Emerald Place Clinic

We rated safe as good. We assessed all eight quality statements. At the time of the inspection the service was subject to NHSE Level 2 Intensive Quality Oversight due to a series of serious safety incidents in which young people and staff were harmed or put at risk of harm. We found that although some improvements had been made there was still much to do to ensure the environment and care was safe and met the needs of young people. Environmental risks remained but a programme of work was due to start imminently and be completed by the end of October 2024 (following the site visit we received photographs which showed that some of the work had been completed). Environmental risk assessments were generic and did not identify all the specific risks at the service. This was a breach of Regulation 15, Premises and Equipment   Until the work had been completed restrictions were placed on young people’s access to fresh air and physical exercise in the garden area. Staff placed blanket restrictions on all young people, meaning that all young people required three staff to escort them into the garden and only one young person could go in the garden at one time. This was not in line with some young people’s risk assessment or plan of care. This was a breach of Regulation 9 Person Centred Care     Young people didn’t always have their needs met; young females requested that only female staff provide their care, especially when they were on enhanced observations and required personal care but at night there were more male staff than female staff. There were no advance statements/directives documented in peoples’ care plans to reflect the views of young people in relation to their choice in relation to gender of staff involved their restraint. This was a breach of Regulation 12, Safe Care and Treatment   Young people were often restrained in their bedrooms which they didn’t like as this was their safe space. There were no advance statements/directives documented in peoples’ care plans to support young people in their decisions that if restraint was necessary, where possible, it would be carried out where they could be protected by the use of CCTV. This was a breach of Regulation 12, Safe Care and Treatment     However, The new hospital directors had made a positive impact on the service despite only being in post for 10 days on the day of the inspection. They had built on the good work commenced when the regional service director who had covered the service on an interim basis. There was now a more positive, focussed approach to maintaining safety; incidents were investigated and there was learning to promote good practice. A programme of training and checking staff competencies had been implemented and staff were more aware of how to provide safe care. Staff had started to receive regular 1:1 supervision and monthly reflective practice sessions were held. All staff spoken with said they made every effort to provide safe care and treatment. There was enough staff on each shift on the ward to meet the needs of young people, including their level of enhanced observations. Leaders could increase staffing levels when needed. The service was actively recruiting health care assistants to ensure there were enough female staff to meet female young people’s needs the service planned to include young people in the recruitment process. Young people were supported to receive their medicines safely, as prescribed and in a way which met their individual needs. 



A parent/carer forum had commenced; each young person now had an identified care-coordinator who was responsible for updating and engaging with parents regularly.



Young people felt safe and were positive about the service, the leaders and staff and said there had been a positive change recently.