Archived: South Essex Partnership University NHS Foundation Trust

Updated 19 November 2015

We rated South Essex Partnership University NHS Foundation Trust as good overall because:

• Services were effective, responsive and caring. Where concerns had arisen the board had taken urgent action to address areas of improvement.
• The board and senior management had a vision with strategic objectives in place and staff felt engaged in the improvement agenda of the trust. Performance improvement tools and governance structures were in place and had brought about improvement to practices.
• Morale was found to be good in most areas and most staff felt supported by local and senior management. There was effective team working and staff felt supported by this.
• Staff treated people who used the service with respect, listened to them and were compassionate. They showed a good understanding of people’s individual needs.
• Admission assessment processes and care plans, including for physical healthcare, were good.
• A good range of information was available for people and the trust was meeting the cultural, spiritual and individual needs of patients.
• The inpatient environments were conducive for mental health care and recovery and the bed management system within inpatient services was effective.
• Services were using evidence based models of treatment and made reference to National Institute for Health and Care Excellence (NICE) guidelines.
• The trust had an increasingly good track record on safety in the previous 12 months. Effective incident, safeguarding and whistleblowing procedures were in place. Staff felt confident to report issues of concern. Learning from events was noted across the trust.
• A formal complaints process was in place and well implemented. However, some informal complaints were not routinely captured and recorded.
• There was a commitment to quality improvement and innovation.

However:

• The trust had undertaken significant work required under the Department of Health’s ‘Positive and Proactive Care: reducing the need for restrictive interventions’ agenda. However, we had concerns about restrictive practice and seclusion across the trust.
• Clinical risk assessment was variable in some services.

• On the majority of wards there were clear arrangements for ensuring that there was single sex accommodation. However, there was a breach of the eliminating mixed sex accommodation guidance during our inspection. This was addressed immediately by the trust.

• Generally medicines management was effective and pharmacy was embedded into ward practice. However, some teams in the community adult mental health and crisis services did not have appropriate arrangements for the storage and transportation of medications.
• Not all patients had timely access to psychological therapies.
• Improvement was needed to procedures for consent to treatment.

Updated 19 November 2015

We gave an overall rating for community health services for adults as good because:

• Staff were identifying and monitoring potential and actual risks to people who were using these services. They were reporting and learning from incidents and monitoring service provision to keep people safe.
• We found evidence of innovative practices in staff training programmes to improve recognition of malnutrition and pressure ulcers within care home settings. Proven results in the “PUFFIN” (pressure ulcer food first initiative) programme had improved people’s quality of care by lessening incidents and the risk of people forming pressure ulcers. There was excellent multidisciplinary team working across each location inspected.
• People who used the service were well cared for and treated with dignity and respect by all staff. Individual feedback forms showed that 98% of people who used this service would be likely or extremely likely to recommend this service to their friends and family. Patients, families and carers were complimentary about the service they received.
• There were minimal waiting times for people across these services with most having access to services the same day. Referral times for assessments and treatment for example musculoskeletal physiotherapy and podiatry were up to 15 weeks. This was within the parameters set by the commissioners of this service and within national guidelines. There was good access to individual services and integration of care with primary care services. There were clear examples of where service changes and improvements had been implemented as a result of trust wide learning from individual complaints and concerns.
• These services had a clear trust wide vision and strategy. We found a positive culture from the trust, local management and staff. There was published innovative practices being disseminated throughout the trust to improve care and treatment practices for patients.

Updated 19 November 2015

We gave an overall rating for community health services for children young people and families as good because:

• All staff showed in depth understanding of safeguarding. There were clear policies and procedures in place which included working with external agencies. A number of children were on protection plans across the service and we saw robust procedures in place to ensure these plans were followed. Governance systems were in place to ensure proper management of medicines. Records we looked at were detailed and evidenced up to date care plans. Evidence was seen of parents being involved in decisions about the care and treatment of their child. Infection control procedures were being followed. There was an individual risk assessment for all patients which was reviewed at least six monthly or at appointments, after incidents or safeguarding concerns.

