Humber Teaching NHS Foundation Trust

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• 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 key question has been rated as good. During this inspection we looked for evidence that people were protected from abuse and avoidable harm. We found that people were safe and protected from avoidable harm. The ward provided a therapeutic and safe environment for young people. There were processes and pathways to ensure timely and effective discharges. Staff involved young people and their relatives in developing and reviewing their care plans and risk assessments.

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.

There were clear policies around learning and staff development in place. There were separate policies for substantial, bank and agency staff in place. Managers had recently completed a review of organisational policies. Staff told us that they were encouraged to learn and develop in their roles, with some staff completing trainee nursing apprenticeships. Staff told us that they had opportunities to attend multi-disciplinary meetings and register interest in specific area’s of learning such as psychology. Staff and managers had good oversight of incidents within the service. We reviewed a sample of incidents and saw that staff knew what to report and how to report them. Staff received feedback from investigations of incidents. Staff met regularly to discuss incidents during handover/ team meetings. There was evidence that staff and leaders complied with duty of candour when reporting incidents and lessons learned. Young people told us that they knew how to raise complaints or concerns to staff. There were also posters around the ward detailing how to do so.

There were clear referral processes and procedures in place. Discharge planning was discussed weekly in multi-disciplinary meetings which were attended by a range of individuals involved with the young person’s care. Young people were encouraged to attend these in person or via video call. Care records demonstrated young people and family involvement in treatment pathways. Young people were supported to have a phased discharge and to visit potential placements and get to know staff. Systems and timetables were in place to ensure education remained consistent whilst young people were in hospital. Staff discussed discharge planning with young people regularly. This included developing discharge goals and reviewing home based treatments options. The service had links with external services including the paediatric assessment unit which offered advice prior to admission. There was a pathway in place for people to access emergency treatment at the local general hospital where appropriate. There were systems in place to oversee the transition of young people to adult services. Relatives and carers gave positive feedback around transitions home and the discharge process. The internal social worker identified needs for discharge and involvement in planning this with young people.

Safeguarding adults training compliance was 100%. The trust target is 85%. Not all staff were up to date with safeguarding children training and training compliance was 75%. However, 5 staff were booked onto this training and a further 3 staff were awaiting allocation. Staff could give examples of how to protect people from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff were 100% compliant with Prevent training which offers an introduction to the Prevent duty, explaining how it aims to safeguard vulnerable people from being radicalised to supporting terrorism or becoming terrorists themselves. Staff knew how to identify adults and children at risk of, or suffering, significant harm and how to raise concerns. This included working in partnership with other agencies. There were clear policies and governance around restraint, restrictive practice and blanket restrictions. There was appropriate guidance for staff around domestic violence, and managing concerns against people in trusted positions and staff were aware how to access these policies. Young people told us they felt safe to raise concerns to staff and were given the opportunity to do so during meetings and one to one engagement. There were monthly safeguarding meetings in place which were attended by the multidisciplinary team. Managers held daily safety huddles which were attended by the safeguarding lead/ a member of the safeguarding team. The ward used PSIRF to inform after action reviews and the patient safety team have attended team meetings to explain to staff their role.

We spoke with 3 young people, 5 relatives and 6 members of staff. Young people told us they felt safe, and that staff knew how to support them during times of distress. Staff involved young people and their relatives and carers in creating care plans and risk assessments. The service worked closely with partner organisations to manage risk through multidisciplinary meetings, which were attended by staff, external teams, the young person and their relatives. Staff used the least restrictive option when supporting young people and documented positive risk taking in care plans. Staff developed positive behaviour support plans within 72 hours of admission in collaboration with young people and carers. Carers told us they felt young people were safe and well looked after. Young people were assessed and reviewed by staff from different disciplines including, occupational therapy, physiotherapy, and dietetics. Young people were also referred to speech and language therapy, where appropriate. The care plans we viewed were up to date and had been regularly reviewed. Overall, we found that incidents were recorded well. Young people told us that safety pods were used rather than any other form of restraint as per DMI policy and clinical guidance. Individual risk assessments were in place regarding items that could be in the bedroom.

