Derbyshire Healthcare NHS Foundation 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

Safe - this means we looked for evidence that patients were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant patients were protected by a consistent and effective approach to safeguarding, whilst positive risk-taking was promoted to support independence and recovery. Patients were fully involved, and the service was open and transparent when things went wrong.

The environment was safe, clean, well equipped, well maintained, and fit for purpose. Staff assessed and managed risks to patients and themselves effectively and understood how to protect patients from abuse. The service worked well with other agencies to safeguard patients. Staff used systems and processes to safely prescribe, administer, record, and store medicines, and the service managed patient safety incidents appropriately to support ongoing recovery and rehabilitation.

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.

Staff maintained a proactive and consistent approach to safety and learning. Staff reported all incidents including near misses, and any alleged incidents through an electronic incident reporting system. Anyone who witnessed an incident completed a report in a timely manner, and staff confirmed this occurred consistently.

Learning from incidents was regularly discussed during Team meetings and reviewed through clinical governance processes. Staff gave examples of learning following safeguarding concerns, such as incidents of risk-taking behaviour during community leave, which led to collaborative working with external partners to reduce the risk of repeated occurrences. One staff member told us, “We always learn lessons from incidents, learning is shared and it helps us to improve.”

Staff felt confident, and safe to raise concerns and participated in regular debriefs following incidents. Patients were supported through debriefs when required. The service also had monthly “Learn the Lessons” sessions. This resulted in practical improvements in risk monitoring and managing contraband items, ensuring patient safety while promoting independence and rehabilitation goals.

Patient’s felt supported and reassured during referral, admission, transfer and discharge processes, which helped reduce anxiety during times of change. Staff gave them information about what to expect from their care and treatment in a variety of formats to suit their individual communication needs.

Staff and leaders explained that the service had effective systems in place that ensured safe admissions, transfers of care and discharge planning, and reviewed referral documentation carefully. Staff understood the importance of robust admission processes, as this ensured the referred patient was appropriate for the service and their needs could be met. Leaders promoted the importance of early planning and communication across teams.

Staff followed a structured process where staff completed a comprehensive admission process when people were admitted, this involved the patient as much as possible and was reviewed regularly. Discharge planning involved coordination between services, for example, community mental health teams (CMHT) and the community enhanced rehabilitation team (CERT) to ensure safe, supported and effective transitions and ongoing care and support. Staff remained focused on achieving discharges in a timely manner where possible. Communication during transitions was effective, and with the consent of the patient, families or carers booked additional appointments with the responsible clinician (RC) for updates and support. Staff managed safety during transition to and from the service which effectively promoted recovery and independence.

Patients felt safe, and staff worked with them effectively to establish what being safe meant for each person and the most effective way to achieve this. Staff focused on improving patients’ lives and supported them in their right to live free from abuse, discrimination and avoidable harm. Staff raised safeguarding concerns promptly. The service had a safeguarding team who offered advice, and support when required. One patient told us, “Staff are always in the bungalows, I always go to them if something is wrong, or I need help.”

Staff completed mandatory safeguarding training and understood what to report, and how to raise alerts and escalate concerns. They protected patients from avoidable harm and discrimination, including those with protected characteristics under the Equality Act 2010. Staff identified adults at risk and worked effectively with external agencies, such as the local authority safeguarding team when required.

The service promoted least restrictive practices, and recognised the positive effect on the patient’s recovery, independence, and quality of life. Staff maintained a person-centred approach that supported patients’ wellbeing and development of life skills. Teams discussed reducing restrictive practices regularly at meetings and held internal audits to ensure they were meeting their own expectations. No safeguarding referrals were made in the 3 months prior to our assessment.

Patients felt involved in discussions about risk and appreciated how staff-maintained safety while promoting autonomy and recovery. Staff worked with patients to understand and manage risks; risk assessments were completed promptly using recognised tools such as the HCR-20, ensuring care was safe, supportive, and recovery focused. Staff assessed and managed risks to patients and themselves, followed best practice and built meaningful therapeutic relationships with patients which enabled them to anticipate and de-escalate any potential incidents promptly. Staff also completed risk assessments when patients engaged in group or social activities to ensure safety while promoting engagement. Staff participated in the trust’s “Positive and Safe” training, which supported safer, recovery-focused care.

Patients were involved in developing and reviewing care plans and risk assessments and accessed their care plans and participated in multidisciplinary team meetings (MDM). One patient told us “I am able to choose who I want involved in my care. I have told the staff that I do not want my family involved at the moment and they respected my decision. I can change my mind when I want.”

Staff adapted communication methods to ensure patients understood their care and treatment. Staff completed communication passports for patients with an identified need. They supported patients to provide feedback through community meetings and ensured access to services, such as Independent Mental Health Advocacy (IMHA).

Staff followed clear policies for observation levels, placing new admissions on the appropriate observations based on assessed risk whilst maintaining a least restrictive approach.