• We reviewed both electronic and hand held care and treatment records. These were detailed and easy to understand. Outcomes of treatment were measured through education and health care plans which were recognised as good practice and audits were undertaken against the continuing healthcare framework and the healthy child programme.Staff training was completed for most staff. Staff were supported and supervised as per the trust policy. Where informal supervision was happening staff felt supported. There were clear processes for assessing new referrals to all services within the service. Referrals were managed effectively within each service. Staff used the electronic record system to record care interventions. We noted that staff obtained consent from young people or their parents for interventions. Consent to share confidential personal information was documented clearly with a date for review if appropriate.

• Staff showed a compassionate and supportive approach towards children and young people when delivering treatment and care. Young people’s dignity was preserved throughout the immunisation clinics and we witnessed children’s hygiene needs being managed with dignity. Staff were respectful of children’s confidentiality. Staff communicated effectively with children and young people to help them understand what was being asked of them and ensuring they understood their care. We saw that interpreting services were available and information was available in additional languages, staff showed empathy to the difficulties and emotional impact of deterioration in individual’s health.

• The most recent Friends and Family test survey resulted in a 100% recommendation rate for this service .The most recent NHS staff survey found that 75% of staff across the trust felt they were able to contribute towards improvements at work.

• The trust had developed effective working relationships with the local authority and other commissioners to assess and meet the needs of the local population. Clear pathways for treatment of complex conditions were in place. The services were based in child-friendly buildings and in locations which were easily accessible to members of the public. There was a patient and carer forum which was pro-actively involved in the planning and development of services for young people. The service was meeting their key performance indicators for referral to assessment times. Waiting lists were monitored through team meetings and managed through a triage system using a risk rating scale. Staff were aware of how to raise a complaint or concern. Lessons learnt from incidents were cascaded to staff through team meetings, monthly emails and group supervision sessions.

• Staff were complimentary and proud of the strength of their management locally and within the individual locations. There was a robust and detailed framework for auditing care provision within the services and this fed into team meetings across the service. There was strong local leadership within the service which was well regarded by all staff. The leaders of the services were visible and approachable and fostered supportive relationships not only within the individual teams but as a whole service.

However:

• There was a lack of a consistent approach with regards to staff receiving level 3 safeguarding training to ensure patients are kept safe and concerns identified are raised appropriately.
• There was no clear strategic future plan for children and young people’s services within the Trust.
• There was no evident clinical leadership for this core service at trust executive level.

Updated 19 November 2015

• The trust had seven dental clinics across South East and West Essex. Prior to the formation of this Trust, community dental services had been provided through a variety of Primary care trusts across the geographical area.
• Overall we found that community dental services were providing safe and effective dental care. Patients were protected from abuse and avoidable harm. Systems for identifying, investigating and learning from incidents were in place.

• Dental services were effective and focussed on the needs of patients and their oral health care. We observed good examples of effective collaborative working between staff to meet the needs of patients. The service was able to meet the needs of the patients who visited the clinics for dental treatment because of the flexible attitude of staff and the trust itself.

• Feedback from patients demonstrated their positive experiences of care. We saw good examples of dental treatments being provided with compassion and effective interactions between staff and patients. Staff were hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed how dedicated they were in what they did.

• The service was responsive. The trust actively sought the views of patients using a variety of means. People from all communities, who met the trust’s acceptance criteria, were able to access the service for dental care and treatment. Effective multidisciplinary team working ensured that patients were provided with dental treatment that met their needs and at the right time. Through effective management of resources, delays to treatment were kept to reasonable limits.

• The service was well-led. Organisational, governance and risk management structures were in place. The senior management team of the service were visible and the culture was seen as open and transparent. Staff were aware of the vision and way forward for the organisation and said that they generally felt well supported and that they could raise any concerns.

Updated 19 November 2015

We gave an overall rating for community health services for adult inpatients as good because:

• Each hospital had processes in place for reporting, investigating and monitoring incidents which caused harm to patients.

• Safety performance was monitored. Each hospital contributed information to the to the trust’s safety thermometer on the number of falls, pressure ulcers and urinary tract infections.

• Staff were aware of the trust’s incident reporting system and had been trained to use the trusts computerised incident reporting system. Managers were alerted to any incident reports submitted so that these could be investigated and followed up. Examples of changes in practice which had been implemented following the investigation of incidents and accidents were identified.

• Effective assessment and care planning processes were in place. Patient care was reviewed by multidisciplinary teams of medical, nursing, therapy and social care staff. Individual outcomes were monitored and compared.

