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Provider: Sheffield Health and Social Care NHS Foundation Trust Requires improvement

Read our previous full service inspection reports for Sheffield Health and Social Care NHS Foundation Trust, published on 9 June 2015.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 5 October 2018

Our rating of the trust went down. We rated it as requires improvement because:

  • We rated safe, and well-led as requires improvement and effective, caring and responsive as good.
  • We inspected eight core services on this inspection. The overall ratings for two of these core services went down to requires improvement and one core service remained rated as requires improvement. One core service improved to good and one core service improved to outstanding. We rated safe as requires improvement in five of the eight core services and inadequate in one core service we inspected. In rating the trust, we took into account the previous ratings of the core services not inspected this time.
  • The trust had recently undertaken a major reconfiguration of services at the same time as restructuring the management. The senior leadership of the trust had not recognised a deterioration in safety of some services during these changes. Also, the reconfiguration of community services had led to some patients having lengthy waits for services and staff were concerned about their ability to provide a safe and effective service. The single point of access was not able to manage or monitor the volume of calls to the service and people requiring a mental health assessment were not always assessed quickly.
  • Governance systems and processes had not ensured that staff were aware of or adhered to all policies and procedures or that they always reflected current national guidance and good practice. They had also not ensured that staff received regular clinical supervision. This was significantly lower than the trust target in most core services that we inspected.
  • Trust managers did not ensure that learning from the investigation of incidents was shared effectively across the trust.
  • There were not enough staff to provide safe care in three core services. This resulted in high caseloads in community teams, leave and activities being cancelled and a high use of agency and bank staff. This meant that one core service did not always have enough appropriately trained staff on duty.

However:

  • The leadership team were aware of the current challenges and were taking action to address them. The senior leadership team were visible and accessible to staff, patients and carers. Managers at all levels promoted a culture that supported and valued staff. Staff knew about the trust’s whistleblowing procedures and who the freedom to speak up guardian was and how to access their support.
  • The trust was actively involved in the local integrated care system and accountable care partnership. They had good relationships with stakeholders and partners, including the local clinical commissioning group, police force and local authority.
  • Mandatory training and staff appraisal rates were high and had significantly improved since our last inspection. However, this improvement had not been seen in two core services.
  • Patients and carers were positive about the care staff provided. Patients felt that staff helped them in a respectful, caring, and compassionate way and helped them to understand and manage their own condition, care, and treatment where appropriate. Carers felt they got the support they needed.
  • Staff, patients and carers were involved in planning and developing services and the trust had commissioned an independent review of the recently reconfigured community services in order to identify lessons learned and inform future changes.

Inspection areas

Safe

Requires improvement

Updated 5 October 2018

  • Nurse call alarms were not in place on the forensic wards and in the learning and recreation hub within the rehabilitation service. Alarms were not easily identifiable or accessible on one of the wards for older people.
  • The seclusion room in the forensic wards did not comply with the Mental Health Act Code of Practice. The trust had failed to take action to ensure that the seclusion room was improved and there was no timescale for this work to be carried out.
  • Environmental risk assessments, including the identification and mitigation of blind spots, reviewed following serious incidents were not always available for staff on the wards.
  • Staff working on the acute ward for adults of working age were required to staff the health based place of safety which had seen a significant increase in usage over the past year. This, combined with a high vacancy rate of qualified nurses in this service, led to the service being unsafe. Sickness absence rates were high at the Mental Health Recovery North Service and Home Treatment Service which had resulted in high staff caseloads at the Mental Health Recovery North Service.
  • The trust was frequently reliant on bank and agency staff to maintain safe staffing numbers and there was not always enough staff on duty trained in the use of physical interventions.
  • Staff on the acute wards for adults of working age did not undertake the required physical health monitoring following the administration of rapid tranquilisation and nursing and medical reviews were not always completed during seclusion. The latest guidance was not always followed regarding physical health monitoring. Some patients on antipsychotic medication had not received the required level of monitoring or health checks in relation to their prescribed medication.
  • The single point of access was not able to manage or monitor the volume of calls to the service; the team had no way of knowing how many people had not been able to access the service. People who had accessed the service and required a mental health assessment were not always assessed quickly. There were a number of people awaiting assessment under the Mental Health Act; one person had been waiting for 10 days.
  • Processes for safeguarding children visiting Burbage ward were not robust.

