ABBI Clinic Manchester

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated Good.

Good: This meant people were safe and protected from avoidable harm.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We have a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There had been no severe harm patient safety incidents in the 12 months prior to the inspection.

The service had an incident reporting and management policy. This was accessible for staff and gave clear guidance on the actions staff should take in relation to incidents.

All staff knew what incidents to report and how to report them.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong.

Staff received feedback from the investigation of incidents, both internal and external to the service. Minutes from staff team meetings showed that lessons learnt were shared with staff. However, this was not a standard agenda item and therefore was not discussed at every meeting.

There was evidence that changes had been made as a result of feedback. For example, the service had introduced a log to keep track of discharge letters following learning identified when a discharge letter had been delayed. They had also updated the process for reviewing these letters to involve an independent team member who provided additional oversight alongside the clinician.

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received and reviewed by staff to determine if the patient’s needs could safely be met by the service. A detailed consultation also took place between the consultant and the patient prior to admission, to explore the patient’s needs and whether the service could meet these.

Once accepted into the service, staff followed the provider’s standard operating procedure for patient admission, ensuring that the patient understood the information they needed to engage with the service.

Staff involved the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. The service liaised with the relevant team taking over the patients care following discharge (for example the community eating disorder services and/or the patient’s GP) to ensure continuity of care following discharge from the service.

We work with people to understand what being safe means to them as well as with our partners on the best way to achieve this. We concentrate on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect, and we make sure we share concerns quickly and appropriately.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did so when appropriate. The service had a safeguarding log in place to ensure that all required actions from identified safeguarding concerns were completed. The services safeguarding policies for children and adults were current and reflected guidance and legislation. Training compliance was 100% for both safeguarding adults and safeguarding children.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies such as community teams involved in patients care.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Mental Capacity Act

100% of staff had had training in the Mental Capacity Act.

Staff had a good understanding of the Mental Capacity Act, in particular the five statutory principles.

The provider had a policy on the Mental Capacity Act, including deprivation of liberty safeguards. The policy also contained considerations for children and young people, including Gillick competence. Staff were aware of this policy and had access to it.

Staff knew where to get advice from within the provider regarding the Mental Capacity Act.

Staff took all practical steps to enable patients to make their own decisions. For example, information was made more accessible by providing it in an easy read or visual format where necessary.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. They did this on a decision-specific basis with regard to significant decisions. For example, the service had assessed a patients capacity regarding consenting to treatment through accident and emergency departments.

When patients were assessed as lacking capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history. An example included the service calling an ambulance for a patient with deteriorating physical health.

The nominated individual had overall responsibility to monitor adherence to the Mental Capacity Act.

We work with people to understand and manage risks by thinking holistically so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We reviewed 5 risk assessments and risk management plans during this inspection. They were detailed, person centred and regularly reviewed.

Staff involved patients in care planning and risk assessment. Patients told us this happened and records confirmed this. Patients views and wishes were reflected throughout care planning and risk assessment documentation.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. For example, easy read versions and visual resources were available to support the group sessions.

Staff enabled patients to give feedback on the service they received through co-production meetings and feedback questionnaires. They could also give feedback through Doctify, an online anonymous feedback system. ‘You said we did’ posters were displayed in the service to demonstrate how the service responded to patients’ feedback.

We do not always detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

We scored the service as 2. The evidence showed some shortfalls. The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service was on the ground floor of a building in a business park. There were 2 rooms that were used for the day service and one-to-one therapy appointments. The large room was an open plan space and had an area where the group sessions took place and a table where patients ate their meals. The environment was modern and staff had listened to patients feedback and had made the lighting more subdued. The service had another 2 rooms where staff were based and meetings could take place.

Staff completed annual environmental risk assessments of the care environment. Within the assessment, hazards were identified. However, the rating of these hazards was not consistent. For example, 2 hazards were scored as ‘2’, however 1 was rated ‘low’ and one was rated ‘medium’, this meant environmental hazards were not consistently rated.

Staff also completed an annual fire risk assessment, however there was not an action plan created from the findings of the assessment. This meant there was no oversight of the findings from the assessment to ensure that action was taken where necessary.

The service managed food safety well. Items were labelled in the fridge and fridge temperatures were taken. Records showed these were all within range.

The service had a location statement for the defibrillator displayed in the service. The statement was past its review date. This meant that the statement had not been recently reviewed.

When patients were weighed, they were weighed in a self-contained shower room, however this was available to other services within the building. The service acknowledged this was not an ideal arrangement. There was a plan to create a sign to put on the door to advise the facility would be available in a few minutes with the aim of promoting patients privacy and dignity.

We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development and work together effectively to provide safe care that meets people’s individual needs.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service employed a consultant psychiatrist, specialist GP, a mental health nurse, 3 psychological therapists, a dietician, a therapy assistant and an operations coordinator. There was a vacancy for a registered manager and an occupational therapist.

Sickness rates for the 12 months before the inspection were 15 hours per month, which was an average of 1.5%

In the 12 months prior to the inspection, 4 staff had left the service, equating to 33%. 1 staff member was clinical and 3 staff members were in administrative or managerial roles.

Managers had calculated the number and roles of staff required by the service. As the service grew, more staff were recruited. The service did not use bank or agency staff.

Staffing levels allowed patients to have regular one-to-one time with their named clinician. Patients confirmed this happened weekly.

There was adequate medical cover with both a responsible clinician and a specialist GP employed by the service.

When staff joined the service, they completed a new starter pack, overseen by senior staff.

Staff had received and were up to date with appropriate mandatory training. All courses had 100% compliance. Staff had all completed Learning Disability and Autism tier 1 training, and the provider was in the process of arranging tier 2 training for staff. At the time of our inspection, we saw that quotes and available dates from a provider of this training had been received.

We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The environment was clean and well maintained. The management company of the building managed the cleaning of the facilities. Staff maintained equipment as appropriate and kept it clean.

Staff adhered to infection control principles, including handwashing. An infection prevention and control guidance poster was displayed in the service for staff.

We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff at the service did not prescribe medicines. However, if a need for any changes in medicines was identified during initial assessment at the service, the consultant psychiatrist wrote to the patients GP to make this recommendation.