The ward was welcoming, clean and well-staffed. Staff told us this had been decorated in collaboration with young people. It offered a range of therapeutic spaces, including quiet rooms, activity rooms, a large communal area and an outdoor space. The ward had anti-ligature and anti- barricade furniture. There were up to date environmental risk assessments in place which managers regularly reviewed and updated. The risk assessments clearly highlighted areas of risk on the ward and appropriate mitigations that were in place to help reduce the risk level. There was an up-to-date fire safety policy in place and maintenance staff carried out appropriate testing of appliances and equipment to ensure safety of equipment on the ward. Young people and carers told us the ward felt safe and that the environment was suitable for their needs. There was enough staff to keep people safe and complete therapeutic engagement observations. All staff were fully compliant with disengagement and managing interventions training (DMI). All staff were trained to respond to incidents to keep people safe. Medicines were stored safely within the clinic in a locked cupboard. There was a pharmacy team on site within the trust who ordered and monitored all medicine for the service. Staff checked controlled drugs weekly and maintained electronic records of these. Risks within the environment were managed well with the use of closed-circuit television (CCTV) and observations to manage individual risks. A ward tour and check of the environment and equipment was carried out during our inspection. Wfound that fire extinguishers were safely contained and could only be accessed by staff. We carried out a check of the clinic room environment and emergency bag, and we found no concerns with this equipment or audit process. There was a separate room available for Nasogastric Tube feeds and other treatments. Staff had access to a range of equipment to support young people.

We spoke with young people, staff and leaders who told us they felt safe on the ward with familiar staff, felt supported to increase numbers to suite the needs of the ward and that it was a good place to work. We reviewed staffing rotas for the previous 3 month leading up to this inspection which showed that baseline staffing numbers were always met and the ward was rarely short staffed. Managers reviewed staffing levels daily and there was a weekly safer staffing meeting to review staffing levels against ward occupancy and patient acuity. When staffing levels needed increasing, managers escalated this in line with policy and actioned this appropriately. The ward rarely used bank and agency staff. Data provided by the service showed only 31% of shifts had used bank/ agency staff during the previous 6-month period. Reasons for staff shortages included sickness and maternity leave. Young people had access to social workers and there were strong working relationships with the local authority. We completed a Short Observational Framework for Inspection (SOFI) as part of the inspection. This is a framework for directly observing and reporting on the quality of care experienced by people who may not be able to describe this themselves. We observed 5 interactions between staff and people. 4 interactions were positive, and 1 interaction was reported as neutral, with 0 negative interactions. We observed staff treating people with kindness/compassion etc. Staff gave reassurance to people when they needed it. Staff had a good understanding of each other’s strengths and how this could benefit the young people. Young people told us that they always had staff to speak to and complete activities with. Young people told us that the staff were familiar and spent time getting to know them.

The ward was well maintained, tidy and cleaned. There were domestic staff present during our inspection who were responsible for cleaning and house keeping duties. Cleaning records were up to date. Managers completed quarterly reports which included an audit of cleaning records and infection prevention control reports from the service Matron. The most recent available performance reports showed that there were no outbreaks or increased incidence of communicable disease. There were some gaps identified in the December 2024 audit where infection prevention and control training was 82%, however an action plan was in place to complete competencies with new staff members for hand hygiene and personal protective equipment (PPE). A staff member delivered training on hand hygiene for young people and staff to support the reduction of transmission of bacteria. We inspected the clinic room and found it to be well maintained and clean, with all equipment cleaned. Staff completed fridge and room temperature checks in line with policy.

The ward stored medicines records electronically and completed regular audits of medicines stock to identify any shortages. There were processes in place which staff followed to check medicines orders on arrival. Staff completed monthly invoice summaries highlighting any medicines outliers. This included medicine that was rarely prescribed or larger quantities of medicine than usual.