• Staff were supervised and new staff completed a two week induction programme to familiarise them with their role.

• Each hospital had scored higher than the national average for cleanliness for community services in a patient led assessment of the care environment (PLACE). Three out of the four units scored higher than the national average for the condition, appearance and maintenance of the unit. The Archer unit scored 88% compared with the national average of 91% for similar services.

• Effective arrangements were in place for providing timely access to services. At Saffron Walden community hospital they aimed to admit patients before 10 am to enable them to settle in and adjust to their environment. The service at the Cumberlege centre aimed to admit new referrals within two hours of arrival on the unit.

• Staff spoke highly of the local managers who led the provision of services.

• The trust’s vision and strategy was clear and we saw examples of posters on display describing this for staff.

However:

• There was significant use of agency staff at Saffron Walden hospital, the Cumberlege centre and St Margaret’s hospital. The service relied on agency staff to cover for vacancies. Staff sickness rates were high at St Margaret’s and Saffron Walden hospitals with rates ranging from 8-12%.

• The trust did not carry out ongoing competency checks to ensure agency staff were competent to administer medication.

• There was limited or no access to medical staff with specialist knowledge about dementia. Advice from specialist mental health liaison staff was limited which meant that it was not always possible to provide people with the specialist support they required.
• Some staff working in these hospitals had not received the necessary skills and training to support patients with semi acute conditions and to care for people at the end of their life.

Updated 19 November 2015

We gave an overall rating for end of life care as good because:

• Staff were aware of the processes for reporting any incidents and there was a strong culture of learning from incidents and complaints to improve the quality of the service provided. They were fully aware of the safeguarding policies and procedures and could clearly tell us what they would do if they had any concerns.

• Targets had been met for staff attending mandatory training and staff reported there was good access to further training specific to their roles within the Trust. Staff were able to access external sources of training. We found current risk assessments in place for patients and that these were reviewed as required.

• Patients told us that their pain was under control. We noted that anticipatory drugs were prescribed to ensure pain relief was administered to patients in a timely manner. We did not observe any patients in pain during our inspection.

• Patients and relatives all reported that they found staff caring and supportive. Patients’ needs were looked at on an individual basis and the service showed us good examples of responsive care.

• The teams worked closely with other members of the multidisciplinary team in order to ensure patients receive timely access to services. We spoke with one relative who told us they had responded to their family member’s needs very quickly when increased pain became difficult to manage.

• Staff were very passionate about their roles and local leadership was good. Staff felt supported in their roles and could discuss any issues they had with senior leaders. Key performance indicators were monitored on a monthly basis which showed the teams were exceeding their targets in most areas. Where targets fell below expected measures, there were plans in place to review and discuss the issues.

However:

• New end of life care planning documentation to replace the Liverpool Care Pathway had been developed by the trust but had yet to be implemented fully across the teams.

• There was no consistent trust wide documentation system. For example, the trust’s assessment paperwork varied across the teams.

• The trust’s current ‘do not attempt cardio pulmonary resuscitation’ policy did not reflect national guidance.

• The trust did not have trust wide policies related to the care of a person following their death and for those deceased patients identified as having an infection. This was a potential health and safety risk for relatives, carers and staff.

• Front line staff had not received confirmation of death training.

• The trust did not have a current ‘end of life’ strategy.
• There was no evident clinical leadership for end of life care at executive level.

Updated 19 November 2015

We rated the service child and adolescent mental health wards as good overall because:

• Staff communicated in a caring and compassionate manner, allowing patients to express their needs, and had an understanding of individual need.
• The premises were fit for purpose and were well maintained. Poplar ward complied with guidance on same sex accommodation.

• A safer staffing model had been implemented and staffing numbers had increased due to ongoing recruitment.
• Risk assessments were fully completed, were linked to the care plans and were reviewed regularly.
• Staff were trained in safeguarding and showed us they knew how to make a safeguarding alert.
• Young people on Poplar ward were able to access psychological therapy regularly as recommended by NICE guidelines.
• The team was multi-disciplinary which meant that the team had a wide variety of skills and experience.
• Staff had access to monthly clinical and managerial supervision.
• The manager had a quality dashboard to gauge the performance of the team.

