Chesterfield Royal Hospital 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

Safe - This means we looked for evidence that children and young people were protected from abuse and avoidable harm. At this assessment we rated this key question Good. This meant children and young people using services were protected by a consistent and effective approach to safeguarding, whilst positive risk-taking was promoted to support independence and recovery. Children and young people were fully involved, and the service was open and transparent when things went wrong.

The environments we visited were safe, clean, well equipped, well maintained, and fit for purpose. Staff assessed and managed risks to children, young people and themselves effectively and understood how to protect people from abuse. Staff worked effectively with other agencies to safeguard children and young people. Staff used systems and processes to safely prescribe medicines, and they managed patient safety incidents appropriately to support ongoing care, support and recovery.

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.

Description: 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.

We scored the service as 3. The evidence showed a good standard of care.

Staff were proactive and had a consistent approach to safety and learning. Staff reported all incidents including near misses, and any alleged incidents through an electronic incident reporting system. Anyone who witnessed an incident completed an incident report promptly, and staff confirmed this occurred consistently.

Learning from incidents were regularly discussed during team meetings and handovers and reviewed through clinical governance processes. Staff gave examples of learning following safeguarding concerns. For example, incidents of risk-taking behaviours in the community, which led to collaborative working with external partners to support the young person to maintain their safety. One staff member told us, “We always learn lessons from incidents, and always have incident reviews and debriefs. Learning is shared across our teams, and it helps us to keep driving for improvement.”

Staff felt confident, and safe to raise concerns and participated in regular debriefs following incidents. Children, young people, parents and carers were supported through debriefs when required. Staff also attended regular incident, and risk overview meetings. This resulted in practical improvements in risk monitoring and management, ensuring children and young people’s safety whilst promoting independence and personal treatment and recovery goals.

Description: We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between different services.

We scored the service as 3. The evidence showed a good standard of care.

Children, young people, parents and carers felt supported and reassured during the referral, starting treatment and discharge processes, which helped to reduce anxiety during times of change. Staff gave children and young people information about what to expect from their care and treatment in a variety of formats to suit their individual communication needs.

Staff understood the importance of robust referral processes, as this ensured the referred child or young person was appropriate for the service and their needs could be met. Leaders promoted the importance of early planning and communication across teams.

Discharge planning involved co-ordination between services. For example, local authority social care teams and young adult services (YAS) to ensure safe and supported transitions and ongoing care and support. Staff were focused on achieving discharges in a timely manner wherever possible, and communication during transitions was effective.

The service worked collaboratively across their teams and with external organisations to improve access and transitions between services. Staff supported access to post-discharge support, including community crisis teams. Staff managed safety during transition to and from the service well which effectively promoted recovery and ongoing support.

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.

We scored the service as 3. The evidence showed a good standard of care.

Children and young people felt safe, as staff worked with them effectively to understand what being safe meant for each individual person and the best way to achieve this. Staff focused on improving children and young people’s lives and supported them in their right to live free from abuse, discrimination and avoidable harm.

Staff raised safeguarding concerns promptly. The service had an organisational safeguarding team who offered advice, and support when required. One young person told us, “I feel safe, my workers always available. It took me quite a while to trust them, but now I do and I know that they’re there for me.”

Staff completed mandatory safeguarding training and understood what to report, how to report and how to escalate concerns. They protected children and young people from avoidable harm and discrimination, including those with protected characteristics under the Equality Act 2010. Staff identified children and young people at risk and worked effectively with external agencies and partners, such as social workers, the local authority safeguarding team and education providers when required.

Leaders ensured staff had the knowledge, support, and confidence to act appropriately and promptly to safeguard the children and young people they cared for. Staff across the service had monthly safeguarding supervision meetings. One staff member told us “We work very closely with the local authority and education providers. We also have a service level information sharing agreement with external partners. Keeping children and young people safe is our priority.”

The service had effective safeguarding systems, policies, and procedures that upheld children and young people’s human rights and promoted a culture of safety. There had been 2 safeguarding referrals made in the 3 months prior to our visit. The concerns had been thoroughly investigated with the involvement and support of the appropriate professionals.

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.

We scored the service as 3. The evidence showed a good standard of care.

Children, young people, parents and carers were involved in discussions about risk and appreciated how staff maintained safety whilst promoting autonomy and recovery.

Staff worked with children, young people, parents and carers to understand and manage risks; risk assessments were completed promptly and used recognised tools, such as, the functional analysis of care environments (FACE). We reviewed 8 risk management plans and found they were person-centred, with child, young person, parent and carer involvement and were reviewed in line with organisational policy.

