Sheffield Children's NHS Foundation Trust

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

During this assessment we rated this key question as good. This meant that peoples’ outcomes were consistently good, and feedback received from various sources supported this.

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.

Carers and young people that we spoke with told us that the service involved them in decisions about care and treatment. They felt involved in the development of care plans and risk assessments.

Young people had access to a range of psychological therapies, art therapy, occupational therapy, carers therapy and specific activities and education. The service was implementing the non-violent resistant approach. Staff were receptive to the introduction of this psychological approach, and managers were rolling out relevant training to all staff.

Young people and carers told us a psychologist and occupational therapist had input into their care and treatment and there was access to art and carers therapies.

Eleven of the 12 carers we spoke with told us that they would feel confident in raising any concerns and felt they would be dealt with effectively. However, one carer told us that issues they had raised had not been addressed and that they didn’t receive regular updates regarding their relative’s care.

Of the records we reviewed, we found young people and carers being involved in the formulation of care plans. They were individualised, holistic and demonstrated strengths and goals with people’s voice evident in some care plans.

Staff told us processes were effective. An example around discharge was given and that discharge planning starts on admission. Access assessments are carried out by staff and staff will think about and identify potential pathways and ongoing education provision. Staff told us that they think about needs that must be met for an admission to be therapeutic. Staff exampled wider team collaboration such as working alongside the learning mentor within the trust to assist with school related needs, attempting to transition people into school environment.

Staff told us that ward rounds are attended by community child and adolescent mental health services. This ensures a clear pathway for child and adolescent mental health services (CAMHS) follow up. Social services have specialist mental health social workers who are proactive in putting things in place and complete thorough searches of placements to find the right one for each young person. Staff told us that where possible they co-ordinate discharges in ward rounds and that carers are invited to these meetings.

Staff told us that they have a system of reciprocal gestures and positive reinforcement for young people, for which they were looking to collate evidence in order to measure the effectiveness of this approach. Staff told us that there was a twice-weekly group for parents and that and that the voice of young people and their carers fed through everything.

Young people were involved in the assessment of their own needs. Staff involved carers, schools and other external bodies when needed to ensure young people’ needs were met.

Staff were trained in specific young people’s assessments, for example, child and adolescent psychiatric assessment schedule (CHAPPAS), autistic diagnostic observation schedule (ADOS) and autistic diagnostic interview (ADI) trained, the Wechsler intelligence scale for children (WISC) assessments, positive behaviour support planning (PBS) and framework and speech and language therapy (SALT) assessments

We saw staff regularly reviewed assessments. Each young person had a named nurse and associate nurse who were responsible for completing these on a regular basis. Staff told us about inclusivity and diversity work they had undertaken to support young people and their carers.

Staff completed a comprehensive assessment of each young person and the 9 care records we reviewed included information on the individual’s needs and preferences to ensure the care was person-centred. Care plans identified physical health needs and physical health monitoring such as the use of national early warning score charts, height and weight charts, nutritional needs, restrictive interventions and expected date of discharge.

We saw evidence of multidisciplinary approaches throughout care records regarding the planning and management of an individual’s needs. These included nursing, occupational therapy, medical and psychological interventions. All interventions prescribed were implemented and monitored.

Staff held weekly community meetings for young people and ensured young people had access to activities and local community groups.

Staff invited carers to meetings and kept them up to date on any activities or changes within the service.

Staff followed the National Institute for Health and Care Excellence guidance. At the time of our assessment, non-violent resistance training was being embedded throughout the service. Young people also had access to dedicated psychology staff. The Becton Centre is part of Sheffield Children’s NHS Foundation Trust. This meant young people using the service were visited by the paediatric team from Sheffield Children’s NHS Foundation Trust every 2 weeks to monitor their physical health.

Managers used supervision and appraisal sessions to identify the development needs of staff within the service.

We saw evidence that staff met young people’s needs in line with current guidance. Multidisciplinary team discussions involved the young person and their carers in decision making and planning care and treatment. Care plans we reviewed included the monitoring required for individual’s physical health. However, records evidenced that staff did not always carry out this monitoring in line with what was specified within the young person’s care plan.

The service had audits in place to ensure staff provided evidence-based care and treatment and was in line with national guidance and legislation such as the Mental Health Act. Restrictions on young people were regularly reviewed to maximise their independence.

Young people were invited to attend meetings about their care. Carers we spoke with felt involved and gave feedback that they were invited to meetings.

Staff felt that meetings held within the service were effective for sharing information internally. The service had meetings in addition to shift handovers such as the daily sitrep, safety huddles and 9am handover meetings.

The service had effective working relationships with external teams and organisations.

We received feedback from independent advocacy. Overall, there was a positive working relationship between staff and advocates. However, it was reported that attitudes towards advocacy services on Sapphire Lodge were disrespectful and obstructive. Advocates told us that nursing staff often did not follow up on issues raised by advocacy on Sapphire Lodge and staff often discouraged young people from using advocacy services.

During our assessment we observed 1 multidisciplinary meeting which was attended by a range of professionals including doctors, a nurse, a social worker and, a psychologist. The meeting agenda included updates from the nursing team regarding previous incidents, mental state examination, interactions, sleep hygiene, nutrition, medication and plans going forward. We observed effective and efficient delegation of roles. Staff evidently knew their young people very well and contributed to the meeting in a respectful, caring and person-centred manner.

We reviewed minutes of meetings from handover meetings, safety huddles and Your Voice meetings. Case notes indicated evidence of external appointments and young people’s participation in art therapy, occupational therapy, and input from other appropriate services. Discharge planning was collaborative with the young person and their carers and involved the social worker in order to identify potential pathways.

Staff met young people’ health needs. Young people and their carers who we spoke with were positive about the activities available, especially art therapy facilities and the sports and gym facilities including access to an off site swimming pool. Young people attended weekly community meetings/Your Voice meetings to discuss activities. Some young people did voice concerns over the lack of activities within the actual lodges and had requested this to be taken into consideration when timetables were being developed.

Staff we spoke with understood the importance of ensuring young people’ needs were met. Young people had access to psychological therapies, dieticians, occupational therapists, advocacy, activity staff, and doctors.

Young people have planned leave to a local farm, leave to local shopping centres, cinema as well as other activities that are planned by activity staff both on and off site as well as access to an off site swimming pool and gym facilities.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Carers we spoke to told us they were able to raise concerns and complaints, and these were acted on. Out of 12 carers we spoke to, only one felt that their concerns and complaints wouldn’t be acted upon effectively. Carers feel that consent is asked by staff when caring for young people and told us they are given information regarding their rights.

Young people had access to advocacy across all 3 lodges with a good amount of signage indicating how to access them outside of planned weekly visits.

We spoke to independent advocates from the 3 lodges. Advocates did inform us of times when young people’s rights as informal young people hadn’t been respected. Advocates told us that they had witnessed multiple staff members inform a young person that was at the time, an informal young person, that they weren’t allowed to leave the lodge. Advocates informed us that they had to interrupt the meeting to inform staff of this incorrect information.

Staff we spoke with had a good understanding of consent including the Mental Capacity Act. Young people were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with their specific needs. This included the use of a communication aids for young people who could not verbalise.

During our site visit, observations showed good interactions between staff and people and staff promoted independence to deliver person centred care and treatment.

At the time of our assessment, the compliance figure in relation to staff completing their training in Mental Capacity Act was 93%.

We saw evidence in the 9 care records we looked at that staff assessed young people’ capacity to consent and read young people their Section 132 rights.