DrPA Secure - Oakhill Secure Training Centre

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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 at 6 quality statements in this key question.

The inspection found some improvements had been made however, gaps remain. Mental health services lacked clear implementation plans, referral processes, and consistent risk oversight, while primary care and substance misuse pathways were absent. Systems were unreliable, audits insufficient, and partnership with community services weak. Leadership was strong and committed, staff felt supported, and diversity was valued.

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

At the time of our inspection the provider had been in place for less than one year. Oakhill STC was the first time the provider had delivered services for children in a secure setting. Because of this, we found an emerging culture and value set yet to be embedded. Staff we spoke with were not always able to clearly outline the values of the organisation. However, all staff and leaders were driven in their shared goal of providing the best possible care for children.

Staff told us there was a positive culture of support within the team. Staff felt able to speak to colleagues and leaders about issues or to suggest service improvements. Staff felt listened to and were provided opportunities to communicate their views in a safe space.

During the inspection we found leaders to be skilled, knowledgeable, experienced and credible. Staff we spoke with told us they valued and respected leaders.

Following our last inspection, the provider employed several additional leaders to review the service and implement improvements. We were told this additional resource was beneficial and having a positive impact on children’s care.

Whilst there were a number of key areas of development outlined throughout this report, leaders demonstrated a desire to address the concerns and implement positive change.

The judgement for Freedom to speak up is based on the latest evidence we assessed for the Well-led key question.

During this inspection we found a service which valued diversity in the workforce. A diverse team reflected the diversity of the children in their care. Staff were sighted on children’s cultural needs and worked to meet them.

Staff told us they were treated fairly by leaders and the provider. The provider’s policies promoted equality throughout service delivery.

At the time of our inspection, the service was undergoing significant change, which we acknowledged and took into consideration during the inspection. The provider was working hard to drive improvements and improve care for children. However, improvements were still required.

Work had recently been completed to remodel the mental health service with the implementation stage beginning. We looked at the model and found it to be positive.

However, at the time of the inspection staff were not working to the model. There was no clear plan in place to demonstrate the safe and effective roll out of the model. Not all staff we spoke with were aware of the model and therefore did not know their responsibilities within it.

Current working practice within mental health services were disjointed and at times disorganised. No referral process was in place with no centralised location to record new referrals. Therefore, we could not be assured all referrals made to mental health services were acted upon.

Oversight of risk within mental health care was inconsistent and confusing. All children receiving mental health care were risk assessed and rated red, amber or green (RAG). There was no recorded rationale for each RAG rating, therefore relied solely on practitioner judgement. In addition, RAG ratings changed without clear rationale. Furthermore, RAG ratings determined the frequency of contact with mental health services. We found children were not always seen in line with their RAG rating and the provider had no system in place to monitor compliance.

At the time of the inspection there was no service model for primary care services. In addition, clinical substance misuse pathways were not in place. The provider acknowledged this and assured us they were working towards it.

The provider’s systems did not always ensure key actions were completed when caring for children. As previously stated, a daily handover was completed however we saw too many examples where important tasks were missed. In addition, electronic systems were used inconsistently and therefore were unreliable. We found the service relied on verbal communication between staff too much which was a risk and therefore should a member of staff be unavailable, children were at risk of incomplete care.

Audits were not completed consistently or thoroughly enough to identify areas of improvement to children’s care. Whilst the provider had credible plans in place to implement an audit schedule, it was not in place at the time of our inspection.

The concerns demonstrate a breach of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we saw some good partnership working however some improvements were required.

Discharge planning was not always thorough. Although some children left the STC with little notice, some did not. Where discharge dates were known, there was not always enough communication with partner services in the community to facilitate good continuity of care.

Partnership working between the wider centre and healthcare services was good. Healthcare staff regularly attended operational led meetings. Meeting minutes demonstrated effective information sharing and a child centred approach to care. In addition, allied health professionals regularly attended the STC to care for children.

Following our last inspection the provider implemented an action plan to drive improvements. During this inspection we saw a number of demonstrable improvements and an improvement in the care children received. However, this work must continue as there remains a number of shortfalls.

Staff we spoke with were aware of our previous inspection findings and the changes made by the provider. Staff viewed the changes as positive and were working hard to address them. In particular, staff viewed the additional staffing, separation of mental health and primary care and additional mental health resources as a positive.