However:

  • Compliance rates for mandatory training were high and had significantly increased since our last inspection.
  • The community mental health services for older people with mental health problems team had good oversight of people on the waiting list and contacted them regularly to manage risks.
  • Staff across the services participated in safety huddles to help reduce harm to patients.
  • The trust used the “respect” training method which emphasises the use of de-escalation techniques before resorting to physical interventions, such as restraint. The trust had one incident of prone restraint during the reporting period.
  • The trust had a policy for managing restrictive interventions and blanket restrictions; staff used a least restrictive practice approach to care. There had been a reduction in the use of blanket restrictions.
  • Within community mental health services staff responded quickly when a patient’s health suddenly deteriorated and there was good use of advance decisions and crisis plans.

Effective

Good

Updated 5 October 2018

Our rating of effective stayed the same. We rated it as good because:

  • Staff across all services showed a good working knowledge of the Mental Health Act and the Mental Capacity Act and their responsibilities in relation to these. Staff protected the rights of patients who were subject to the Mental Health Act and followed the Mental Health Act Code of Practice.
  • The trust had achieved its target of 90 percent for staff appraisal across all areas of the organisation.
  • Services had a full range of specialists within the teams including psychiatrists, psychologists, nursing staff, recovery workers, support workers, occupational therapists, social workers, and other allied health professionals.
  • Staff provided a range of care and treatment interventions, which were in line with guidance from the National Institute for Health and Care Excellence. They used recognised rating scales to rate severity and outcomes.
  • There was innovative use of information technology to support and maintain independence for the patient group within the older people’s community mental health services.
  • The wards for people with learning disabilities and autism participated in the STOMP (stop over medicating people with a learning disability) initiative. They worked with professionals within and outside of the trust to work together to reduce the use of anti-psychotic medications for people with learning disabilities.

However:

  • The trust’s target for clinical supervision was 66 percent. Compliance was significantly lower than 66 percent in most core services.
  • A new appointment system had been introduced in the crisis team which had led to staff not always having the time to read patients’ records prior to the appointment.
  • Staff did not always follow the latest national guidance or best practice
  • In the acute wards for adults of working age and psychiatric intensive care units audits which had been undertaken had not identified issues which we found on inspection.

Caring

Good

Updated 5 October 2018

Our rating of caring stayed the same. We rated it as good because:

  • Staff were kind, caring and compassionate and were respectful of patients’ personal, social and cultural needs.
  • Staff respected patients’ privacy, dignity and confidentiality.
  • Patients and carers were positive about the care staff provided. Patients felt that staff helped them in a respectful, caring, and compassionate way. They felt they got the support they needed and were helped to understand and manage their own condition, care, and treatment where appropriate. Carers felt they received the help they needed.
  • Staff involved patients and carers when appropriate in decisions about their care and treatment and patients had access to advocacy where appropriate.
  • Patients and families had been involved in the redesign of services and were involved in designing future developments.
  • The trust provided a range of opportunities for patients and carers to provide feedback about the services provided, including the option to feedback through a third party organisation.

However:

  • Although we saw involvement of carers and relatives in patients’ care and treatment records, the feedback we received from carers and relatives in the wards for people with learning disabilities and autism said they did not feel involved and poor communication was a problem.