However:

• We found that some young people had been secluded in their bedrooms. The seclusions were not reported, recorded or reviewed as per the Mental Health Act code of practice.
• Some young people who were not detained under the Mental Health Act had been restrained by staff to maintain their safety. These incidents were reviewed weekly in the ward round.
• There were no care plans, records or reviews for the use of long term segregation as per the Mental Health Act code of practice.

• Consent was reviewed in the weekly ward round notes. However, we found that individual consent forms were not regularly updated.

Updated 19 November 2015

We rated the community mental health services for children and young people as good because:

• Waiting and interview rooms were clean and well maintained, cleaning records were up to date. Interview rooms were fitted with alarms at all locations inspected.

• Core staffing levels had been set by the trust. Currently the established levels of qualified nurses was 17 whole time equivalent (WTE). The current vacancies were 3.38 WTE.

• Caseloads were managed and reassessed regularly by manager. The average caseload for the service was 30 cases per care coordinator.

• Case records seen had risk assessments in place with plans identified to reduce the risk to the young person.They had been reviewed regularly and we found evidence of this documented in case notes.Parents were involved in the formulation of the risk assessments.

• There had been one serious incident in the last 12 months which was fully investigated. The outcomes of incidents were discussed in monthly governance meetings.

• Psychological interventions offered by the service were based upon NICE (National Institute for Health and Care Excellence) recommended therapies.

• The team had a full range of mental health disciplines required to care for young people. This meant that young people who used the service had access to a variety of skills and experience for support. All staff completed a trust and CAMHS specific induction when commencing their employment. Staff had access to monthly clinical and managerial supervision and had annual appraisals completed.

• We observed staff communicating in a caring and compassionate manner, allowing young people time to express their needs. Staff demonstrated that they had an understanding of the individual needs of the young people. Young people reported that they were involved in the writing and reviewing of their care plans. We found evidence in case notes that young people and their families were invited to meetings to discuss their care and this was reflected in their care plans.

• The service met the 18 week target for young people to start their treatment. The average waiting time from referral to assessment was 5.2 days and the waiting time from assessment to treatment was 9.7 days.

• Managers discussed the clinical risk registers in the monthly senior manager meeting. They were linked to the trust’s risk register.

• We saw evidence that staff were open and transparent and explained to young people and their families when something went wrong through the complaints process.

Updated 19 November 2015

We rated community learning disability services as good overall because:

• Safeguarding procedures were in place to protect people from potential abuse.
• Risk assessments were completed with people and plans were put in place to minimise risk to people who use the service.
• Staffing levels were good within the team. This mean that people had regular access to staff for support.
• Staff were up to date with mandatory training and were also able to access specialist training for their role.
• There were good working relationships with other agencies such as social services.
• The team had a variety of skills, experience and professional training. This meant that people were able to access support from people with a variety of skills and expertise.
• Staff worked with people who use the service in a caring and compassionate way.
• The service offered appointments to people at a variety of different times and at a variety of different locations to facilitate people attending appointments.
• Staff received regular supervision and appraisal from the management team.
• Incidents were reported and managed appropriately and there was a good system in place to share learning throughout the team.

However:

• People could wait up to two years for psychological interventions.
• Referrals to psychological interventions were managed by date. This meant that individual risk profile was not taken into consideration.
• Care plans did not always demonstrate that people were involved in the care planning process.
• There were delays in processing HR issues such as grievances and sickness management when they were handed over to managers outside of the team.

Updated 19 November 2015

We did not rate community-based mental health services for older people because we did not have sufficient evidence:

• The service operated safely, with adequate numbers of well trained staff, with a good understanding of safeguarding and the implementation of lone working policies and procedures.
• The people using the service had comprehensive holistic assessments, which demonstrated National Institute for Health and Care Excellence (NICE) guidance and best practice. People’s care plans were person centred.
• There was clear evidence of the monitoring of key performance indicators (KPIs), national audits and peer review to ensure outcome measures.
• The teams were appropriately skilled, knowledgeable and motivated to deliver care and treatment for their patients. With staff having undertaken or been offered opportunities to develop further skills such as nurse prescriber, advanced practitioner or nursing training.

• People using the service were treated with kindness, dignity and respect and staff made sure that patients were at the centre of their interactions.
• Referrals into the service were effectively managed and there were no waiting lists in respect of referrals and assessments.
• Line managers were responsive, praised highly by staff and understood their responsibilities.

