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Inspection Summary


Overall summary & rating

Good

Updated 30 September 2019

This was the first time we have inspected and rated this service.

We rated Stepping Stones Clinic as good because:

  • Young people and their carers were extremely positive, describing staff as ‘superb’, ‘brilliant’ and ‘fantastic’. Staff were described as discreet and of displaying high levels of empathy. Young people and carers were fully involved in all aspects of their care. A feedback survey from young people and carers was very positive.

  • Staff provided a range of treatment and care interventions for young people based on national guidance and best practice. The service had developed its own mobile app for young people focusing on coping skills. The design of the app was evidence-based, easy to use, and allowed users to download their own content to personalise it. A range of tailor-made, jargon-free, leaflets had also been developed. These provided information and practical advice and were written in a way which empathised with young people’s, or their carers, experiences.

  • Young people and carers were able to become involved in the management and operation of the service. This included attendance as a service user representative at the weekly management meetings.

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for young people, carers and staff.

  • A staff satisfaction survey reported 98% of staff had job satisfaction, found the management team accessible, felt involved in decisions and considered the leadership team demonstrated the service values.

  • Operational performance and risks in the service were managed well.

However:

  • Information concerning young people was not always stored in young people’s care and treatment records. This included the details of physical examinations and investigations, the reasons for prescribing specific medicines and detailed risk management plans. Clinical staff may not have had all of the information required to provide safe care and treatment.

  • Clinical staff contracted to work in the service had one professional reference before starting work in the service, rather than two. All other staff checks were completed. The service did not have a system in place to record and monitor when clinicians had received supervision.

  • When staff were working alone with clients there was no system where they could summon urgent assistance.

  • Young people and their carers did not have a care plan which they could easily understand and refer to. There were no ‘easy read’ leaflets or leaflets available in languages other than English, for young people or their carers.

  • The complaints policy did not describe how complainants’ could appeal if they were dissatisfied with the outcome of a complaint investigation or how it was investigated.
Inspection areas

Safe

Requires improvement

Updated 30 September 2019

We rated safe as requires improvement because:

  • Information concerning young people was not always stored in their care and treatment records. This included details of physical examinations and investigations. This meant clinical staff may not have had access to all of the information they needed to provide appropriate care and treatment.

  • The reason why certain medicines were prescribed for young people was not recorded. This included ‘off label’ medicines prescribed in a way not covered by the medicines licence. Best practice guidance concerning such medicines was not followed.

  • Clinical staff contracted to work in the service had one professional reference before starting work in the service, rather than two. All other staff checks were completed.

  • Although young people’s risk management plans were discussed with young people and their carers, they were not documented in detail in young people’s care and treatment records.

However:

  • The premises where young people and carers received care was safe, clean and well furnished.

  • Staff assessed and managed risks to young people. They responded promptly to sudden deterioration in a young person’s health. Staff worked with patients and their families and carers to develop crisis plans.

  • Staff understood how to protect young people from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • Staff regularly reviewed the effects of medicines on each young person’s physical and mental health.

  • The team had a good track record on safety. The service managed safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team.

Effective

Good

Updated 30 September 2019

We rated effective as good because:

  • Staff assessed the mental health needs of all young people. They worked with young people and families and carers to develop individual care and treatment plans.

  • The service had developed its own mobile app for young people focusing on coping skills. The design of the app was evidence-based, easy to use, and allowed users to download their own content to personalise it.

  • Staff provided a range of treatment and care interventions for young people based on national guidance and best practice.

  • The service included or had access to the full range of specialists required to meet the needs of young people under their care. Staff had a range of skills needed to provide high quality care. The service supported staff with appraisals and opportunities to update and further develop their skills.

  • Staff supported patients to make decisions on their care for themselves proportionate to their competence. They understood how the Mental Capacity Act 2005 applied to young people aged 16 and 17 and the principles of Gillick competence as they applied to people under 16.

However:

  • Young people and their carers did not have a care plan which they could easily understand and refer to.

Caring

Good

Updated 30 September 2019

We rated caring as good because:

  • Young people and their carers were extremely positive concerning staff in the service. Staff were described as ‘superb’, ‘brilliant’ and ‘fantastic’. Young people and carers reported that staff made a particular effort to fully understand them and their needs. The quality of these relationships was recognised as very important by young people, carers and staff.

  • A range of leaflets had been made by the service tailored to the needs of young people, and separately, for their carers. These leaflets were jargon-free and provided information and practical steps to minimise young people’s distress. The leaflets were written in a way which empathised with young people’s, or their carers, experiences.

  • Young people and carers were fully informed and involved in all aspects of their care. They were asked for their views which were then integrated into young peoples’ care and treatment plans.

  • Young people and carers were able to become involved in the management and operation of the service. This included attendance as a service user representative at the weekly management meetings.

  • The latest feedback questionnaire from young people and carers indicated 89% of them were very satisfied with the service. Ninety four per cent felt that they were understood, all areas they raised were addressed and that they would recommend the service to family or friends.

  • Staff had no hesitation in raising any issues concerning discrimination towards young people or their carers. They were confident their concerns would be taken seriously and did not expect there to be negative consequences for them for raising concerns.

Responsive

Good

Updated 30 September 2019

We rated responsive as good because:

  • The service was easy to access. Its referral criteria did not exclude young people who would have benefitted from care. Staff assessed and treated young people who required urgent care promptly and young people who did not require urgent care did not wait too long to start treatment. Staff followed up young people who missed appointments.

  • The service ensured that young people, who would benefit from care from another agency or professional, made a smooth transition.

  • The service had a complaints policy and staff knew how to handle complaints. There had been no complaints about the service in the previous year.

However:

  • The complaints policy did not describe how complainants could appeal if they were dissatisfied with the outcome of a complaint investigation or how it was investigated.

  • Although the service had undertaken a ‘green light toolkit’ audit, information for young people and carers was not available in an ‘easy read’ version. Information was not available in languages other than English.

Well-led

Good

Updated 30 September 2019

We rated well led as good because:

  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed, and were visible in the service and approachable for young people, carers and staff.

  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

  • Staff felt respected, supported and valued. They felt able to raise concerns without fear of retribution.

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

  • A staff satisfaction survey reported 98% of staff had job satisfaction, found the management team accessible, felt involved in decisions and considered the leadership team demonstrated the service values.

  • The service had developed a bespoke mobile app for young people and were planning to apply for network accreditation from the Royal College of Psychiatrists.

However:

  • The service did not have a system in place to record and monitor when clinicians had received supervision.

Checks on specific services

Specialist community mental health services for children and young people

Good

Updated 30 September 2019