Responsive

Good

Updated 5 October 2018

Our rating of responsive stayed the same. We rated it as good because:

  • The trust managed complaints well; patients knew how to complain and information was available to support the process. Staff investigated and responded to concerns and complaints and made improvements as a result of complaints. Older peoples services had received no complaints and 221 compliments in the last year.
  • There was a recovery college which patients could access which gave patients the opportunity to learn about their illness and treatment and to gain recognised qualifications in subjects such as English and maths. Staff supported patients in accessing education and work opportunities and encouraged them to build and maintain relationships with the people who mattered to them.
  • The rehabilitation service had a clear recovery focused-pathway that meant patients had a discharge plan at an early stage of their admission. The service had now discharged most patients who had a longer than expected length of stay.
  • The trust had a vision to provide care based on personalisation and ensure that people could receive the right care and treatment without going into hospital. Services had been reconfigured in order to support the implementation of this, although some further work was required in community services
  • Crisis services were flexible; patients who could not access the service could be seen at home or in the local community.
  • Acute wards for adults of working age had a co-ordinated and effective approach to discharge from hospital. The process involved patients, discharge co-ordinators, community mental health staff and families. Average length of stay for patients in this and most other inpatient services had reduced.
  • Patients were supported during transfers and referrals to other services and were accompanied if this was appropriate when they attended appointments with other services.

However:

  • Some staff did not receive feedback concerning the outcome of complaints.
  • Waiting times for some routine assessments were lengthy and there was a high rate of people not attending for assessments. There were a high number of calls to the crisis team and the telephone system was not fit for purpose. This meant that some people might have phoned the crisis line and not got through to a member of staff.
  • Crisis services were not always delivered in a way that focused on people’s needs. Appointments were made for mornings only and a double booking system had been introduced which did not always meet patients' needs.
  • The interview rooms at Netherthorpe House lacked privacy. The rooms faced a noisy main road. The main office was also very busy which meant that staff could not always hear a patient on the telephone.
  • Bed occupancy in the wards for adults of working age remained consistently high across the service.
  • The accessible information standard had not being fulfilled, although there was a plan in place to address this, there was not enough resource to implement the plan effectively.

Well-led

Requires improvement

Updated 5 October 2018

Our rating of well-led went down. We rated it as requires improvement because:

  • The senior leadership of the trust had not recognised a deterioration in safety and effectiveness of services during the reconfiguration of services and the implementation of a new management structure.
  • Governance systems and processes were not robust. Not all policies and procedures reflected current national guidance and good practice. Where revised policies were in place they were not always adhered to and lessons learned from incidents was not effectively shared across the trust.
  • There were not enough staff to provide safe care in three core services. This resulted in high caseloads in community teams. Leave and activities were cancelled on wards for people with learning disabilities and autism. On acute wards for adults of working age and psychiatric intensive care units there was a high use of agency and bank staff which meant that there was not always adequate numbers of staff on shift trained in the use of physical interventions.
  • The reconfiguration of community services had led to some patients having lengthy waits for services and staff were concerned about their ability to provide a safe and effective service. The single point of access was not able to manage or monitor the volume of calls to the service and people requiring a mental health assessment were not always assessed quickly.
  • Systems and proceses in place had not effectively identified that clinical supervision rates across most services were low. Compliance was significantly lower than the trust target.
  • The trust had not ensured that building work required to improve seclusion facilities in the forensic wards had been completed.
  • Physical healthcare standards were inconsistent across the trust despite a physical healthcare strategy being in place.

However:

  • The senior leadership team were visible and accessible to staff, patients and carers. Managers at all levels promoted a culture that supported and valued staff; staff felt supported by their managers and felt they could raise concerns or approach their managers. They knew about the trust’s whistleblowing procedures and understood the role of the freedom to speak up guardian. We saw examples of how the guardian had supported staff to raise concerns.
  • The staff across all services had good knowledge of the trust vision and values and demonstrated those values in their practices.
  • The trust had involved staff, patients and carers in the design and development of services and was actively involved in the local integrated care system and accountable care partnership. They had good relationships with stakeholders and partners, including the local clinical commissioning group, police force and local authority.
  • The trust leadership team were aware of the concerns raised by staff following the reconfiguration of community services and acknowledged that some lessons had been learned. They were now monitoring the impact of the reconfiguration and had commissioned an independent review which would include staff and patient feedback in the terms of reference.
  • Staff had access to support for their own physical and emotional health needs, including access to counselling and physiotherapy. Since the introduction of the physiotherapy service the trust had seen a reduction in staff sickness due to musculoskeletal problems.

