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Provider: Rotherham Doncaster and South Humber NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 11 January 2018

During a routine inspection

  • We rated caring, effective, responsive and well led as good and the overall rating for Community inpatient services went up to good at this inspection.
  • With the exception of mental health rehabilitation services, patients’ physical and mental health risk assessments were comprehensive. Appropriate management plans were in place and patients had up to date and comprehensive care plans, which reflected national guidance and best practice and met their individual needs.
  • The trust board and senior leadership team had the appropriate range of skills, knowledge and experience to perform its role and the non-executive directors had the appropriate skills and knowledge in order to provide relevant challenge to the trust board. The senior leadership team and senior managers understood the key priorities within the services.
  • We rated one adult social care location, 88 Travis Gardens, as outstanding in the caring domain.
  • The trust had an excellent staff, patient and public engagement strategy which followed a recognised methodology. Staff throughout the trust had access to specialist training and development and had been empowered to implement quality improvements.
  • Leaders were visible in the service and approachable for patients and staff. Staff felt supported by their managers and felt they could raise concerns or approach their managers for support.
  • A physical health and wellbeing strategy was in place under the executive lead of the medical director. We saw in all core services we inspected that patients had good access to physical health care; physical health checks were undertaken and staff promoted healthier lifestyles.

However:

  • We rated safe as requires improvement in four of the 14 core services. The overall rating for acute wards for adults of working age and psychiatric intensive care wards had gone down to requires improvement.
  • Although the trust had improved its overall mandatory training compliance, staff in some wards and teams were not up to date with their mandatory training requirements. Training for prevention and management of violence and aggression, a key component of enabling safe care was below 75% in acute wards for adults of working age and psychiatric intensive care units. Compliance was only 15% in one ward.
  • There were medicines management issues in three core services at this inspection. At our last inspection we found that patients allergy status was not completed on some prescription charts in the community based mental health services for adults of working age. At this inspection we found that this had not been rectified across all teams.
  • Not all staff had received an up-to-date appraisal of their performance.
  • Patients in some services had limited access to psychological therapies and occupational therapy.


CQC inspections of services

Service reports published 28 June 2018
Inspection carried out on 11 January 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 478.57 KB (opens in a new tab)Download report PDF | 1.99 MB (opens in a new tab)
Inspection carried out on 11 January 2018 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 478.57 KB (opens in a new tab)Download report PDF | 1.99 MB (opens in a new tab)
Inspection carried out on 11 January 2018 During an inspection of Community-based mental health services for adults of working age Download report PDF | 478.57 KB (opens in a new tab)Download report PDF | 1.99 MB (opens in a new tab)
Inspection carried out on 11 January 2018 During an inspection of Community health inpatient services Download report PDF | 478.57 KB (opens in a new tab)Download report PDF | 1.99 MB (opens in a new tab)
Inspection carried out on 11 January 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 478.57 KB (opens in a new tab)Download report PDF | 1.99 MB (opens in a new tab)
See more service reports published 28 June 2018
Service reports published 11 May 2017
Inspection carried out on 15-18 September 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF | 261.75 KB (opens in a new tab)
Service reports published 12 January 2017
Inspection carried out on 26 - 28 September 2016 During an inspection of Substance misuse services Download report PDF | 257.07 KB (opens in a new tab)
Inspection carried out on 12 September - 15 September 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 342.64 KB (opens in a new tab)
Inspection carried out on 05 - 08 September 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 274.44 KB (opens in a new tab)
Inspection carried out on 26 September 2016 - 28 September 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 280.49 KB (opens in a new tab)
Inspection carried out on 26 September 2016 - 29 September 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 280.64 KB (opens in a new tab)
Inspection carried out on 26-27 September 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 263.4 KB (opens in a new tab)
See more service reports published 12 January 2017
Service reports published 19 January 2016
Inspection carried out on 14-18 September 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 300.08 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 357.51 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 331.83 KB (opens in a new tab)
Inspection carried out on 15-18 September 2015 During an inspection of Community health services for children, young people and families Download report PDF | 362.34 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Forensic inpatient or secure wards Download report PDF | 298.83 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 297.06 KB (opens in a new tab)
Inspection carried out on 15 - 18 September 2015 During an inspection of Community health services for adults Download report PDF | 385.32 KB (opens in a new tab)
Inspection carried out on 15-18 September 2015 During an inspection of End of life care Download report PDF | 351.66 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 305.74 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Community-based mental health services for older people Download report PDF | 297.58 KB (opens in a new tab)
Inspection carried out on 15-18 September 2015 During an inspection of Community health inpatient services Download report PDF | 306.42 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 400.52 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 411.46 KB (opens in a new tab)
Inspection carried out on 14-18 September 2015 During an inspection of Substance misuse services Download report PDF | 303.89 KB (opens in a new tab)
See more service reports published 19 January 2016
Inspection carried out on 10 October 2016

During an inspection to make sure that the improvements required had been made

Following this inspection, which took place throughout September and October 2016, we changed the overall rating for the trust from requires improvement to good because:

  • In September 2015, we rated 11 of the 15 core services as good. The intelligence we received, before the 2016 inspection, suggested they had maintained their quality and they were not visited during this inspection.

