8 July 2020
Our rating of the trust stayed the same. We rated it as good because:
- We rated effective, responsive and well-led as good. We rated caring as outstanding and safe as requires improvement.
- We rated all seven services we inspected as good. This included improvements in the overall rating in three core services. In rating the trust, we took into account the current ratings of the five services not inspected this time.
- Across the trust we found that children had good outcomes because they received effective care and treatment that met their needs.
- We found that children’s’ needs were met through the way services were organised and delivered.
- We saw evidence that people were truly respected and valued as individuals and were empowered as partners in their care.
- We noted improvement in the leadership and culture, which were used to drive and improve the delivery of high-quality person-centred care.
- Although we found the trust’s services largely performed well, it did not meet some legal requirements relating to the safe domain, meaning we could not give it a rating higher than requires improvement in this domain.
- We found some risks which had not been identified by the trust’s internal governance structure. We escalated this to the trust at the time of the inspection, who took appropriate action.
21 June 2018
We have not rated this service before. We rated it as good.
For a summary of this service see the overall trust summary section.
8 July 2020
Our rating of this service stayed the same. We rated it as good because:
- The service provided safe care. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the children and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The ward team included or had access to the full range of specialists required to meet the needs of children on the wards. Managers ensured that these staff received training and appraisals. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
- Staff treated children with compassion and kindness, respected their privacy and dignity, and understood the individual needs of each child. They actively involved children, families and carers in care decisions. Consideration was given to children‘s care after they were discharged and the service offered extensive support to carers to ensure they could support children after discharge from the service.
- Staff planned and managed discharge well and liaised well with services that could provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
- The service was well led, leaders had the skills knowledge and experience to perform their roles, staff felt respected and valued and performance and risks were managed well.
- The ward environment was not well maintained. There were a number of maintenance jobs that had not been completed. There were infection control risks on the ward that had not been identified. We found equipment that was out of date. Checks on equipment were not up to date. Cleaning records were poor and did not provide assurances of regular cleaning and clean stickers were not in use.
- There were no personal emergency evacuation plans to provide guidance to staff around the evacuation of individual children. We raised this and personal emergency evacuation plans were put in place by the second day of our inspection.
- Clinical supervision levels were low at 54%, staff received other methods of supervision but these were not always recorded and it was not clear whether staff were receiving the level of supervision they needed.
8 July 2020
Our rating of this service improved. We rated it as good because:
- The service provided safe care. Clinical premises where children and young people were seen were safe and clean. The number of children and young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each child the time they needed. Staff managed waiting lists well to ensure that children and young people who required urgent care were seen promptly. 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 children and young people. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The teams included or had access to the full range of specialists required to meet the needs of children and young people. 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 understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
- Staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs. They actively involved children, young people and families and carers in care decisions.
- The service was easy to access. Staff assessed and treated children and young people 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 children and young people who would have benefitted from care.
- The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.