Living Mind

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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 looked for evidence that people were protected from abuse and avoidable harm.

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

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 provider promoted an open, no-blame culture in which the small team could report concerns, incidents and near misses. Policies covered incident management, duty of candour, complaints and whistleblowing. The consultant psychiatrist reviewed incidents, complaints, feedback, safety alerts and relevant guidance through governance arrangements and used this information to identify learning and improvements. For example, after reviewing national suicide prevention guidance, the service moved from a traditional risk assessment model to a collaborative safety assessment approach.

Learning was discussed through governance meetings, supervision and training. Relevant staff received training, and clinical documentation and care processes were updated to reflect the change.

The service investigated incidents, implemented actions and shared learning within its small team. Following an administrative error in which correspondence was sent to the wrong patient, the provider applied the duty of candour, investigated the incident, introduced additional safeguards and reinforced checking procedures. Actions were recorded and monitored through governance arrangements.

The service had systems and standard operating procedures for identification, consent, referrals, assessment, treatment, prescribing, risk management, communication and discharge. These supported consistent care and appropriate information sharing across the person's pathway.

There were robust systems to verify patient identity, with clinicians confirming identity during every initial assessment in line with the service's Patient ID Verification policy. Consent procedures were well embedded within practice. Although written consent documentation was provided prior to appointments, clinicians routinely revisited consent at the start of consultations to ensure patients understood the proposed treatment and were aware of their right to withhold or withdraw consent at any stage.

The service maintained effective referral and discharge systems to support continuity of care. Clinicians referred patients to other healthcare professionals and services appropriately. Records demonstrated that referral correspondence was consistently shared with relevant clinicians. The provider identified an opportunity to strengthen communication and introduced a system for routinely sending referral letters to psychologists when patients were referred for psychological interventions. This ensured relevant clinical information was available to professionals involved in patients' care.

Clinical records were maintained electronically through a secure digital platform that supported video consultations, appointment management and electronic patient records. This gave the consultant psychiatrists and practice staff timely access to patient information, referral correspondence, care records and governance documentation. Patient pathways and treatment criteria were clearly defined, supporting consistent assessment, treatment and discharge. The service also had prescribing procedures, including guidance for controlled drugs and systems for monitoring and responding to Medicines and Healthcare products Regulatory Agency safety alerts.

The service had safeguarding policies for adults, children and young people, alongside Prevent guidance. A named safeguarding lead provided oversight and advice. Staff knew how to recognise, record and escalate concerns to relevant external agencies.

Staff demonstrated a good understanding of their safeguarding responsibilities and had access to clear procedures for raising and escalating concerns. Safeguarding processes were embedded within routine clinical practice, including identity verification, consent procedures, record keeping and assessments of vulnerability. The service maintained clear pathways for escalating safeguarding concerns, with documented safeguarding alert processes and referral procedures to ensure concerns could be shared promptly with local safeguarding services where appropriate.

The provider maintained oversight of safeguarding. Safeguarding training formed part of the service's mandatory training programme, with completion monitored through a training matrix and staff records. Disclosure and Barring Service checks were also monitored to ensure staff remained suitable to work with patients.

The service had not identified active safeguarding cases or made safeguarding referrals during the inspection period. However, records showed clinicians considered vulnerability, risk factors and wider circumstances during assessments and reviews. Processes were in place to record and escalate concerns and maintain an audit trail.

Safeguarding was understood as a responsibility shared across the small team. Concerns, incidents, complaints and learning were reviewed through governance meetings and supervision. These arrangements supported reflection, shared learning and oversight of safeguarding practice. The provider reviewed policies, training and procedures to ensure they remained current and aligned with relevant guidance.

People were actively involved in understanding and managing risks relating to their care and treatment. Clinicians discussed risks, protective factors and coping strategies during assessments and reviews and involved people in decisions about how risks would be managed. Risk discussions formed part of ongoing care and treatment reviews, helping people understand factors that could affect their safety and wellbeing.

Risk information was considered alongside clinical history, current presentation and individual circumstances when determining whether the service could safely meet a person's needs. Where risks increased or clinicians identified concerns that required additional support, people were referred to appropriate services through established pathways.

Subject to the person's consent, carers could be involved in discussions about safety planning and ongoing support where this helped promote safe and coordinated care.

The service identified and managed risks associated with its premises, remote consultations and day-to-day operations. Health and safety, fire safety, medical emergency, lone-working and incident procedures guided staff. The service also had appropriate insurance arrangements.

The premises were subject to health and safety and fire safety arrangements, with clear procedures for responding to emergencies. Staff had access to guidance covering medical emergencies, lone working and incident reporting. Appropriate insurance arrangements were in place to support the safe operation of the service.

The service had enough suitably qualified and experienced staff to meet people's needs. The service was led by a consultant psychiatrist and supported by a second consultant psychiatrist, a practice director and a practice manager. These arrangements provided clinical, operational and administrative support for the delivery of care. Recruitment processes included employment history, references, role-specific requirements and appropriate pre-employment checks. The provider monitored appointment availability and waiting times to help ensure people could access care in a timely way.

The consultant psychiatrists maintained their professional competence through appraisal, revalidation, continuing professional development and clinical supervision. The service audited appraisal and revalidation processes to provide assurance that professional standards were maintained and clinicians continued to meet the requirements of their professional registration.

Staff were supported to maintain and develop their knowledge through training, supervision and professional development. Clinical supervision provided opportunities for reflective practice, discussion of complex cases and ongoing professional development, supporting safe and effective decision-making. Training records showed staff remained up to date with mandatory and role-specific learning.

The provider reviewed information relating to appointment availability, waiting times, incidents and governance activities to identify opportunities for improvement and ensure arrangements remained effective and responsive to people's needs.

Staff described a supportive working environment and said they could access advice and guidance when needed. Governance, supervision and appraisal arrangements supported professional accountability and the delivery of safe and effective care.

The service had effective arrangements to prevent and control infections. An Infection Prevention and Control (IPC) Lead provided oversight of IPC arrangements and ensured policies and procedures reflected current requirements. IPC checks were incorporated into routine clinical documentation and monitored through audit. The clinic environment and equipment were maintained to support safe care and reduce the risk of cross infection.

The service monitored the effectiveness of its infection prevention and control arrangements through audit and review. An IPC and hand hygiene audit covering 442 clinical sessions demonstrated 99.5% compliance, with relevant staff up to date with required training and no significant concerns identified. IPC was reviewed through governance arrangements so the provider could monitor performance and address concerns.

The service had systems to support safe prescribing. Clinicians reviewed mental and physical health information before prescribing and considered medicines alongside psychological, social and other therapeutic interventions. People were told about benefits, risks, alternatives and, where relevant, medicines used outside their licensed indications.

Clinicians prescribed within agreed boundaries and British National Formulary dose limits. Monitoring arrangements covered higher-risk medicines, including lithium and antipsychotics. Clinicians sought information from GPs and encouraged their involvement where ongoing physical health monitoring was required. Prescribing audits and clinical governance meetings provided oversight.

The service used prescription logs within its secure electronic consultation and patient record system, including logs for controlled drugs. The service audited prescribing and record keeping. Audit findings led to improvements in recording physical health monitoring and patient information. These arrangements supported oversight of prescribing activity and identified where practice could be strengthened.

The consultant psychiatrists recognised that low acceptance of shared care arrangements by some GP practices could affect people's experience of care and ongoing access to prescribing and monitoring. Although this was largely outside the provider's control, they maintained communication with GPs, discussed options with patients and identified alternative routes for recommended monitoring when this could not be arranged through primary care.