• There were clear vision and values which staff understood.

• There was a culture of openness and honesty across the service.

However:

• Electronic care records systems and processes in place were insufficient to ensure that people’s care is managed safely. For example a female patient’s documents were scanned into a male patient’s care record. Scanned documents were not easy for staff to find. There was a delay in scanning pharmacy medication charts which impacted on accessibility for pharmacy staff. The trust were made aware of this and made improvements immediately.

Updated 19 November 2015

We rated mental health crisis services and health-based places of safety overall as good because:

• All clinic rooms seen were clean and environmental risk assessments and audits took place.
• CRHT and RAID patients had individualised risk assessments.
• Staff were trained in safeguarding and knew how to make a safeguarding alert and do this when appropriate.
• We found good patient safety protocols including lone working practice except at the places of safety.

• CRHT and RAID staff were able to explain how learning from incidents was shared with staff via team meetings.
• CRHT patients’ physical health needs were assessed and physical healthcare observations were routinely carried out for the first three days.

• Across all teams we found that assessments were completed quickly with urgent referrals being prioritised and assessed within one hour.
• Staff teams were aware of the specific needs of the patient they were supporting and discussed plans to address their care needs.

• Staff teams had a level of trained staff within their teams which enabled them to consider a range of psychosocial interventions such as cognitive behavioural therapy and brief solution focused therapy.

• Patients and carers were positive about the support they received and the ‘family and friends’ satisfaction survey April and May 2015 results reflected this.

• Patient and carers told us the CRHT staff were accessible and responsive and information was given to them as to whom to call when support was needed.

• A gatekeeping assessment report on A&E liaison and West RAID in 2014 showed that staff were effectively gatekeeping admission to hospital.
• The street triage team had led to a decrease in patients being brought by the police to a place of safety for assessment under section 136 MHA.

• Staff referred to various ways they could give feedback or raise concerns such as team meetings and ‘take it to the top’.
• Trust magazines and emails gave staff opportunities to keep up to date with trust developments and sharing good practice.
• Teams had staff champions to lead and monitor areas further for example on safeguarding and involving carers.
• Meetings took place with acute hospital and police staff to review trust interagency working.

• Both CRHTs had achieved home treatment accreditation scheme accreditation in 2015, a peer led review. East CRHT had achieved ‘excellent’ status.

However:

• Staff vacancies of 28% and cover for A&E liaison, GP crisis line and RAID meant that not all rotas were covered despite use of bank and agency staff who knew the service. Psychology staff support was limited for patients.
• One CRHT patient’s assessment had not been updated following self harm and two patients’ care plans were not completed. This posed a risk that patients may not receive the support they needed. Place of safety risk assessments were not robust and lacked detail across sites.
• Medicines management processes across CRHTs needed improvement relating to safe storage and records.
• Basildon Mental Health Unit place of safety was small and furnishings did not meet the Royal College of Psychiatrists’ 2011 national standards. The entrance was accessed by a busy car park and did not afford patients’ privacy or dignity when they were being brought by the police for assessment.

• CRHT and staff at the places of safety showed little understanding of the MCA and how it applied to their work. Gaps were identified in MHA training for four CRHT staff.

• In West CRHT complaints were resolved within the team and not recorded as a complaint which was against trust policy.

• The governance and leadership structure for the place of safety was not clear and effective as staff were from other wards. Forums such as unit meetings for reviewing issues were not robust as staff attendance could be poor.

Updated 19 November 2015

We rated wards for people with a learning disability as good because:

• Staff were trained in safeguarding and could explain safeguarding processes. This meant they were aware of how to protect people from potential abuse.
• Staff told us that they felt supported by the management team and received regular supervision.
• There was a multi-disciplinary team in place which meant that the team had a wide variety of skills and experience.
• Alternative therapies were being used such as therapy dogs and therapy ponies. This meant that people were able to access a variety of therapeutic interventions.
• Patients told us that they liked the staff and they were treated well.
• Staff demonstrated good knowledge of patients and interacted in a way that demonstrated they knew about individual’s preferences.
• The premises were fit for purpose and health and were well maintained.
• Incidents were reported appropriately and lessons were learned and shared amongst the team.

