Avon and Wiltshire Mental Health Partnership NHS 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 people were protected from abuse and avoidable harm.

At our last assessment we rated this key question Requires Improvement At this assessment the rating has changed to Good

Good: All clinical settings were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Staff assessed and managed risks to patients and themselves well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used systems and processes to safely prescribe, administer, record and store medicines. The service managed patient safety incidents well.

We rated this key question good because:

• Young people on the waiting list had access to 24-hour crisis support.
• Staff were trained in safeguarding adults and children, and made appropriate safeguarding referrals.
• The young people had up to date risk assessments with crisis plans in place.
• The service actively sought feedback from the young people and their families.
• The teams had low staff vacancy and sickness rates.

However:

• Staff had not recorded actions they would take on the electronic recording system following incidents.
• Staff did not always document capacity assessments to demonstrate if a young person could consent to their treatment or not.

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.

In the 12 months prior to our inspection there had been 3 serious incidents across the teams. Staff offered support to young people and their families following a serious incident and looked for any learning to stop the incident happening again.

All staff we spoke to knew how to raise an incident using the electronic incident reporting system. Senior managers told us that CAMHS community teams had not always reported all incidents that should have been reported in the past, but they had done work with the service to improve this. This included training for staff to help them recognise different types of incidents that needed reporting. Managers reviewed incidents with staff to make sure incidents were correctly reported. We saw that staff did not always document actions needed following an incident in the electronic system. Managers had developed a spreadsheet to track actions but this was not in use.

There was a process in place to ensure staff received feedback following incidents. The electronic incident recording system allowed managers to send email feedback to the staff member completing the form. There was a monthly CAMHS Safety, Effectiveness, Experience Oversight Group that reviewed and gave feedback regarding compliments, complaints and incidents. Managers ensured that staff had opportunities to discuss incidents both as a group and in individual supervision. Staff invited the trust’s safeguarding team to all incident review meetings, to help them identify any safeguarding issues.

When young people were referred to the service the team assessed them to ensure the referral was appropriate and that the service could meet their identified needs. The staff contacted all appropriate services to collect all relevant information needed to meet the young person’s needs.

The service communicated with other services involved with the young people to ensure they received consistent care. For example, the provider invited staff from social care teams, when appropriate, to discharge meetings.

When a young person was placed on a waiting list staff gave them access to the duty team and out of hours crisis team. They could access these teams if they needed support, before staff assigned them to a caseload. Staff checked on young people on the waiting list at regular agreed intervals to see if their needs had changed or their risk had increased. This was an improvement since our last inspection and meant that staff could now respond to a young person whose mental health was deteriorating quicker.

The trust trained staff in safeguarding both adults and children from level 1 to 3. At the time of the inspection 94% of staff were up to date with the training. Staff we spoke to could give examples of the sort of issues they would refer to the local safeguarding team. There was a designated lead professional for safeguarding who staff could contact if they were unsure whether they needed to refer an issue to safeguarding. Staff knew who this was and explained that they would attend meetings if requested.

There were regular safeguarding meetings to discuss any concerns or referrals the teams had made. The North Somerset Team had not had a safeguarding meeting for 2 weeks as the manager had not been available.

Staff could explain how they would identify safeguarding issues for both adults and children, particularly people with protected characteristics under the Equality Act.

Mental Capacity Act

All staff received training in the Mental Capacity Act. At the time of the inspection 89% were up to date with Mental Capacity Act training. Staff could explain the guiding principles of the Mental Capacity Act and when the Gillick Competencies rule applied.

The trust had a policy on the Mental Capacity Act and staff knew where to get support when needed. Staff worked with young people and their families to help the young people make decisions. Staff would assess a young person’s capacity to make decisions and if they lacked capacity, would work with them and their families to make decisions in their best interest. We saw in all 14 of the care records we reviewed and during all both the episodes of care we observed that staff always gained consent from the young people for their treatment and that this was recorded in their notes. However, although we saw that staff considered the capacity they had only recorded this in 5 of the 14 records we reviewed.

We reviewed 9 care records and saw that all young people had a risk assessment which staff reviewed regularly. Eight of the 9 records we reviewed contained a crisis management plan. Staff had discharged the young person without a crisis plan before the plan was finalised and we saw that there had been some crisis planning with a parent. We spoke to 8 parents of young people and asked if they had a risk assessment in place and got a mixed response. Five told us that the young person had a risk assessment and they had been involved in developing it, 3 told us they did not have a risk assessment in place.

Young people and carers were able to give feedback about their experience of using the service. The provider actively sought feedback and collected it online and on paper. There were posters encouraging people to give feedback and they had QR codes for people to scan and leave feedback.

The locations we inspected were clean and tidy and in a good state of repair. Staff completed regular audits of the environment to identify any issues and address them if needed. At the South Gloucestershire team, the consulting rooms had been designed with input from young people to be a comfortable as possible. For example, the young people had identified the ticking of the clocks as a distraction, so staff replaced them with silent clocks. However, we noticed some furniture was damaged and in need of repair. We advised the staff who told us new furniture was on order. The provider had recently refurbished the consulting rooms at the North Somerset team, and they were modern and comfortable. The provider had not refurbished the consulting rooms at North Bristol and therefore the rooms were not as calming as the other locations. For example, they still had clocks that ticked loudly.

The clinic rooms at South Gloucestershire and North Somerset were clean and tidy and fully equipped. In North Bristol the clinic room was untidy, and some medical devices did not have clean stickers on them. There was no clinical waste bin and the examination couch was ripped. The defibrillator was in the building next door with no sign advising staff of this. We told senior staff about this, and they told us this would be addressed.

The teams employed the range and number of clinicians expected to be employed at this type of service. This included psychologists, psychiatrists, nurses, social workers, occupational therapists and drama, music and art therapists.

At the time of this inspection the average vacancy rate across the 3 teams was 1% with the highest vacancy rate in the North Somerset Team which was 8.7% higher than the NHS national vacancy rate of 6%. Senior managers told us that the vacancy rate for the North Somerset team had improved over the past 12 months. The sickness rate for the 3 teams was 5%, which was lower than the NHS average of 6%. The average turnover rate of the 3 teams we visited was 6% which was better than the NHS average of 10%. Managers told us that the retention of staff had improved over the last 12 months and most leavers were moving on for positive reason such as promotions.

Most staff were permanently employed but the service would deploy bank staff when required and employed locum psychiatrists. Managers told us that the bank and locum staff had experience in CAMHS and knew the young people they worked with.

Staff across the 3 teams were 94% compliant with statutory and Mandatory training.

Housekeeping staff cleaned the team bases daily and the trust audited cleaning to ensure it was of the agreed standard. We saw that equipment had clean stickers on which were in date.

Staff cleaned toys weekly and kept a record of this. However, there was no record of cleaning items in-between use. We discussed this with managers and the trust sent us a copy of a new cleaning procedure that included cleaning items between use and removing them from use until they were cleaned.

Staff received training in infection prevention and control and at the time of the inspection 94% of staff had completed the training.

None of the three locations we visited stored medicines on site.

The teams had an arrangement with a local NHS hospital to undertake blood tests and ongoing physical health monitoring related to medication prescribing.

Prescribing staff stayed up to date with national guidance to make sure they followed best practice when prescribing medicines.