Torbay and South Devon NHS Foundation Trust

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

The service had a good learning culture and people could raise concerns. Managers investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks and knew how to protect children, young people and their families from abuse. The service worked well with other agencies to do so. Facilities and equipment met the needs of people, were clean and well-maintained. Staff completed and updated risk assessments for each child and young person and removed or minimised risks. The service had enough staff with the right skills, qualifications and experience to keep children, young people and their families safe from avoidable harm and to provide the right care and treatment. Staff received training on how to recognise and report abuse and they knew how to apply it. Staff kept detailed records of children and young people’s care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Families know how to complain about the service or raise safety concerns and felt supported by staff to do so. Staff created detailed care plans, which demonstrated multi-agency working. Care plans included relevant details around children’s care needs and families were confident staff know how to support and care for children and young people. Families told us they felt safe, heard and supported by the team, which meant they had a better understanding of their child’s needs.

There was a positive culture of learning from incidents to improve services. Staff knew how to raise safety concerns and were encouraged to do so by their managers. Managers shared learning from investigations. Staff and managers worked collaboratively to reduce risk for children, families and staff.

There was an embedded culture of learning and openness with collaborative working to seek and maintain the safety of the service. Staff used a system to report incidents, near misses and safety events. Managers proactively monitored, analysed and shared lessons learned with those involved. When things went wrong, staff apologised and gave people support. Learning from incidents and complaints resulted in changes that improved care for others.

Young people were referred to the service either by the school the young person attended, their GP or transferring their care from hospital inpatient into the community. They found the process easy and felt “looked after” by the staff. There was a joined-up approach with schools, GPs and hospitals to ensure children and young people had everything in place to be safe in their own homes, at school and in the community.

Staff understood how to support people between services and at times of transition. Staff took steps to ensure there was continuity of care, including when people moved between services and local authorities. Planning for a child’s transition into adult services was started years in advance, to fully prepare the young person. Staff collected and used the voice of people who had previously used the service. Staff invited families to attend a range of meetings and contribute to surveys. Records of feedback were reviewed by staff to implement improvements.

Staff and managers worked with people and healthcare partners to establish and maintain safe systems of care, which was monitored for effectiveness. Systems supported staff to work together with families and their wider care teams that kept the young person at the centre of what they did. A range of professionals attended regular multi-disciplinary meetings to discuss on going needs and transitioning both in and out of the service. This was an opportunity for staff to discuss the future needs of the young person during the meetings but to also capture the needs and wants of the young person at the start of their journey from children to adult services.

Parents felt staff listened and understood their concerns and were knowledgeable about the needs of the family and their children. Parents felt staff responded in a timely way and they were not kept waiting for support.

Staff understood the importance of additional training in understanding the needs of people with a learning disability and autistic people. The provider was investigating options of how to provide additional training, as they were performing below compliance, but had no specific plans. Staff understood their role and responsibilities in raising a safeguarding concern. Staff know who their safeguarding lead was and staff were confident in raising safeguarding concerns. Staff could access additional professional safeguarding support if needed. Staff documented safeguarding referrals with relevant information.

Processes ensured staff had access to safeguarding advice and support when needed. Specialist staff who had additional training in safeguarding provided support in a range of ways. Safeguarding training was provided for staff and was a mandatory part of their training. We reviewed safeguarding referrals and each record was well documented with relevant information. Safeguarding supervision was provided for staff and there was a rota for safeguarding specialists to be available for additional advice and support for staff when they needed it. A recent project across the service had been to promote the use of professional curiosity. This included giving a speech and raising awareness during a conference. This encouraged staff to question actions in a supportive and protective way which would keep young people safe.

Care plans were written to involve children, young people and their families to ensure their needs were recognised. Relatives were informed of risk around using equipment in their home, such as sleep systems, walkers and seating aides. Their ability to use the equipment safely was regularly assessed by occupational therapists. Staff involved people and families who had lived experiences of the service in creating protocols and improvements in the service.

Staff worked with children and their families to understand their likes, dislikes, interests and ambitions. Care plans demonstrated the collaboration between families and professionals in identifying needs, reducing risks and gaps in care provision. Staff understood their role in assessing risk and reporting any concerns. Staff felt supported by their management team in reporting risk and ensuring safety at all times. Records of identified risk and actions taken to reduce the risk were clear and up to date.

There were proportionate risk management systems in place to either mitigate or reduce risk, which involved reporting tools, regular well attended meetings where minutes were captured and shared. Staff completed risk assessments which contained relevant information to manage risk safely and consistently. Care plans were reflective of the needs and requirements of the young people and identified how to reduce and manage personal risk. Systems allowed staff to capture behavioural or physical changes which were shared and discussed with managers when more support was required. Risk management policies in place were in line with best practice and national guidelines. Staff had access to a variety of role specific training and were supported to take the time to complete these. Risk was reported and reviewed by executive leaders who reported their findings to a committee.

Families told us equipment prescribed by staff meet their needs and was regularly assessed for suitability. Equipment was maintained by a third-party organisation using a contractual agreement. Staff were able to flag and raise concerns to them directly if repairs were needed in between regular maintenance schedules. Families were given training in how to use the equipment safely.

Staff understood their roles and responsibilities to ensure the safety of service users when using equipment. There was a risk assessment tool in place linked to the persons digital care plan and a quick escalation process to enable the service to detect and control potential harm.

Staff used systems which enabled them to detect and control potential risks in the care environment. Risk assessment forms were digitally linked to patient care records which would alert staff when not completed but would also create a workflow for pending work to be done. There were processes in place where prescribers were able to monitor and maintain equipment. Staff were able to use the assessment tool to assess home environments to identify where adaptions were required to meet the needs of the families. Staff used the assessment tool to provide information to the local authority for building adaptions , including stairlifts, widening of doorways or outside ramps for access.

Families felt supported by staff and felt they had effective training to care for their young people safely. Families appreciated the consistency of familiar staff and expressed trust in the care provided.

Staff felt well supported by supervision provided by their managers and specialist staff. Staff attended training which was relevant to their role and had protected time to complete their training. Staff felt well supported by their line managers who were approachable and mindful of staff well-being.

The provider had implemented a workforce planning tool which allowed them to monitor current and future staffing needs. Managers used systems to monitor mandatory training. Staff received automatic alerts when they were due to be undertaken. Regular supervision and meetings with managers were recorded and stored confidentially. The one to one meeting with their manager could also involve a career conversation. This was where staff could discuss progression and additional training needs.

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.