Emerald Place Clinic

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• 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 best available evidence.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

Staff completed mental health and physical health assessments for all young people on admission or soon after. We reviewed the care plans of 6 young people; all the care plans were personalised and there was evidence that the young people had input in their care plans. Young people were encouraged and supported to manage their own health and well-being. Young people’s care and treatment was delivered in line with national guidance, regularly monitored and reviewed at individual clinical reviews with input from young people and their parents. The multidisciplinary team and staff across the service worked well together respected each other’s thoughts, ideas, and opinions. Young people were detained under the Mental Health Act. Staff were aware of their roles and responsibilities under the Act and understood the principles of Gillick competence. The service followed Quality Network for Inpatient CAMHS standards and are working towards full accreditation following being peer reviewed.

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.

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.

We reviewed the care plans of 6 young people; all the care plans were personalised and there was evidence that young people had input into their care plans. All young people had a physical health and mental health assessment on or soon after their admission. Physical health needs were reviewed as required.

Staff completed risk assessments for each young person and that these were reviewed at regular intervals. Risk assessments were linked to appropriate interventions within the care plan. Staff embedded crisis plans in the care plans. Care plans were also reviewed on a regular basis.

All young people had care plans addressing key areas: keeping healthy, keeping safe, keeping well and keeping connected. Some young people also had a care plan around the use of physical restraint. Care plans also included young person’s own voice.

Discharge planning was evident within care plans and external professionals were invited to attend ward rounds to support this process.

Managers audited care plans on a monthly basis. The audit ensured that the needs and wishes of young people were embedded in the care plans and ensured that if there were any restrictions in place, they were reviewed regularly.

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 understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Staff held weekly community meetings which were attended by various members of the multidisciplinary team, including the ward consultant. The minutes of the meetings were on display in the communal lounge. Names of staff were attached to actions, and young people were encouraged to hold staff to account for the actions they were required to complete.

Managers used supervision and appraisal sessions to identify the development needs of staff within the service.

Staff met young people’s needs in line with current guidance. Multidisciplinary team discussions involved the young person and their carers in decision making and planning care and treatment.

Restrictions on young people were regularly reviewed to maximise their independence.

At the time of the inspection, 91.7% of all permanent and non-permanent staff working on the ward had completed training on the Mental Capacity Act and DOLs and 100% of permanent and non-permanent staff had completed Mental Health Act Code of Practice training.

Staff regularly assessed and reviewed mental capacity.

Staff undertook regular audits and reviews and managers had oversight of the care and treatment on the ward. This ensures that care and treatment remain effective.

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.

Young people were invited to meetings about their care. We spoke to 4 family members, and they all reported feeling involved in the care of their young person and felt able to share any concerns they had with the team.

During our assessment we observed a multidisciplinary meeting which was attended by a range of professionals including doctors, a nurse, member of staff from the school, psychologist and professional members of staff from the community who joined the meeting remotely. The meeting agenda was led by the feedback given by the young person prior to their ward round. Updates were given by the members of the MDT regarding previous incidents, mental state examination, interactions, progress in school, nutrition, medication and plans going forward. Section 17 leave was discussed in a positive manner. The team knew the young people very well and contributed to the meeting in a collaborative, caring and person-centred manner.

The service had an “internal care coordination” role to ensure that communication with external stakeholders for the young people was effective. The internal care coordinator was also responsible for maintaining weekly contact with families and carers, promoting continuity of care and communication.

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.

The ward had a weekly activity timetable that was developed by the Occupational Therapists and the young people. The activities were varied and are scheduled for 7 days a week. The timetable was displayed on the ward outside the main lounge area. The activities included exercise sessions, football and tennis. Sessions also included pamper sessions, baking, clay making, painting, karaoke, henna art and community trips. There were also evening activities timetabled.

Staff supported young people to live healthier lives through the activities in the timetable such as exercise sessions on weekends.

Two young people we spoke to felt that the activities were repetitive, but they did confirm that activities happened in the evenings.

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.

The service utilised recognised rating scales to record severity and outcomes during admission. These include Health of the Nation Outcome Scales, Recovering Quality of Life, Functional Independence Measure, Functional Assessment Measure and Life Star. We found that 100% of young people in the past 6 months had completed the tools.

The outcomes of the scales were discussed and used to continuously improve the service delivery.

The evidence showed a good standard. The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Young people had access to advocacy and signage on how to access advocacy was available on the ward.

During the inspection, we observed some good interactions between staff and young people. The care records indicated that young people were read their rights under Section 132 and this was repeated at regular intervals. When young people did not understand their rights, the process was repeated and understanding is recorded when this is achieved.

Staff carried out capacity assessments, which were decision specific. The assessments were recorded in the care records.

At the time of the inspection, 91.7% of all permanent and non-permanent staff working on the ward had completed training on the Mental Capacity Act and DOLs.