Dorset Healthcare University 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

This means we looked for evidence that young people were protected from abuse and avoidable harm.

At our last inspection we rated this key question good. At this inspection the rating has remained good.

• Staff assessed and managed risks to young people and themselves.
• Staff understood how to protect young people from abuse and the service worked well with them and other agencies to do so.
• Young people were involved in discussing risks and how to protect themself.
• The service used systems and processes to safely prescribe, administer, record and store medicines.
• The ward was clean, well equipped, well furnished, well maintained and fit for purpose.

However:

• some unsafe items were found within the ward garden areas.

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.

We reviewed incidents and saw that staff knew what incidents to report and that the managers reviewed them. We attended a ward meeting where a safety incident was discussed and saw that the care plan was updated afterwards. Managers reviewed incidents and identified any actions that needed to be completed to prevent similar incidents happening again. Managers told us that staff used a tracking document to ensure they had completed all necessary actions.

There was evidence that changes had been made because of feedback. For example, managers increased the number of staff debriefs; introduced talking therapy to reduce the amount of physical restraint used; used CCTV for investigations which had identified that young people had been sharing unsafe items; and leave was monitored and adjusted when approaching discharge dates. However, staff received information from a parent about a young person being likely to abscond from the garden. Despite a risk assessment being completed and extra measures put in place, the young person absconded from the garden area.

We reviewed two serious incidents and saw that the staff team had updated the young people’s risk assessments and changed some of their procedures to reduce risk.

Managers reviewed incidents and were supported by trust teams with specialist skills. For example, incidents where young people needed to be supported by staff using restraint holds were reviewed by restraint training staff, who issued recommendations if necessary.

Managers held staff debriefs at the end of shifts or as soon as possible after an incident. Senior staff shared learning from the debriefs at shift handovers.

Staff understood the duty of candour (a legal requirement for providers of health services to be open and honest when things go wrong with care and treatment). They explained things clearly and gave young people and families a full explanation if things went wrong.

Young people received feedback after incidents had been reviewed.

We viewed care and treatment records and saw they were detailed and contained relevant information. The trust’s referral and admission processes ensured that all essential information about the young people was received and recorded. For example, staff involved social workers to ensure young people had continuity of safe care. Staff planned and worked early with the young people and teams to focus on an expected discharge date and the treatment goals needed to meet it. The ward had a transitions team to help plan and support young people after discharge.

Staff we spoke to were confident that they could seek support from each other and had the opportunity to discuss complex clinical matters at complex case panel meetings.

The service worked with young people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving young people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff knew how to identify and report incidents where someone could be at risk of, or suffering, significant harm. This included working in partnership with other agencies. A social worker worked alongside staff and met with external professionals when needed.

Staff and managers told us they were focused on reducing restraint and we saw that ward managers had reviewed all restrictive rules and blanket restrictions.

Staff followed safe procedures for families visiting the service. Some young people had court restrictions on who could visit or whether they needed to be supervised during visits. Staff had included this information in the care and treatment plans.

Mental Capacity Act

We reviewed staff training records. On the day of inspection, 84% of staff had received training in the Mental Capacity Act. Staff we spoke to had a good understanding of the Mental Capacity Act, particularly the 5 statutory principles. Staff knew where to get advice from within the trust about the Mental Capacity Act.

We reviewed care and treatment plans and saw that staff had assessed and recorded the young persons’ capacity to consent to treatment decisions appropriately. When young people lacked capacity, we saw staff made decisions in their best interests and recognised the importance of individual wishes, feelings, culture and history. They did this on a decision-specific basis and involved young people who knew the young person were appropriate.

We spoke to staff who knew and explained Gillick competence (a test in medical law to decide whether a child of 16 years or younger, is competent to consent to medical examination or treatment).

There had been no applications made in the last 12 months, to protect young people without capacity to make decisions about their own care.

Staff involved young people and their families in creating their risk assessment and planning their care and how to cope in crisis. Each young person had a named key nurse to help plan and lead their care. Staff kept an information folder in the office for easy access to key information about the young person’s care and treatment. The young people contributed to the design of their own information folders. The young people had copies of these folders in their rooms if they wanted them.

Staff and young people told us that they felt more engaged with their care and treatment because they had been involved in planning it. Staff provided care plans and information folders in a format the young people could understand. For example, easy read.

Staff told us there was a culture and practice of keeping young people safe by talking to them and following the crisis management plans. Young people received talking therapy and staff were trained to support this. Young people told us they felt safe, protected and respected.

We observed a weekly ward care review and saw that the young people were able to contribute in writing, in person or through staff. We saw that staff valued the young person’s information and opinions. We viewed 5 care and treatment plans and saw that staff had recorded the views of the young people and their family. We saw that risk assessments and care plans were recorded comprehensively. Staff were told about changes to care plans in ward meetings and handovers.