Checks on specific services

Wards for people with a learning disability or autism

Good

Updated 5 October 2018

Our rating of this service stayed the same. We rated it as good because:

  • Staff participated and worked with outside agencies to promote and deliver the Stop Over Medicating People with a Learning Disability (STOMP) initiative. This is aimed at reducing the use of anti-psychotic medication for people with learning disabilities.
  • Since our last inspection, the trust had undertaken work to build seclusion room and a new clinic room to improve patient care and experience. The service also met the King’s Fund ‘enhancing the healing environment’. The trust had implemented safety huddles within staff handover meetings to try to improve staff and patient safety and managers had introduced other measures to try to improve safety on the ward.
  • Staff understood their responsibilities and had sound understanding of the Mental Health Act, Mental Capacity Act and safeguarding. Patients had access to a full range of multi-disciplinary professions and care plans were comprehensive and recovery oriented.
  • All of the patient care and treatment records that we reviewed contained comprehensive assessments and holistic recovery oriented care plans.
  • Observations showed positive interactions between patients and staff. Feedback from patients was positive about how staff supported them. Patients felt involved in their care and treatment and all patient care and treatment records contained comprehensive and holistic care plans. Patients left positive discharge messages for others.
  • Staff understood the trust’s visions and values and how they applied to their work.

However:

  • Managers did not always have effective oversight of the service. At the time of our inspection, there were 71 incidents which required manager review. This is something we told the trust they should address following our last comprehensive inspection.
  • Not all staff had received an induction or completed all of their required training before starting work on shift. Three training courses fell below 75% compliance and only 56% of staff were receiving clinical supervision in line with trust policy.
  • Shortages of staff had an adverse impact on the quality of care. Support staff could not always attend multi-disciplinary meetings or be actively involved in other reviews of patients’ care and treatment. This problem was compounded by a high rate of sickness.
  • There were deficits in the induction and training of staff. Some staff had not completed induction or mandatory training before working shifts on the ward. There were thirteen shifts over a three-month period that did not include the minimum required number of staff who had completed training in managing violence and aggression and restraint. This posed a particular risk because the service was standalone without surrounding staff who could assist in an emergency.
  • Carers did not always feel that staff listened to them and not all staff received feedback on the outcome of complaints.

Wards for older people with mental health problems

Good

Updated 5 October 2018

Our rating of this service stayed the same. We rated it as good because:

  • The wards were bright, clean and well maintained.
  • Each ward had a ligature risk assessment.
  • Staff safeguarding training was at 95% and staff were aware of how to raise safeguarding concerns.
  • All patient care plans that we reviewed were personalised, holistic and recovery focused.
  • Multidisciplinary team meetings were patient focused.
  • The culture within the service was a very positive one with staff being complimentary toward the managerial staff.

However:

  • Dovedale ward’s records of emergency equipment being had gaps which showed that checks were inconsistent.
  • The walkway to the garden on Dovedale ward was slippery and could be dangerous for patients.
  • The rate of clinical supervision for staff was below the trust target.
  • Although good practice in relation to delayed discharges had been implemented across both wards, G1 ward had a disproportionate number of delayed discharges due to the nature of the patients.

