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Archived: York & Selby Early Intervention Service Good

Inspection Summary


Overall summary & rating

Good

Updated 15 March 2017

We rated the York and Selby Early Intervention Service as good overall because:

Following our inspection in June 2016, we rated the services as good for responsive and caring. Since that inspection, we have received no information that would cause us to re-inspect these key questions or change the ratings. During this inspection, we found that the service had addressed the issues that had caused us to rate safe, effective and well led as requires improvement following the June 2016 inspection. However, the service had outstanding issues in the effective domain regarding training in the Mental Health Act.

The service was now meeting Regulations 12, 15, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

  • We felt that the service was safe because medicines management practice had improved. The provider had also made changes to the building to make it safer for service users and staff. Staff had received training in resuscitation and in the prevention and management of violence and aggression. The learning of lessons from incidents had improved.
  • We felt that the service was effective because the provider had made clear policies and guidance available to staff regarding the Mental Health Act and Mental Capacity Act. The provider had made training in both Acts mandatory for staff. The involvement of advocacy services had increased.
  • We felt that the service was well led because the service manager had taken action to rectify the concerns raised from the last inspection and made improvements. The service had a robust governance system in place relating to policies and procedures which had been updated since our last visit. The service had formed a clearer governance and reporting structure with the NHS trust it contracted with.
Inspection areas

Safe

Good

Updated 15 March 2017

We rated safe as good because:

  • The service had addressed the issues that had caused us to rate safe as requires improvement following the June 2016 inspection.

  • In June 2016, we found that the management of medicines was not safe. Staff had not monitored what medications the service kept on site, we found out of date medication, and staff did not check the temperature of medication being stored. When we visited in February 2017, we found that staff monitored the temperature of the medication room daily and the service had a procedure in place for auditing medication and controlling stock.

  • In June 2016, we found that the environment of the service was not safe as there was access to items and fixtures that could be used to self-harm. Rooms where staff saw service users did not have alarms, which they could use for assistance in an emergency. The health and safety manual was dated 2014. At this inspection, we found that the service had made improvements to the safety of the environment. Staff were aware of risks and how they should manage at risk service users in the building. All staff carried personal alarms and rooms used by service users had panic alarms in place to protect staff and service users. The health and safety manual had been updated.

  • In June 2016 the service did not train staff who worked alone with vulnerable service users in basic life support and management of violence and aggression. This meant they could not give emergency support to service users or manage aggression safely. At this inspection, the service had trained all staff in resuscitation techniques and in the management of violence and aggression.

  • In June 2016, Community Links were not taking the lead in investigating incidents and lessons learnt were not delivered to the staff team in a timely manner. At this inspection, the manager explained that this system had improved. Both the service and the trust investigated incidents jointly to ensure they could share learning. Staff had a good understanding of how the service managed incidents.

However:

  • We found a sharps box in the medicines cabinet, which staff had not labelled. The manager told us staff had rectified this immediately following our visit.

  • During this inspection we saw the key pad to unlock the door into the building was not concealed to prevent visitors from viewing the code. The service agreed to look into this and we will follow this up at the next inspection.

  • During this inspection we found that an internal door on the first floor of the building was not obscured. It was possible for staff in the next building to see into the service which placed service users confidentiality at risk.

Effective

Good

Updated 15 March 2017

We rated effective as good because:

  • In June 2016, the service did not have Mental Health Act and Mental Capacity Act policies in place for staff to follow. At this inspection, these policies were now in place and provided guidance in supporting staff to work with service users who lacked capacity to consent to their care and treatment, or who may be subject to a community treatment order.

  • In June 2016, we found that involvement with advocacy services was low. At this inspection, we found that advocacy information was accessible to service users in waiting areas. We saw that the service had made links with the local advocacy service by inviting them to patient event groups. The service told us that they had started an audit tracker of advocacy usage on case files to embed this practice into the service.

However:

  • Staff had not received training in the Mental Health Act. At our inspection in June 2016 we stated that the service must ensure it trained staff in the Act. This was to ensure that all staff were aware of the Act and their responsibilities to service users. The service had made improvements by ensuring that training had become mandatory. However, the provider had not trained staff due to a lack of available training dates.

  • In June 2016 we were concerned that the service was not undertaking capacity assessments at all times that this was indicated (for example if a patient had a learning disability). At this inspection, we reviewed patient files and found that in the majority of files, practice had improved. However, for three service users there was no recording on the system of whether the patient had capacity to make decisions about their care and treatment. This was inconsistent as most files recorded whether the person had capacity to consent to working with the service. In addition to this, two service users were under 16 and there was no recording of assessment of Gillick competence.

Caring

Good

Updated 15 March 2017

At the last inspection in June 2016 we rated caring as good. Since that inspection we have received no information that would cause us to re-inspect this key question or change the rating.

Responsive

Good

Updated 15 March 2017

At the last inspection in June 2016 we rated caring as good. Since that inspection we have received no information that would cause us to re-inspect this key question or change the rating.

Well-led

Good

Updated 15 March 2017

We rated well led as good because:

  • In June 2016, the whistleblowing and safeguarding policies did not provide details for staff to contact the Care Quality Commission (CQC). At this inspection, the service had updated the whistleblowing policy and included the CQC contact details. The service had updated the adult and children’s safeguarding policies and included information about contacting the CQC.

  • In June 2016, some policy and procedures such as safeguarding were outdated, and important policy such as Mental Health Act and Mental Capacity Act was not in place. This meant that staff did not have the necessary information and guidance to perform their roles adequately, this may have had limited knowledge of what actions they should take. At this inspection, we saw that the service had updated policies regarding whistleblowing, safeguarding, the Mental Health Act, Mental Capacity Act, and Duty of Candour. The provider had also developed a new governance structure and a policy dashboard for all staff to access.

  • In June 2016, the service had not updated the local risk register with known risks such as issues regarding building safety and access. At this inspection, we found that the service had updated the risk register on a regular basis and included risks regarding the building.

  • In June 2016, staff described feeling confusion regarding who were leading them and which organisational policy, procedure and training they should follow. Senior managers from Community Links did not meet regularly with senior managers from the NHS trust with whom they were contracting, and this had an impact on day-to-day practice. At this inspection we found that there was a more joined up approach with the NHS trust. There were monthly contract meetings and senior managers met on a more regular basis. The service manager had updated the training matrix to involve mandatory training from both providers and staff were clearer about the management and reporting of incidents.

  • In June 2016, staff recorded their appointments at patient’s homes on the computer system; however, this did not always work. This meant that staffs whereabouts were not always known which could compromise their safety. At this inspection we found that in order to reduce risk, the service had transferred staff calendars to a more reliable NHS system.

  • In June 2016, Community Links were not taking the lead in investigating incidents and lessons learnt were not delivered to the staff team in a timely manner. At this inspection, the manager explained that this system had improved. Both the service and the trust investigated incidents jointly to ensure they could share learning. Staff had a good understanding of how the service managed incidents.

  • In June 2016 records were not accessible, because the computer system was complex and staff could not access historical information quickly. At this inspection we found care records were clear and accessible and all information was held on one system.

Checks on specific services

Community-based mental health services for adults of working age

Good

Updated 15 March 2017