Following this inspection we have changed the ratings of three more core services from requires improvement to good. These core services are:

  • Specialist Community Mental Health Services for children and young people

  • Community Mental Health Services for people with learning disabilities or autism
  • Substance misuse services

Following this inspection, the core service of long stay/ rehabilitation wards has not changed from requires improvement for the key question of safe or the overall rating of good.

The overall rating of wards for older people with mental health problems has not changed from good. However, following this inspection, the rating for the key question effective remains as requires improvement because care and treatment was not always provided in accordance with the provisions of the Mental Capacity Act

The ratings at provider level have changed from requires improvement to good as a result of our findings from this inspection.

The trust acted to meet the requirement notices we issued after our inspection in September 2015.However it had not met all of the requirements in relation to the Mental Capacity Act.

The trust improved its governance and reporting on the quality of care. Operational reports showed how each area was performing so the board had real-time reports on quality measures.

The trust had met its duties under duty of candour with compassion and sensitivity.

The trust had used innovative approaches to engage with staff, patients and local communities.

However:

We have continued to rate community based mental health services for adults of working age as requires improvement as we were concerned about the quality of risk management, care plans and poor compliance with mandatory training. However, the key question of safe was changed to good and the key question of well-led was changed to requires improvement.

Inspection carried out on 14-18 September 2015

During an inspection to make sure that the improvements required had been made

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We rated Rotherham Doncaster and South Humber NHS Foundation Trust (the trust) as Requires Improvement because:

  • Community mental health services for people with learning disabilities or autism at the Ironstone Centre did not have enough staff to meet the needs of people who used the service. We also identified shortages of community nursing staff in some locations.
  • Medication management was not overseen effectively and different systems had been allowed to evolve in different areas of service. The community-based mental health teams did not have regular pharmacist support to ensure safe and effective administration of medicines. This had been identified as ‘high risk’ by the trust on the pharmacy risk register. In the community-based mental health services for adults of working age there was no consistent approach to medication management to support safe practices. In the substance misuse service, staff who were not suitably trained or competent administered medications in the social detoxification service at New Beginnings. The service had no consistent approach to recording medicines patients brought with them on admission and no clear protocols for stock control and storing patients’ own medicines. There was only limited oversight of the process and it was not audited.
  • Staff did not consistently monitor the physical health needs of patients of mental health services,which could result in some people’s physical health needs not being met. In the community health inpatients service, Hawthorn and Hazel wards did not complete venous thromboembolism risk assessments in line with guidance from the Nationial Institute for Health and Care Excellence (NICE) relating to adults admitted to hospital as inpatients.
  • Not all risk assessments were completed, up to date and of good quality. Some lacked relevant information and important detail.
  • At the time of the inspection, the percentage of staff completing mandatory training averaged 77% compared with the trust’s mandatory training target of achieving 90% by 31 December 2015. Compliance with compulsory training, appraisal of work performance and managerial supervision was inconsistent across services and the trust was not meeting its own targets. Trusts should ensure that staff maintain their skills knowledge and training to carry out their roles safely and effectively and are up to date with changes to best practice. Staff who had not completed mandatory training could have been unaware of important changes in the trust’s policies and procedures.
  • The trust’s senior management team were aware of the poor compliance with mandatory training and inconsistencies in recording which staff had completed some or all of the training. They had started to deal with these issues and recognised deficiencies in appraisals and were introducing changes. However, poor compliance with mandatory training had the potential for a negative impact on patient care and safety.
  • The trust was not fully complying with its responsibilities under duty of candour and people did not always receive a timely apology when something went wrong. The trust did not provide enough guidance for staff on their responsibilities under the duty of candour.

However :

  • There was a culture of collective responsibility between teams and services, and openness and transparency in communicating generally.
  • People who used the trust’s services were supported and treated with dignity and respect and were involved as partners in their care. Feedback provided by people who use the trust’s services was generally positive. Staff were caring, engaged and supportive towards patients. People and staff were working together to plan care and there was evidence of shared decision-making and a focus on recovery.
  • We rated the responsiveness of the community health services for children, young people and families as outstanding. The service planned and delivered care that met people’s needs and was responsive to the changing needs of the local population. They also used innovation in care to meet the needs of local people and hard-to-reach groups.
  • The trust handled complaints to a good standard, with managers and staff listening and responding to complaints and concerns and resolving issues quickly where possible.
  • While in some clinical areas staff had problems with recording information on the trust’s IT system, such as mandatory training, there were systems to monitor performance information.
  • The chief executive had been in post for only three months at the time of the inspection, but had received a handover from the previous chief executive and demonstrated an understanding of what the key issues were for the trust. She was improving quality and staff across the organisation were clear about how the trust should develop. The board and senior team had the experience, capacity and capability to put the trust’s strategy into effect. The trust leadership team actively engaged with staff, people who use the services, their representatives and stakeholders.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Reports under our old system of regulation (including those from before CQC was created)


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.