Mental health crisis services and health-based places of safety

Requires improvement

Updated 5 October 2018

Our rating of this service stayed the same. We rated it as requires improvement because:

  • Staff were struggling to deal with the volume of calls to the crisis service. The team had no way of knowing how many people had not been able to access the service. The service had a significant waiting list and the telephone system was not fit for purpose in that people could not always get through.
  • There was a significant delay in patients receiving a timely Mental Health Act assessment. At the time of the inspection there were 13 people awaiting a Mental Health Act assessment.
  • Staff were not always given the time to fully review triage/risk information before providing care, treatment, and support. Patients had to repeat information or answer the same questions during assessments.
  • Staff were providing a range of care and treatment interventions but this was not always documented in a written care plan.
  • Multidisciplinary team meetings at Netherthorpe House took place regularly but their effectiveness was limited. There was no clear focus and meetings were held at the same time that assessment appointments took place, which meant that some staff could not attend.
  • There was mixed staff morale across the teams. Some members of the single point of access/emotional wellbeing team did not feel valued or supported by the trust.

However:

  • The trust had responded to the last inspection and made improvements to the health-based place of safety. Staff were now completing risk assessments, and carrying out physical health checks and observations as required. There were monthly audits of the activity in the health-based place of safety. Joint liaison meetings were taking place with representatives for all agencies.
  • Although some staff did not feel valued, senior managers were aware of the issues in relation to the single point of access/emotional wellbeing service. Issues regarding the service were included on the risk register. Weekly meetings were taking place and plans for a crisis hub were being developed.
  • Staff carried out an initial triage for all new referrals. Any emergency referrals were offered an assessment within four hours and any routine assessments were allocated to the emotional well-being service. All records reviewed contained a risk assessment.
  • Staff were up to date with mandatory training and were receiving regular supervision and appraisals.
  • The issues with the telephone system had been escalated and the trust had put some mitigation in place to support the system.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 5 October 2018

Our rating of this service improved. We rated it as good because:

Community-based mental health services for adults of working age

Good

Updated 5 October 2018

Our rating of this service improved. We rated it as good because:

  • The service buildings were clean, tidy, wheelchair accessible and staff carried out environmental risk assessments and health and safety tests were up to date.
  • Staff ensured that patients could provide feedback on the service they received. The feedback that we collected suggested that staff treated people with kindness, dignity and respect and were polite, caring and compassionate. The service ensured that patients had access to advocacy, signers, translators, spiritual support and speech and language therapists.
  • Staff responded quickly when patients’ health deteriorated, prioritised urgent referrals, encouraged patients to attend healthcare appointments and encouraged them to lead healthier lifestyles. Staff communicated with patients with communication issues using cue cards, easy read information and translators. They engaged with patients who failed to attend their appointments and supported patients in accessing education and work opportunities.
  • Staff were skilled and experienced, were appraised and had access to specialist training for their role. Staff knew about safeguarding, whistleblowing, the duty of candour and handling complaints. Staff reported incidents appropriately and told us that they could raise concerns without fear of reprisals.
  • Staff had a good understanding of the Mental Health Act and the Mental Capacity Act. We saw evidence in patients’ care records that staff had undertaken mental capacity assessments when this was indicated. Staff involved other professionals within and external to the team when appropriate and helped patients to make decisions on their own behalf.
  • Staff had carried out a range of clinical audits within the service between February 2017 and May 2018, including an audit in relation to the identification of carers and assessment of their needs. Staff were given opportunities to consider ideas for improving and innovating and participated in national audits.

However:

  • The clinic room was too small for patients to receive depot injections in a seated position at the Mental Health Recovery North service.
  • Staff at the Mental Health Recovery North service were not up to date with their mandatory training. Staff sickness absence rates were high at the Mental Health Recovery North and Home Treatment Team services which resulted in poor staff morale. Staff told us that their caseloads were high.
  • Staff at the Mental Health Recovery North service did not update patient care plans or risk assessments regularly.

Forensic inpatient or secure wards

Requires improvement

Updated 5 October 2018

Our rating of this service went down. We rated it as requires improvement because:

  • Staff did not provide information in alternative formats or languages. There were no information leaflets for patients whose first language was not English. Patients were not asked if they wanted to receive information in alternative languages or formats.
  • Patients did not have access to nurse call systems. None of the rooms within the service was fitted with nurse call systems and patients were not provided with any form of hand held or personal device. This meant that patients could not summon help if they needed it.
  • The service produced a ward booklet for patients, which provided patients with the rules, and restrictions in relation to smoking but staff did not follow these. The implementation of the policy relating to contraband items was delayed as the ward manager was not aware of any updates.

