2 - 4 November 2020
During an inspection of Child and adolescent mental health wards
We carried out a responsive, unannounced inspection over three days. This was because of information we had received giving us concerns about the safety and quality of the services.
This was a focused inspection looking at safe effective and well led key questions. We did not rate key questions at this inspection. However, due to a regulatory breach in well led this domain has been limited to requires improvement.
Summary
- The use of restrictive practices had increased significantly since the last inspection, including the use of mechanical restraint.
- Governance systems had identified that limited formal debriefs were taking place. Managers had started to implement changes to address this. However, at the time of the inspection the level of formal debriefs taking place was not in line with trust policy.
- There was evidence of oversight and scrutiny of the use of restrictive practice within the trust management forums. However, the trust had not maintained a continued reduction in restrictive practices within services for children and young people.
However,
- The wards had enough nurses and doctors. Staff usually assessed and attempted to manage risks well.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients.
- The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
- Staff felt respected, supported and valued by local leaders.
How we carried out the inspection
We visited four wards at Ferndene and two wards at Alnwood. We spoke with 23 staff members including clinical managers, nurses, support workers and members of the multidisciplinary team, four young people, two carers and reviewed 15 care records and attended three meetings. We also spoke to the advocate and commissioners before the inspection.
What people who use the service say
We were able to speak to four young people who all said that they felt safe on the wards and that staff supported them. The young people said that staff had spoken to them after incidents of restraint, but one young person felt that they weren’t listened to about their experience of a restraint.