HMP Thameside

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

We assessed a total of 5 quality statements from this key question. We found incidents were reported and learnings from incidents were shared. The service worked well with people and health system partners to establish and maintain safe systems of care. The service worked well with people to understand and manage risks. Staff received adequate supervision. Medicines were well managed.

Find out what we look at when we assess this area in our information about our new Single assessment framework.

During our last inspection we found incidents were not always reported and learnings from incidents were not always shared. During this inspection we found improvements had been made.

Staff we spoke with were clear about how to report unusual or untoward incidents and told us managers had actively encouraged them to report more, specifically in relation to incidents of aggression towards them. One staff member commented incident reporting was always the number one item at any meeting.

At the time of our inspection only one incident report was waiting to be allocated, 12 were awaiting approval following completion of their investigation, and 29 were currently being investigated. The new deputy head of healthcare had been regularly dip sampling the quality of submitted reports to ensure they met expected standards and was providing feedback to staff when they did not.

We found evidence learning from incidents was routinely shared with staff. For example, we saw meeting minutes focused on what could have been done to better respond to a person who had fallen from height. Staff were provided with an overview of the number of incidents received in the previous month and common themes.

During our last inspection we found the service did not work well with people and health system partners to establish and maintain safe systems of care. They did not manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services. During this inspection we found improvements had been made however some areas for development remained.

New people arriving to the prison were assessed immediately and offered support for any identified healthcare needs. For example, one person arrived and was identified as having a particular treatment need. The nurse ensured the person received immediate care and booked the person into the relevant clinic to ensure they received ongoing care.

People with long term conditions received good care. We reviewed five care records for people with diabetes. We found all people had received care in line with national guidance.

We reviewed the records of 3 people with wounds. Although we were assured they were receiving the care they required, there was not always a thorough assessment or care plan in place. This meant people were at risk of receiving inconsistent care from staff.

Where people required diagnostic tests, we found the provider had ensured they were completed and the results shared with people in good time.

There had been significant improvements in the management and oversight of peoples’ external hospital appointments. The provider had implemented systems to ensure people requiring hospital treatment were able to access care. For example, monitoring systems tracked dates for each appointment. In addition, staff had received clear written and verbal instructions of the administration of appointments and their role in facilitating them. Where appointments were cancelled by the prison or hospital, the provider ensured they were rebooked.

For people who left the service, we found discharge plans were in place and of good quality. Although the service dealt with a high volume of discharges on a daily basis we found care was transferred appropriately.

The judgement for Safeguarding is based on the latest evidence we assessed for the Safe key question.

During our last inspection we found the service did not consistently work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. During this inspection we found some improvements had been made however more work was required.

Care records we reviewed showed people were receiving regular contact with mental health staff and having their medicines reviewed. All had appropriate and up to date care plans in place, outlining the support and care they required, along with their identified goals. Strategies for self-management were outlined, as well as crisis plans. However, we noted it was not always clear from the records if the referral was routine or urgent, or if people had been offered a copy of their plan. Some of the language used in care plans was very generalised and lacked detail to ensure the person received specific individualised support from staff. 3 of the 10 care plans did not contain an assessment of risk such as self-harm, suicide or violence, and it was not clear what strategies staff may use to mitigate risk.

The judgement for Safe environments is based on the latest evidence we assessed for the Safe key question.

During the last inspection we found staff did not always receive adequate supervision. During this inspection we found improvements had been made.

We reviewed the staff supervision tracker which demonstrated almost all staff had received a recent clinical and managerial supervision. A sample of supervision records we checked confirmed the tracker was accurate.

Compliance rates had improved overall with 100% of primary care staff, 100% of mental health staff and 77% of the senior leadership team having received appropriate support and supervision. Staff clinical supervision often consisted of small group training meetings and we noted recent sessions had been held for staff in relation to care planning, learning from clinical case reviews and clinical documentation. We spoke with 6 staff all of whom confirmed they had received recent supervision which they described as meaningful and helpful.

We noted information about the importance of supervision was now displayed in staff areas, with the question to staff ‘Have you had your supervision?’ along with details about the different types of supervision, and a copy of the clinical supervision toolkit.

The judgement for Infection prevention and control is based on the latest evidence we assessed for the Safe key question.

At our last inspection we found the service did not always make sure that medicines were safely managed or met people’s needs, and people frequently missed medicines due to delays in the ordering process or unavailability of staff. During this inspection we found improvements had been made however more work was needed.

Where people were known to require treatment for a particular medical condition, we found they were prescribed medicines safely and appropriately

We viewed 18 people’s medication records and found medicines were administered in accordance with the prescribed frequency. Where people were unable to collect their medicines due to the prison regime, the provider took appropriate action each time to minimise the risk to people. We saw few examples where people missed doses of their medicines, however, the provider took appropriate action each time to minimise the risk to people.

Where people were able to have medicines in their own possession, staff completed risk assessments to keep people safer.

We saw some examples of peoples’ medicines being changed without clear records detailing the reasons. This meant we could not always be assured changes to people’s medicines was based on sound clinical reasoning.