However:

  • Since our last inspection, work had been carried out to reduce ligature risks in the service. All the bathrooms in the service had been refitted with anti-ligature fittings. The doors in the service were in the process of being refitted with anti-barricade doors that had anti-ligature fittings.
  • Patients were able to access courses through a recovery college, which allowed them to learn about their illness or gain recognised qualifications.
  • Staff had a good understanding of the Mental Health Act, Mental Capacity Act and safeguarding.

Acute wards for adults of working age and psychiatric intensive care units

Requires improvement

Updated 5 October 2018

Our rating of this service went down. We rated it as requires improvement because:

  • A high number of posts for qualified nurses were unfilled and there was a reliance on bank and agency staff to maintain safer staffing numbers. Despite the use of bank and agency staff, there was not always the required number of staff on duty to undertake physical interventions safely.
  • Demand on staff time, acuity and staffing levels remained a constant challenge.
  • Staff did not always manage medications correctly.
  • Staff did not receive regular clinical supervision.
  • Patients subject to restrictive interventions, such as seclusion or rapid tranquilisation, did not always receive appropriate monitoring or support.
  • Safeguarding procedures for children visiting the service were not always robust.
  • The service was not always well led. The service did not effectively use its systems and processes to ensure actions were identified and change was implemented. Audits within the service were not regularly completed or effective at identifying issues.

However:

  • The service had a positive and proactive approach to least restrictive practice.
  • The service undertook comprehensive assessment of patients’ mental and physical health upon admission to hospital. Assessment and management of patient risk was thorough.
  • Staff received mandatory training and annual appraisal.
  • The trust promoted a culture that supported and valued staff. Staff across the service were committed to delivering the best quality care.
  • Patients and carers spoke positively about the service. Engagement by the trust was good.

Community-based mental health services for older people

Outstanding

Updated 5 October 2018

Our rating of this service went up. We rated it as outstanding because:

  • The environment was clean, tidy and well maintained. The building was bright and welcoming and there was clear signage for visitors.
  • Staff completed risk assessments for all patients and they were detailed and addressed risk and how to manage it appropriately.
  • Mandatory training for the team was all above 80%.
  • Staff received meaningful supervision and appraisal on a regular basis.
  • Assessments were comprehensive and completed in a timely way. Service users were seen quickly from being referred.
  • Staff were kind and caring towards service users and carers. Staff were highly praised by service users and they were observed to be empathic and sensitive.
  • Staff had reached out to harder to reach communities by attending groups for the South East Asian community, the Chinese community and the Somalian community. Here they spoke about mental health and the support that their team could offer.
  • There was a strong emphasis on maintaining patients’ links with the local community with lots of groups for older people and an active service user group who made decisions and gave feedback on proposed changes to the service.
  • There were strong links with external services such as care homes and GPs. Staff met regularly to discuss service users with complex needs.
  • The senior team had good oversight of staff performance including sickness, supervision and appraisal. Staff feedback about the support they received from managers was universally positive.

Substance misuse services

Good

Updated 30 March 2017

We rated substance misuse services as good because:

  • All areas were clean, well maintained and offered good facilities for the provision of services. Clients and staff told us they felt safe using the service. Services sharing locations had separate entrances for their clients.

  • Staff had good knowledge of safeguarding procedures and made appropriate referrals. There were beneficial links with the local authority safeguarding team who provided guidance and training to support the service.

  • Clients received care and treatment underpinned by best practice. Clinical staff demonstrated a good working knowledge of guidance and treatment options for drug and alcohol users. They received weekly continuous professional development and could access specialist training relevant to service delivery.

