Providence House and Moira House

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.

At our last assessment we rated this key question Good. At this assessment the rating has remained 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.

The service had a culture of safety, based on openness and transparency. They listened to concerns about safety and investigated and reported safety events. All staff knew what incidents to report and how to report them through an electronic incident reporting system. Staff received feedback from investigation of incidents. This included sharing feedback through regular meetings and by email.

There had been 1 incident during the last 12 months which the provider had categorised as serious. They had completed a full investigation in response to the incident identifying actions for improvement. There was evidence of learning from incidents. For example, following several ‘tailgating’ incidents, where patients attempted to enter clinical areas behind staff, managers had shared learning and arranged for the physical intervention instructor to meet with staff to raise awareness around door management.

Learning from incidents was shared with governance and assurance committees, and meeting minutes showed that managers completed implemented actions in response to incidents where appropriate.

Staff understood the duty of candour and could provide examples of when they had followed the duty of candour process. There were no recent incidents that met the duty of candour threshold. Nevertheless, there was a duty of candour policy in place which was reviewed annually by senior managers. Staff we spoke with understood the duty of candour and said they were open and transparent and gave patients and families a full explanation if and when things went wrong.

Staff were debriefed and received support after incidents. Care records showed that staff also gave patients a de-brief after incidents.

Risk assessments were regularly reviewed and updated after incidents. Care plans were person-centred and included clear therapeutic goals personal to each individual patient.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Description: 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.

The service worked with patient and stakeholders to keep people safe. Staff shared key information when handing over their care to others during morning and evening handovers. This included updates on the previous 24 hours, changes in presentation, incidents, medical appointments, physical health needs and any changes to care plans.

Some patients fed back that they did not always feel safe due to violence and aggression or incidents involving other patients. Staff we spoke with described how they tried to ensure the safety of all patients including by ensuring individual patient observation levels were met, appropriate risk management was in place, and ongoing work took place with patients in order to adopt an individualised approach to support. We saw that individual patient Positive Behaviour Support Plans were in place to support a reduction in the likelihood of such incidents and need for physical intervention.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. They completed work with patients around mutual expectations and ran mutual help meetings. Staff also completed reconciliation following disagreements between patients to help maintain their relationships and to develop understanding and respect for one another.

The psychology team delivered a psychoeducation programme which covered a variety of topics including boundaries, expectations, healthy relationships, racism, and hurtful comments.

Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Managers attended multiagency safeguarding meetings with attendance from the police and social services.

Staff received training specific for their role on how to recognise and report abuse. All ward- based staff received Level 3 safeguarding training. Training compliance was 98% for Providence House, and 97% for Moira House.

There was a safeguarding policy in place which was subject to regular review. Staff were knowledgeable about safeguarding and knew how to raise a concern when required. They were able to identify different forms of abuse, and the signs associated with these. Staff attended regular meetings where important information and lessons learned were shared. Staff were observed having a caring and compassionate approach when engaging with people. Safeguarding referrals were discussed in governance and assurance committees with any actions and learning identified shared.

Description: 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.

Care provided met people’s needs and was safe, supportive and enabled patients to do the things that mattered to them. We reviewed 5 sets of care records during the assessment. These showed that staff involved patients in care planning and risk assessments. Staff completed risk assessments for each patient on admission, using a recognised tool, and reviewed this regularly, including after any incident. Some patients told us that they had been involved in their risk assessment and knew what their risks were. Other patient said staff did not involve them in assessing risk.

However, in all the records we reviewed we could see that each patient was offered a ’patient friendly’ version of their risk assessment. Managers said these were designed to be more accessible to patients and contained less jargon and professional language.

Managers described how high staffing numbers helped keep people safe and manage risk. All staff completed an accredited physical intervention training course. Staff we spoke with knew about and dealt with any specific risk issues relevant to individual patients.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. They used pictorial versions of risk assessments where appropriate, and patients had access to grab sheets providing summaries of their positive behavioural support plans. Staff also implemented communication care plans for patients who needed this.

Patients were invited to participate in multidisciplinary team meetings and offered copies of their care plans.

Managers compiled a blanket restrictions log for each house. We had sight of these and saw that each restriction was only imposed where necessary to meet the needs of the patients and that staff reviewed these regularly.

We reviewed 2 instances of restraint in response to behavioural disturbance which had taken place in communal areas within the last 30 days. The footage showed that staff managed both incidents well. They intervened appropriately, using recognised holds. Staff ended the restraint as soon as it was safe to do so and staff appeared to use verbal de-escalation, although it was acknowledged there was no sound on the footage so this could not be confirmed. Following the incidents managers ensured staff and patients received a de-brief. The CCTV review did not raise any concerns about the behaviours of staff when engaged in a patient restraint.

Training on the management of aggression and violence was provided to all staff. Staff and managers told us most incidents were managed with the use of verbal de-escalation and engagement. They said they used restraint as a last resort and only after all efforts at verbal de-escalation had failed and this was supported by the CCTV footage we reviewed.

Staff enabled patients to give feedback on the service they received through a service user survey which was commissioned by an independent organisation. Patients we spoke with could also tell us about the different ways they could feedback directly within the service.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Description: 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.

The service made sure there were staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. They worked well together to provide safe care which met people’s individual needs.

The service used a recognised tool to determine staff numbers. Managers accurately calculated and reviewed the number of registered nurses and support workers needed for each shift. At Providence House, baseline staffing numbers were 2 registered nurses and 10 support workers for day and night shifts. At Moira House there were 2 registered nurses and 7 support workers on day shifts, and 2 registered nurse and 6 support workers on night shifts. There was also an additional night manager who worked across both houses during night shifts. Staff we spoke with generally told us staffing numbers were sufficient and enabled them to safely care for patients.

Managers regularly reviewed and adjusted staffing levels and skill mix and identified and arranged cover for any shortages. There was a workforce plan in place which managers used to calculate baseline staffing numbers, and they used agency and bank staff to ensure baseline staffing numbers were met. Managers told us they used staff familiar with the service wherever possible.

Managers, staff and patients all fed back that there were sufficient staff on shift to meet patients’ needs. We reviewed staffing data for the previous 4 weeks and found that baselines numbers were met for all shifts, and that for most shifts the service was staffed above baseline numbers.

Data for the previous 6 months showed that managers had used agency staff for 10% of shifts, and had used bank staff, for 9% of shifts at Providence House. For Moira house these figures were 8% and 9% respectively.

Managers gave bank and agency staff a full induction prior to working on the wards and those staff were required to complete the same training as substantive staff.

Staff had received and were up to date with appropriate mandatory training. The mandatory training was comprehensive and met the needs of patients and staff. Training modules included relational security, attachment and trauma, self-harm and immediate life support. Most training modules had over 95% compliance, with the lowest being 83% for gender equality at Moira House, and 87% for relational security at Providence House.

Staff had access to regular management support and supervision. Compliance for the most recent round of supervision was 98% for Providence House and 100% for Moira House. Managers made sure staff received an annual appraisal. Compliance was currently 91% for both Providence House and Moira House.

The service had some vacancies for both registered nurses and support worker posts. Providence House had one vacant nursing post, and 13 out of a total of 53 support worker posts were currently vacant. At Moira House, there were no vacant nursing posts, but 14.5 out of 44 support worker posts were currently vacant.

Managers acknowledged that turnover rates were an area of focus. Annual turnover was 36% for Providence House, and 32% for Moira House.

The service had low sickness rates. The average absence during the last 12 months was 4% for both Providence House and Moira House. Managers monitored sickness regularly and ensured there was suitable cover available.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.