This meant staff really knew the young people’s wants and needs and could tailor their care accordingly.

We saw evidence that the trust and managers had recently reviewed all ward rules that may restrict young people’s choices or freedom. Young people were involved in discussions with staff about whether blanket rules continued to be appropriate or whether they needed to be reconsidered. Sixteen blanket rules were recently removed following discussions between staff and young people. Rules that had been amended included: no kitchen access past 10.30pm; ground leave not being arranged before the first weekly ward meeting; and a maximum number of young people being allowed in the garden.

Leaders regularly reviewed the use of restraint. Young people and families were involved in debriefs and sharing any learning themes. There was a clear and consistent culture of working to avoid restraint. The trust ensured staff had training to meet the individual risks of the young people. Staff recorded the young people’s opinions when making restraint plans.

In the 6 months leading up to November 2025: prone (face down) restraint was used an average of 2 times a month; face up restraint was used an average of 4 times month; and rapid tranquilisation was not used at all. The ward had a long-term segregation area that had been used for 2 young people on 2 occasions in the last 6 months, for a total of 4 days.The trust reviewed the use of restraint within the ward and had identified that the number of restraints was high due to incidents caused by a small number of young people. Actions were in place to monitor and reduce restrictive interventions for young people.

We found there were potentially unsafe items in the ward garden and segregation garden. We informed managers during our visit and these items were removed.

Staff completed a ligature risk assessment yearly. However, we identified a ligature point in the segregation area that had not been identified in the ligature assessment. This meant staff were not aware of the risk and how to safely manage it.

Staff reported that young people were sometimes admitted to the service whose risks of self-harm could not safely be managed at the service because of environmental risks. There was a separate segregation area where staff could care for people with high risks. If young people needed to be transferred to an alternative service for their needs to be met, staff reported delays due to lack of available placements. This increased the likelihood that staff may need to use restrictive interventions to manage incidents of distress. A new building was being commissioned next to the ward that should reduce these delays.

The ward doors had color-coded discs on them to remind staff and young people who could access these rooms, even if locked. Some doors did not have these. For example, the lounge door to the garden and a downstairs toilet, had no indicators on them. This meant young people were not visibly made aware that they could access those areas.

Garden lighting was provided near the building but there were areas nearer the fences that we saw appeared dimly lit when dark outside. Managers told us they were aware of this and were assessing whether more lighting was needed for these areas.

There were two emergency resuscitation kits. We did not see any signs that showed people where they were stored. We looked at the records when staff made daily equipment checks and saw they were incomplete. This meant the trust could not be assured that the equipment had always been available for use.

However, the ward layout allowed staff to observe corridors in the ward. Records were viewed that showed staff regularly checked all other areas of the ward to make sure they were safe. Young people told us they were safe and protected on the ward.

The ward had one bedroom corridor with 10 bedrooms, occupied by male and female young people. We saw that a staff member is always present in the bedroom corridor to ensure young people are always kept safe.

All staff used security fobs and keys. Staff had easy access to alarms and young people had easy access to staff call bells in the bedrooms. Young people said they rarely needed to use them.

Managers had calculated the number and type of staff required to provide safe and effective care for the young people. On the day of the inspection, we saw the ward was staffed appropriately. The ward manager could adjust staffing levels to take account of the needs of the young people. When necessary, bank and agency staff were used to maintain safe staffing levels. When temporary staff were used, they received an induction and were familiar with the ward.

We observed that a qualified nurse was always present in the communal area of the ward. There were sufficient staff to carry out risk interventions safely, for example, observations, restraint and seclusion and staff had been trained to do so.

There was medical cover day and night and a doctor could attend the ward in an emergency.

We viewed training records and saw 97% of staff had completed their mandatory training courses. This included safeguarding training. Managers showed us how they monitored training records and ensured any delayed training was completed quickly.

However, some staff told us they would like more induction training to help when they were new to the ward and on techniques they could use to verbally de-fuse unsafe situations.

Some young people told us activities had been cancelled because of staff shortages.

We saw that the ward areas were clean, had good condition furnishings, were decorated and well-maintained.
There was a ward cleaner. We viewed cleaning records which showed the ward areas were cleaned regularly.
 

We inspected the clinic room and found it to be well-organised and clean. We checked medical and safety equipment and saw it was in good working condition and that it had been checked by the trust.

We viewed care and treatment and other records that showed evidence of appropriate medicine management. Staff get up to date information from the electronic system that prompted when medicine needed to be administered. Reports could be used to check for any missed or high doses.

Young people were involved in medicine decisions and understood why they were taking them. Staff reviewed the effects of medicine on young people’s health.

Medicine was reviewed weekly in ward round meetings and could be adjusted remotely by the doctors if needed.

Staff told us they were clear about assessing the right medicine treatment and could seek additional support if they needed it. Staff described the ward team as having an open culture that provided a collaborative focus to discuss and find the best treatment options.