1 Kingdom Street

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

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

Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

This service scored 82 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, diversity and inclusion, engagement, and understanding challenges and the needs of people.

Staff were aware of the service’s visions and values and how they applied to the work of their team.

Managers communicated the service’s vision and values to the staff in supervision sessions and wider team meetings. The staff survey showed that the majority of staff rated the amount of information they receive about service performance and feeling part of the business as ‘excellent’.

Staff had the opportunity to contribute to discussions about changes within the service. For example, staff told us they were asked their views on using neuroaffirming language in their reporting and interactions with patients and carers.

Staff appraisals included conversations about career progression where relevant and how they could support staff development. Staff spoke positively about opportunities for professional development. For example, some administrative staff had been given more responsibilities in areas they expressed interests in.

The service had exceptionally inclusive leaders who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Managers had the skills, knowledge and experience to perform their roles. They had a deep understanding of the service they managed, and the service’s they offered. Managers could explain clearly how the team was working together to provide high quality care.

Leaders were visible within the service, and they were available should staff or patients need to discuss any concerns. All staff told us managers were supportive and approachable. Staff spoke highly of the support and guidance they received from managers. Carers told us managers and senior clinicians were accessible and approachable, and responded to their queries without delays.

There were weekly operational meetings, which the registered manager and operations manager attended, to discuss any operational concerns or updates. Managers communicated with staff through individual supervision, all-staff messages, and team meetings. Managers also arranged team social events for staff.

Leadership development opportunities were available for employed staff. We saw examples of development discussed with staff in their appraisal.

Following the initial feedback provided at the end of the inspection, managers were responsive and quick to make improvements. For example, submitting a statutory notification and updating patient booking information to include information on the complaint’s procedure.

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Staff told us they felt supported by their colleagues and managers. The service’s staff survey also showed staff found the ease of communication between staff and managers as ‘excellent’.

Staff were aware of the whistleblowing procedure and how to use it.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were able to work flexibly. Clinicians kept managers updated on which days and time slots they were free to meet with patients.

The service actively recruited clinicians from different specialties and backgrounds to ensure they were able to provide diverse treatment to patients, such as having staff members who could speak a number of different languages and a range of clinical professional backgrounds to carry out different assessment elements.

Adjustments had been made to ensure all staff were valued, for example, a staff member told us managers had supported them in getting a standing desk following a back injury.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

The findings from the other key questions demonstrated that governance processes operated effectively and that performance and risk were managed well.

The service had a framework of what must be discussed in monthly governance meetings. This included service improvements, audits and policy updates. The service also had weekly administrative staff business meetings and clinical staff meetings every 2 months. These meetings discussed incidents, complaints and any performance concerns.

There was a clear organisational structure, and staff understood their own roles and responsibilities. The management team worked closely with staff so that patients and families received a high quality and responsive service.

There was a system in place for families and staff to provide feedback. Feedback was reviewed by managers and improvements were made where needed. For example, providing a telephone call after an assessment to provide additional support and signposting to families where needed.

The service raised safeguarding concerns when needed with the local authority. Managers kept track of all referrals and followed up areas as needed. Staff told us they discussed cases with the service’s safeguarding lead and the local authority to support their patients. The service had not notified CQC of a recent safeguarding referral, however this was retrospectively completed once this was highlighted to managers.

Safe recruitment practices were followed when staff first joined the service. When clinicians were onboarded they uploaded information, such as, professional certificates, DBS, and professional registrations.

The service had assurances that staff received appropriate training, supervision and appraisals. Administrative staff and the operations manager were responsible for following up any training that was due to expire.

The service completed a range of audits on areas such as, clinical record keeping, patient wait times and infection and prevention control. Managers highlighted areas for improvements following audits, for example, ensuring all clinicians include their role and names throughout the written report.

Staff maintained and had access to the risk register. All staff were able to escalate their concerns if needed. Their risk register noted areas such as IT failures and potential high clinical patient risk.

The service had a business continuity plan in place for emergencies. This plan covered areas such as power failures and disease outbreaks.

Information governance systems included confidentiality of patient records. Staff took patient confidentiality and information security seriously. Staff could access all required policies and procedures through the service.

Staff had access to the equipment and information technology needed to do their work. Staff said these systems worked well.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Managers engaged with external stakeholders and agencies, such as insurance companies and local health services. Managers had also created links with external services, such as local authority safeguarding leads and charities.

Managers met regularly with the NHS trusts who referred patients into this service. They discussed areas such as activity output, any concerns and shared patient feedback.

Staff, patients and carers had the opportunity to give feedback on the service to managers, influencing its future direction.

The service had a strong focus on continuous learning, innovation and improvement across the organisation. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The service had a positive approach to quality improvement, and we saw a number of improvement projects that had taken place. For example, co-producing accessible leaflets and video content with the support of families.

Innovations were taking place in the service. For example, clinicians created videos for the service’s website on a range of topics, such as information on sleep and diet. The service was also updating their website to be more user friendly and accessible to children.

The service worked with charities and non-profit organisations to widen community engagement for children and their families. For example, the service worked with a golf trust, which included organising therapeutic golf activity days, with support from the service’s clinicians. These activities supported children’s social communication, turn taking and emotional regulation.

The service supported a non-profit organisation in South Africa, providing Autism Diagnostic Observational Schedule (ADOS) assessments kits and training on how to assess children. This work supported the increase of standards of assessments in under-served communities.

The service had sponsored and organised a community paediatric training course which was chaired by the service’s clinical director. Managers told us they were committed to the wider workforce development, shared learning, and improving standards of care across the wider paediatric and neurodevelopmental community.

The service had also provided fundraising, advocacy and resource contribution to a range of charities, as highlighted on their social media accounts.