However:

• There was no psychological input commissioned for inpatient services. This meant that patients were unable to access regular psychotherapy sessions.
• There was evidence of restrictive interventions being used for a patient for example restricting them from going outside if they had not followed staff requests.
• Segregation and seclusion was being used in a behavioural plan as part of therapeutic intervention when a patient self-harmed.
• There were long delays in processing grievances and staffing issues.

Updated 19 November 2015

We rated forensic inpatient/secure units as good overall because:

• Generally services were delivered from modern, well designed and pleasant environments to live and work in.

• Nursing staff on the wards were very enthusiastic in their approach and patients spoke positively about them.

• Staffing levels were good although vacancies could be high meaning use of temporary staff.

• Patients were treated by a full multi-disciplinary team and patients had access to therapy, activities and good facilities.

• All admissions were planned following pre admission assessments and local risk assessments were carried out post admission.

• All patients had their physical healthcare needs met.

• Patients knew how to complain and were involved in the development of the service.

• The leadership on the wards was highly visible and had a positive presence on the ward.

• Each team had a full multi-disciplinary team in place.

  However:

• Seclusion and segregation was not always recorded and managed in line with the safeguards set out in the Mental Health Act code of practice.

• Although local risk assessment tools were completed the Historical Clinical Risk management -20 (HCR-20) was not completed and reviewed in line with good practice.

• At times there could be a lack of attendance of junior doctors at Brockfield House.

• Restraint, particularly prone restraint was high on Fuji ward.

Updated 19 November 2015

We rated wards for older people with mental health problems as Good because:

• Care and treatment was delivered in a person centred, kind, respectful and considerate way
• Patients and their carers told us that most staff treated them with kindness, dignity and respect. Patients and families told us they were satisfied with the care they received and most felt safe on the wards.
• Care Programme Approach and patient ward reviews were carried out in a timely manner. There were suitable care plans and risk assessments in place for patients which were reviewed regularly. Patients and their carers were involved as partners in care planning.
• There was a strong culture of staff managing complex patient behaviours effectively, only using medication when they needed to.
• There were strong links with the Mental Health Act administrator who was visible on the wards to support staff.
• The ward environments promoted dignity and well-being for patients and there was access to outdoor space.
• Patients had routine and regular contact with a range of health professionals to promote their physical health and well-being. Different professions worked effectively together to assess the needs of patients and to support the discharge process.
• There was an active occupational therapy and physiotherapy team who developed individual plans and therapeutic activities with patients. The pharmacy team were accessible to ward staff and provided ongoing monitoring and support with medication management
• Staff showed a clear understanding of the Mental Health Act and the Mental Capacity Act including Deprivation of Liberty Safeguards.
• There was a suitable training plan in place for staff to enable them to keep up to date with their clinical or leadership skills and to develop these further.
• There were robust systems in place to record incidents and learning from incidents was routinely shared amongst staff.
• Morale amongst staff we spoke to was generally good; they enjoyed their jobs and were clear about their roles and responsibilities. Staff told us they felt valued and supported by the Trust and felt confident they could report their concerns without fear of reprisal.
• Local leadership was visible and available to support staff.

However:

• Staff did not always have good access to patient records in order to deliver safe and effective care at all times.
• The door to one ward office, which contained paper files and confidential information, was left open even though it exited onto a public garden area. Another ward had an open door from a staff break room which led out onto a publicly accessible drive way.
• We found that there were three falls recorded as serious incidents within the last six months which resulted in patients sustaining fractured limbs.
• Some patients could not access psychological therapies in a timely manner.
• Two female patients told us that they did not feel safe on the wards because male patients came into their rooms at night and this frightened them.
• Patients were not permitted to use one garden area following rain because the ground surface was deemed to be too slippery and posed a risk of falls. Two garden areas had no shaded areas which meant that patients were not protected from the heat or sun.

Updated 19 November 2015

Overall we rated this core service as good because:

• We saw consistently kind and appropriate interactions between staff and patients.
• Ligature risks were well assessed, managed and minimised.
• Multidisciplinary working was evident across all of the wards.
• Handovers and ward rounds were well-structured and comprehensive, with team members sharing the relevant information.
• The executive team were, on a daily basis, kept fully informed of the issues on the acute and PICU wards, through established mechanisms.
• There were highly visible, enthusiastic and innovative ward managers on each ward.