Patient’s felt the environment was safe. One patient told us “We have cleaners that come daily. They clean the bedrooms, the rest of the bungalow and the outside area. I can also do it myself and the staff help me.” The service maintained clean and well-equipped environments that promoted and supported the safe delivery of care. Equipment was audited, maintained, stored safely and used appropriately.

Staff completed regular security and safety audits of the environment, this ensured there were no unidentified risks, including ligature risks, any concerns were fed back at shift handover meetings and addressed promptly. Staff carried personal alarms and radios, and patients had access to nurse call systems throughout the environment to ensure they could request assistance, or support.

Facilities, equipment, and technology supported staff to deliver safe and effective care. The service utilised a contact-free, infrared technology, camera-based monitoring system to track patients’ vital signs (pulse and breathing rate) and movement without needing to enter the room, reducing sleep disturbance.

Leaders and staff considered how environments could keep people safe from psychological harm as well as physical harm, including attention to sexual safety and sensory needs.

Patients felt safe and supported by staff, and described staff as well-trained, attentive, supportive and responsive.

Leaders maintained safe and effective staffing levels to deliver person-centred care. Leaders calculated the required numbers of staff and adjusted them daily to meet the needs of the patients and the service. A staff member was allocated to each bungalow, which ensured patients received consistent support, and ensured their needs were met effectively. It also enabled meaningful engagement on a regular basis.

Appropriate employment checks were completed prior to staff starting work. When necessary, bank staff were used to maintain safe staffing levels, with the vast majority of bank staff being regular to the service, and familiar with the patients. All bank staff completed an organisational induction. The service maintained adequate medical cover day and night, with a doctor or pharmacist being available, and able to respond promptly in cases of emergency.

Staff achieved 98% compliance with mandatory training. They reported that training was tailored to their development needs, including recovery-focused approaches, and risk management. Staff at all levels attended supervision, and managers addressed poor performance appropriately. Policies and guidance supported the supervision process and promoted professional development. However, although staffing numbers were met, recent acuity had resulted in some cancelled activities and therapeutic sessions. Leaders demonstrated actions taken to address and improve this. Staff had the training, support, and resources needed to meet the needs of patient’s and provided recovery focused care, rehabilitation and independence.

Patients felt confident in the infection prevention and control (IPC) measures in place and were assured that staff were taking necessary precautions to protect them from the risk of infection. One patient told us “The cleaners are very good. They come every day and keep things clean and looking nice.”

Staff adhered to infection prevention and control principles and consistently followed handwashing protocols, used personal protective equipment (PPE), and cleaned equipment in line with guidance. We observed all environments to be clean and well-maintained. Cleaning records evidenced areas were cleaned regularly. Staff following appropriate handwashing and infection control procedures and had a clear understanding of their roles in maintaining a clean and safe environment. Hand sanitising stations were situated throughout the service.

Processes were in place for assessing and managing infection risks. Infection, prevention and control procedures aligned with current national guidance. Infection control audits were conducted regularly, and concerns addressed. Identified risks were shared appropriately with external agencies, staff, patients, and visitors. The service had an infection, prevention and control team for advice, and support. There were clear roles and responsibilities for infection prevention and control, and staff received ongoing training in line with best practice guidance.

Patients told us staff explained medicines clearly and that they felt safe, informed, involved and supported in decisions about their treatment. Patients were supported to make decisions, and staff actively supported understanding and promoted choice, encouraging patients to take responsibility for managing their medications safely. Patients were supported to self-administer medicines in readiness for rejoining their communities. There were three different administration levels,1, 2 and 3, patients who were on level 3 administration, administered their own medicines without supervision. One patient told us “I take my own medication. I keep my own blister pack and keep an alarm on my phone. I usually am pretty good at remembering but staff do check and it makes me feel safe.” Patients who administered their own medicines stored medication securely in their rooms with the appropriate safety measures, and monitoring in place from staff, which ensured medicines concordance, and patient safety.

Medicines were managed in a safe and effective way, and clinic rooms were fully equipped with accessible resuscitation equipment and emergency medicines, which staff checked regularly to ensure preparedness for any emergency situation. Staff adhered to best practice and national guidance, including storage, recording, administration and disposal of medication. Staff completed training and competency assessments before administering any medicines. Medicines, including controlled drugs were stored securely and appropriately. The pharmacy team completed regular audits and advised of actions needed when required. Managers monitored findings from audits, shared alerts, and addressed any required actions through clinical governance meetings. Staff completed medicines reconciliation and maintained up-to-date records to ensure continuity of care when patients were discharged or moved between services.

Medicines were regularly reviewed in multi-disciplinary meetings, and patients were involved in decisions about their medicines wherever possible with preferences and capacity documented in care plans. Staff monitored the effects of medication on physical health, particularly for patients prescribed psychotropic medications, in line with guidance. They reviewed as required (PRN) medicines regularly which ensured patient’s behaviour was not inappropriately controlled by medication.