All inspections: The Zone - Care Quality Commission

The Zone is a charity based in Plymouth city centre which provides a range of support services to young people. It provides two distinct services that are registered with CQC known as Icebreak and Insight. Icebreak is for younger people aged 16 to 22 who are experiencing severe emotional distress that are influencing their day-to-day lives and mental well-being. This service is for patients who may have an emerging personality disorder.

The Zone was last inspected in July 2019. The service was rated good overall with a rating of good for the safe, effective, caring, responsive and well led domains. There were no requirements made at that inspection.

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

Our rating of this service stayed the same. We rated it as good because:

The service provided safe care. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff managed waiting lists to ensure that patients who required urgent care were seen promptly. Staff followed good practice with respect to safeguarding.

Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
The teams included or had access to a full range of specialists required to meet the needs of the patients. Managers ensured thatstaff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in decisions about care.
The service was mostly easy to access. Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude patients who would have benefitted from care.
The service was well led and the governance processes ensured that that procedures relating to the work of the service ran smoothly.

However:

The service did not ensure that all patient files contained an up to date risk assessment.

The service did not always ensure CQC was notified promptly after incidents occurred.

We rated The Zone as good overall because:

The service provided safe care to patient adults experiencing their first episode of psychosis and for young people experiencing severe emotional distress. Clinical premises where patients were seen were safe and clean. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed. Staff regularly contacted those on the waiting list and signposted them to appropriate services, if a patient’s mental health had deteriorated whilst they were waiting to access the service. This was an improvement from the previous inspection. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. The service engaged well with local stakeholders and external organisations to ensure there was no gap in clients care and support. For example, by working with local alcohol and drug treatment services, homelessness services, and Livewell Southwest CIC.
The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
The service was easy to access. Staff managed waiting lists well to ensure that patients were assessed in a timely manner and did not wait too long to receive treatment. This was an improvement from the previous inspection. The criteria for referral to the service did not exclude patients who would have benefitted from care. Since the previous inspection, the Icebreak service had reduced patient’s length of wait to access the service by 62%. The maximum wait to access the service was now 16 weeks. Staff followed up patients who missed appointments.
The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly. Staff engaged in clinical audit to evaluate the quality of care they provided.

However:

Some staff were overdue a refresher training in safeguarding and the majority were overdue to attend a refresher course on detecting radicalisation (known as Prevent).
Staff were not clear on the provider’s vision and values and how they were applied in the work of their team.

We rated The Zone as requires improvement because:

There was a long waiting time for the Icebreak service (for clients with difficulties relating to personality disorder). All Icebreak clients had a fixed two-year treatment time regardless of their individual needs. The provider did not monitor whether this timeframe was effective, the wellbeing of clients on the waiting list for Icebreak or that appropriate health care professionals monitored clients who had self-referred to the service. The Zone was in the process of redesigning the Icebreak service to reduce the number of clients on the waiting list.
Children and young people, who might be unaccompanied (from the age of 13 years) shared a waiting room with adults who could be distressed or may exhibit challenging behaviour. There were no clear procedures or policies to enable staff to protect children or adults from challenging behaviour. Staff did not always have access to alarms when consulting with clients in the building.
Staff reused Paleperidone (a medicine used to treat schizophrenia) which should only be given to the client it has been prescribed for. This was against good practice guidance and the provider’s policy.
There was a lack of incident reporting, investigation and learning from incidents which could help prevent future incidents. Staff did not know the full range of incidents they should report.
Staff had not all completed training in the Mental Capacity Act and did not understand their responsibilities under the Act. There was no policy on the Mental Capacity Act. Clients and carers were not aware of advocacy services available to them.
Staff working in the Insight service (for clients experiencing a first episode of psychosis) had not had appraisals or performance reviews and therefore had not had the opportunity to discuss their goals and development.

However

The service was fully staffed and staff sickness and absence rates were low. Staff received supervision and training for their roles, they were driven and motivated to provide good care. Staff said they enjoyed their jobs and had good job satisfaction.
Clients said staff treated them with respect and dignity and that they were professional, helpful, kind and caring. Clients could contact the service while they were on the waiting list for advice and signposting information. Staff reached out to clients who missed appointments in case it was a sign of a decline in the client’s mental health.
Safeguarding policies and procedures were in place. Safeguarding is the action that is taken to promote peoples’ welfare and protect them from harm. Staff completed safeguarding training to help them keep clients safe. Staff made safeguarding alerts when needed.
Care plans and risk assessments were of good quality. Clients and staff wrote care plans together and they included goals and information on physical health and wellbeing. Staff kept care plans up to date. Families and carers were involved in clients’ care if the client wanted.
The service followed best practice guidelines by offering effective talking therapies. Staff ran a variety of groups that clients liked and found helpful. Teams included a range of mental health disciplines to meet the needs and preferences of clients.
The service had good working links with other agencies to help it provide holistic care. Staff liaised with GPs and other health professionals to support clients’ physical and mental health needs. Staff provided employment, housing and benefits support for clients.

During out visit to the Zone we met with people who used services, spoke with staff on duty and reviewed six care records and three staff files. We found people were involved in decisions about their care and treatment and staff understood the principles of the Mental Capacity Act (2005) which ensured people's human rights were respected.

Care and treatment was provided in accordance to people's needs. There was evident in the care records which considered people's physical, mental health and social needs. Evidence of health and social care professional's involvement was apparent. Risks were assessed and updated if people's needs changed.

The premises were suitably and comfortably furnished and the health and safety of the staff and service users was taken into account.

There were robust systems in place to ensure that before staff began working in the Zone that they were safe and trained to look after the people.

The Zone monitored there service provision on a regular basis. One comment 'The service is very young person led with young people at its heart.' This demonstrated that the Zone valued the feedback from the young people using the service.

The Zone provides information, advice and support to young people who have early psychosis or severe emotional distress.

During our inspection we spoke to three people who used the service, five members of staff and the chief executive. People who used the service were very happy with the care and support that they had received. One person said, 'This service has changed my life so much. I can't imagine what I would have done without it'. Another person said, 'The staff have helped me loads'.

People told us they were involved in the planning of their care and the reviewing of their progress. People could choose where they wished to receive their support. This could be at the services registered location or within the community.

We saw that people's needs were assessed and care was planned and delivered in a manner that met their individual needs.

People were protected against the risks of abuse because staff understood people's individual risks and were aware of the appropriate procedures to report any concerns.

Staff received the required support and training to enable them to meet people's needs.

We saw that there was an effective system in place to enable people to give feedback and complain if they were unhappy with their care and treatment.

The Zone

All Inspections

28 October 2021

During a routine inspection

16 - 17 July 2019

During a routine inspection

16 - 17 October

During a routine inspection

27 January 2014

During a routine inspection

25 March 2013

During a routine inspection