetings, and there was not always a clear reference to Gillick competency (a test in medical law to decide whether a child under 16 years is competent to consent to medical examination or treatment).