Staff built meaningful therapeutic relationships with children and young people which enabled them to anticipate and attempt to de-escalate any potential incidents promptly. Staff completed risk assessments when children and young people engaged in one to one or group therapies and activities to ensure safety while promoting engagement. Children, young people, parents and carers were involved in developing and reviewing care, crisis, safety and risk plans and participated in multidisciplinary team meetings (MDT).

Staff adapted communication methods to ensure children and young people understood their care and treatment. Staff fostered a culture of involvement and co-production when formulating care, safety and crisis plans.

Description: We detect and control potential risks in the care environment and make sure that the equipment, facilities and technology support the delivery of safe care.

We scored the service as 3. The evidence showed a good standard of care.

Facilities, equipment, and technology supported staff to deliver safe and effective care, and treatment. Staff considered how environments could keep children and young people safe from psychological harm as well as physical harm, including attention to sexual safety and sensory needs.

Staff maintained clean and well-equipped environments that promoted and supported the safe delivery of care. Equipment was audited, maintained, stored securely and used appropriately.

Staff across the sites we visited completed regular safety checks of their environments. Service safety leads also completed a monthly safety audit, which ensured there were no unidentified risks. Any concerns identified were fed back at daily meetings and addressed promptly by the organisation’s maintenance and facilities department.

Staff carried personal alarms, and GPS tracking technology which supported safer community visits. Children, young people, parents and carers had access to staff call systems throughout the environments across the service to ensure they could request assistance, or support if required when attending site based appointments.

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.

We scored the service as 3. The evidence showed a good standard of care.

Children, young people, parents and carers felt safe and supported by staff. They described staff as well-trained, attentive, responsive, and professional.

Leaders maintained safe and effective staffing levels to deliver person-centred care. The service had a daily duty worker system, duty workers effectively covered appointments if a child or young person’s worker were unavailable, the system ensured consistent and meaningful engagement was available on a regular basis.

Staff were safely recruited. The appropriate employment checks were completed prior to staff starting work. The service maintained adequate medical cover day and night, with an urgent care team and an on-call psychiatrist available outside of usual working hours, who were able to respond promptly in cases of emergency.

Staff achieved 86% compliance with mandatory training and 90% compliance with appraisals. Training was tailored to staffs development needs, including recovery-focused and trauma informed approaches, crisis, safety planning and risk management. Monthly bite sized topical training packages were also promoted. All staff completed a comprehensive induction. Staff had regular structured supervision, and managers addressed poor performance appropriately. Staff accessed regular breaks, and rest periods.

Leaders supported staff to further develop skills and knowledge. For example, a band 5 development and talent management programme, which ensured competency and effective delivery of care. Policies and guidance supported the supervision process and promoted professional development.

Description: We assess and manage the risk of infection, detect and control the risk of it spreading and share any concerns with appropriate agencies promptly.

We scored the service as 3. The evidence showed a good standard of care.

Children, young people, parents and carers felt confident in the infection prevention and control (IPC) measures in place and were assured that staff were taking the appropriate precautions to protect them from the risk of infection.

Staff adhered to infection prevention and control principles and consistently followed handwashing protocols, used personal protective equipment (PPE) when required, and cleaned equipment in line with guidance. We observed all environments to be clean and well-maintained. Cleaning records evidenced areas were cleaned regularly. Staff followed the appropriate handwashing and infection control procedures and had a clear understanding of their roles in maintaining a clean and safe environment. Hand cleansing facilities were situated throughout the services we visited.

Infection, prevention and control procedures aligned with current national guidance. Infection control audits were conducted regularly, and concerns were addressed. Identified risks were shared appropriately with external agencies, staff, children, young people, parents, carers and visitors to the service. Staff had an infection, prevention and control team for advice, and support. There were clear roles and responsibilities for infection prevention and control, and staff received ongoing training in line with best practice guidance.

Description: We make sure that medicines and treatments are safe and meet people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen.

We scored the service as 3. The evidence showed a good standard of care.

Staff explained medicines clearly to children and young people who were prescribed them, which ensured that they felt safe, informed, involved and supported in decisions about their treatment. Staff actively supported understanding and promoted choice, encouraging children, young people, parents and carers to take responsibility for managing their medicines safely.

Medicines were managed and prescribed in a safe and effective way, and staff had the appropriate equipment to routinely monitor the physical health of children and young people at their 1 2 1 appointments and home visits if they were prescribed medicines. Staff completed medicines reconciliation and maintained up-to-date records to ensure continuity of care when children or young people were discharged or transitioned between services.

Medicines were prescribed by the responsible clinician, specialist GP partners and advanced nurse practitioners and were regularly reviewed in multi-disciplinary meetings. Children and young people were involved in decisions about their medicines wherever possible with preferences and capacity documented in their care records. Staff and GP partners monitored the effects of medicines on physical health.