  • Partnership arrangements ensured a multidisciplinary approach. Staff had formed effective external working relationships with the local recovery community and mutual aid groups. This provided clients with further support and activities during and after their treatment with the service.

  • Clients spoke positively of the service; they felt involved in their treatment options and told us the staff team treated them with kindness and respect. We observed positive interactions between staff and clients in clinics and group sessions. Staff understood the needs of their clients and used this to build positive relationships with them.

  • Staff ensured that it was easy for people to access the service. Waiting times to access and begin treatment were better than national averages. People could attend for assessment at the opiate, non-opiate and alcohol services without an appointment. Staff were able to provide flexible appointment times.

  • The alcohol service had developed and updated an online screening tool for monitoring alcohol intake, which allowed health and social care professionals in Sheffield to make direct referrals into both the alcohol and the non opiate service.

  • Services provided a range of clinics and access to specialist staff to meet people’s needs and preferences, offering choice and continuity of care. This included home detoxification, wound care clinics, clinics for those using performance enhancing drugs and inpatient detoxification.

However:

  • Staff in the opiate service did not use appropriate areas to activate urine tests and dispose of clinical waste. Instead, they used consulting rooms that were not fit for this purpose. This meant that staff and clients were exposed to an avoidable infection control risk.

  • Staff did not always update risk assessment records and management plans using the trust's recognised risk assessment tool following changes in a person’s circumstances or following a multi-disciplinary team review. Risk plans did not include agreed actions staff would take if a client missed an appointment or dropped out of treatment unexpectedly.

  • Clients did not always have care plans that were holistic, or recovery orientated. Some concentrated solely on appointment attendance and maintenance of treatment. Clinical staff did not routinely audit the quality of clients’ care records.

  • Services received over 500 telephone calls a day and had difficulty managing the volume of daily telephone calls. This meant that clients and professionals experienced delays when trying to contact the service.

  • Services were not able to monitor their team’s performance adequately at local level. Trust figures showed staff were not compliant with mandatory training and the recording of supervision compliance. There was a need to improve the mechanism for recording training and supervision sessions.

Community mental health services with learning disabilities or autism

Good

Updated 30 March 2017

We rated community mental health services for people with learning disability or autism as good because:

  • Clients told us that they felt involved in their care and decisions made about their care and if they wanted a copy of their care plan they received one.

  • Clients told us that staff were interested in their well-being and reported that they were happy with the services that they received from teams. Clients told us that staff were polite, respectful and caring.

  • We observed staff interactions with clients and their carers. We saw that staff explained to clients the purpose of their visit.

  • Incidents were reported by staff and were handled appropriately. After each incident staff and clients were debriefed and a review of the detailed risk assessment and management plan took place.

  • The environments were accessible to clients who had difficulty with their mobility. Staff mostly saw clients in their own homes or other community venues.

  • Staff understood the lone working policy and everyone understood their responsibility to stay safe.

  • Staff completed assessments focussed on the involvement and intervention that the client required. They reflected the individual need of the client. Psychological therapies were available including cognitive behavioural therapy, dialectical behaviour therapy, and acceptance and commitment therapy.

  • The teams had developed pathways to other services, for example to employment, housing and palliative care to enable them to access the most appropriate services. Where more specific knowledge was required, staff signposted clients to other organisations that were more appropriate to advise and support.

  • Staff attended a number of meetings some monthly and some bi-monthly. These meetings allowed for the managers of the community teams to look at the service they were providing and the quality of the service. Professional meetings take place on a weekly basis at team level and a monthly basis at service level to allow for the development of various professions.

  • Staff reported they did not feel bullied or pressured in their role and they felt confident about taking any concerns, complaints or safeguarding to their line manager in order to keep clients safe.

However:

  • The recording of mental capacity assessments was inconsistent, and did not always follow the Mental Capacity Act Code of Practice. Staff understanding about the Mental Capacity Act was varied and the Act was not always discussed by staff making plans for clients care.