08 May to 12 June 2019
During an inspection of Specialist community mental health services for children and young people
Our rating of this service stayed the same. We rated it as requires improvement because:
- Staff did not always assess or manage risk well. Staff did not follow up on all identified risks, create management plans or appropriate crisis plans. The service did not actively monitor children and young people on waiting lists to detect and respond to increases in level of risk.
- Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offer this service. Children and young people on waitlists did not have a formal care plan until they received intensive treatment. For those admitted into the service care plan entries were written from a clinical perspective, more so than for the individual receiving treatment.
- Staff did not always record consent clearly for children or young people in their care records.
- Staff did not ensure that children and young people and their families and carers had access to all the information they should. This included information on complaints, carers assessments and LGBTI support.
- Issues relating to on-call provision were not yet fully resolved. There were staffing gaps in the rotas as there were not enough staff to cover all responsibilities.
- Staff did not always follow systems and processes for cleaning and checks of clinical equipment. The Barnsley service did not have CQC ratings from the previous inspection displayed in patient areas.
However;
- Clinical premises where children and young people were seen were safe and clean. The number of children and young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving people using the service the time they needed. Staff ensured that children and young people who required urgent care were seen promptly.
- The service had identified issues with long waiting lists for intensive treatment and gaps in commissioning and were working to resolve these. When appropriate, they provided low level interventions to those waiting for intensive treatment. They were implementing new service models to better meet the needs of people using the service and were working with commissioners to get additional funding and a clear service specification.
- Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of children and young people. Staff engaged in clinical audit to evaluate the quality of care they provided.
- The teams included or had access to the full range of specialists required to meet the needs of those using the service. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
- Staff understood the principles underpinning capacity and competence in line with the Mental Capacity Act and Gillick competence.
- Staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved children, young people and their families and carers in care decisions.
- The service was easy to access in terms of referrals and initial assessment. Staff assessed and were able to expedite treatment for children and young people who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
- The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.