However:

• The seclusion area within Hadleigh unit had fittings and fixtures in a state of disrepair.
• There were issues related to recording compliance with the Mental Health Act 1983.
• There was a restrictive practice operating across the acute wards (the locking of patient bedrooms during the day).

Updated 19 November 2015

We gave an overall rating for community based mental health services for adults of working age as good because:

• Staffing levels were safe, except for in the Rayleigh and Basildon teams which were small teams with staff off sick and maternity leave at the time of the inspection. Bank and agency staff were used to cover absence. Teams used bank and agency staff who knew the service wherever possible. Recruitment was in progress for vacancies. There was access to a psychiatrist when needed. The teams were multi-disciplinary consisting of psychiatrists, psychologists, nurses, social workers, occupational therapists and support workers. There was effective working with other agencies and services.
• Caseloads were managed and re-assessed regularly and were discussed in supervision. Staff received regular supervision and annual appraisal. All staff said they could raise issues with their manager if required and action would be taken.
• The environment in the team buildings was clean but some were in need of redecoration, for example Thurrock, although some work had started. Infection control information was on display. There was a system in place for reporting required estates work.
• Risk assessments were recorded and updated regularly. Comprehensive assessments were completed in a timely manner. Care records showed personalised care which was recovery oriented. Physical healthcare needs were considered during assessment and treatment. The records for people who were subject to a community treatment order were up to date and contained all relevant information. Staff had received training in the mental health act. Staff demonstrated an understanding of mental capacity and had received training.
• There was an effective incident reporting system in place and there was learning from serious incidents. All staff knew how to report an incident and de-briefs were offered. Staff were aware of their responsibilities in relation to the duty of candour. Teams responded to and learned from complaints. Local resolution was tried wherever possible. If the complaint needed escalating the complaints department was informed, who then monitored compliance. Regular reports on complaints were received in teams from the patient advice and liaison service.
• Staff were trained in, and aware of, safeguarding requirements and showed they used the referral process. Staff received, and were up to date with, mandatory training. They had access to training specific to their role, for example brief psychological interventions, cognitive behavioural therapy and recording of an electrocardiogram.
• Staff were aware of, and followed NICE (National Institute for Health and Care Excellence) guidance. Outcome measures were used to evaluate the effectiveness of care and treatment.
• Staff were respectful and caring when they spoke with people. Carers said staff were very caring. There was positive feedback from people who used the services and their carers. People said they felt involved in their care planning and treatment and this was documented in the care record.
• The specific needs, for example cultural and disability needs, of people were considered. Work was underway at Thurrock to improve access to the building. There were interpretation services available when required.
• Rooms were available for confidential discussion/reviews.
• Information leaflets were available on a variety of topics for example how to complain, services available.
• Staff were aware of the trust’s vision and values and could describe them. Staff knew who the senior managers and executive directors were. They had met the executive and non-executive directors. They felt well supported by associate directors.
• Sickness rates were low in seven of the nine teams, poor attendance was addressed using the relevant policy and managers said they had received advice and support from human resources.

However:

• There was no monitoring of medicines stock in the Basildon team; the manager addressed this by the end of the week of the inspection. The teams at Basildon and Rayleigh did not have secure bags to transport medication when visiting people at home. Two out of 15 medication charts checked had incorrect dates.
• At Basildon there were not enough rooms available for staff to use for one to ones or confidential staff interviews.
• The personal alarm system and lone working practice were not fully embedded in Southend teams (recovery and wellbeing and assertive outreach team).
• The locality teams did not have direct access to the system providing results of blood tests, which might cause a delay in clinicians being able to adjust medication or arrange for further tests if required. Some psychiatrist could access the system but not all.
• The electronic record systems caused staff anxiety. They reported there was a risk that information was missed and there was duplication. There were two systems in use and information was held in both. The trust was in the process of rolling out the one system.
• Managers did not receive reports on time from referral to first face to face contact. The target was 14 days.
• In the community mental health teams no appointments were offered outside of working hours (for someone who is in work).
• Managers reported the human resources processes, for example disciplinary cases, took a long time to complete/resolve.
• Staff did not feel a recent productivity project took into account all the work staff do in teams.