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Provider: Sheffield Health and Social Care NHS Foundation Trust Inadequate

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

Inadequate

Updated 30 April 2020

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

  • We rated safe and well led as inadequate, effective and responsive as requires improvement, and caring as good.
  • We rated three of the trust’s core services inadequate overall, and two of the trust’s services as requires improvement overall. In rating the trust overall, we considered the current ratings of the five services not inspected this time. The adult social care and primary medical services provided by the trust were not inspected this time, and their previous ratings were not aggregated into the trust’s overall rating. We rated well-led for the trust as inadequate.
  • At this inspection, three of the trust’s core services had worsened since the last inspection. Acute wards and psychiatric intensive care units had worsened from a rating of requires improvement to inadequate. Wards for older people with mental health problems had worsened from a rating of good to a rating of inadequate and crisis and health-based places of safety had worsened from a rating of requires improvement to inadequate. Community mental health services for adults of working age had worsened from a rating of good, to a rating of requires improvement. We had not seen the required improvements in forensic wards and this service had maintained a ratings of requires improvement.
  • The trust did not always provide consistently safe care. We identified issues during our inspections in relation to; staffing, mandatory training, safeguarding, the management of physical health, environmental safety, risk assessment processes and incident reporting and management.
  • The trust did not always provide effective care. The trust had failed to appropriately monitor and deliver staff supervision and appraisal, and there were not audits in place to monitor adherence to the Mental Capacity Act. Specialist staff were not in place to deliver the range of care and treatment required.
  • There were some pockets of culture within the organisation which was not caring and compassionate. This included that staff had used non-approved restraint techniques on one ward, and that care plans were not entirely person centred and recovery orientated.
  • The trust was not always responsive to the needs of patients. Areas of the trust estate were not fit for purpose. Dormitory accommodation remained in use and the seclusion areas were not all private, comfortable and dignified. Some community services held long waiting lists and complaints were not always managed in line with the trust’s own policy and in a timely way.
  • The delivery of high quality care was not assured by the governance of the trust. There were low levels of staff satisfaction and the trust did not prioritise the supervision, training and appraisal of staff. Leaders did not always understand, manage and mitigate the risks faced by front line services. The information that was used to monitor performance and make decisions was not of high quality which had a direct impact on the quality and delivery of services. The trust had not addressed all the areas identified for improvement at the last inspection. Where leaders were cited on issues and risks they had not acted with enough pace to make required improvements.

However:

  • We rated forensic inpatient wards as good in the effective, caring and responsive key questions. The caring key question was rated as good or outstanding across the trust other than in acute wards and psychiatric intensive care units (this considered the ratings of services not inspected this time).
  • The trust encouraged staff to learn lessons from incidents and worked from a multi-agency approach to manage safeguarding across the organisation.
  • When serious incidents had occurred, the trust had taken visible action to mitigate risks and had complied with action plans in making service improvements in line with regulation 28 reports.
  • Staff interactions we observed during the inspection we kind, compassionate and respectful. The leaders of the organisation acted within the values of the trust.
  • The trust had good working relationships with partner organisations and was an active member of the accountable care partnership. The trust focussed on providing care across the city of Sheffield to meet the needs of the community.
  • The trust encouraged patient and carer engagement and actively sought feedback on services to make improvements. They encouraged patients to become active partners in their care. The strategy for quality improvement was underpinned by patient and carer feedback and involvement.
  • The trust were aware of the diverse needs of the population they served and put services in place to meet these needs.
  • The trust continued to have a partnership in Uganda to share teaching and learning.
  • Leaders were passionate about improving the care they delivered and keen to make improvements. They had attempted to seek assurance on the quality of care delivered via a variety of audits and research and via working towards the accreditation of some services.
  • Leaders were aware of some areas requiring improvement and had begun to take action. They were working on; rebuilding relationships with staff, organisational development (including board and council of governors) development, improving the quality of data, and replacing the trust information technology systems. The trust were in the process of revising their strategy.
  • The trust had maintained a strong financial position and there were limited cost improvement plans.

On the basis of this report, the Chief Inspector of Hospitals is recommending the trust be placed into special measures.

Inspection areas

Safe

Inadequate

Updated 30 April 2020

  • We rated the safe key question as inadequate in three of the core services we inspected and requires improvement in the other two services.
  • Not all services and inpatient wards were safe, clean and fit for purpose. Seclusion suites were not fit for purpose and were not in line with guidance in the Mental Health Act Code of Practice. Dormitory accommodation remained in place on inpatient wards. There had been several sexual safety incidents and patients continued to smoke on the acute wards. The layout of the psychiatric decisions unit was not in line with guidance for eliminating mixed sex accommodation, and patient areas were not private and dignified. The sites used to deliver community services were not always clean and private. Staff in community services did not have access to the equipment required to support patients in an emergency.
  • The trust’s governance systems and processes had failed to address that there were not enough numbers of suitably qualified, competent, skilled and experienced staff working within the trust. This had an impact on quality and safety of care. Services did not have enough nursing and medical staff, who were experienced, knew the patients and received basic training to keep patients safe from avoidable harm. The trust used agency staff on the acute wards and psychiatric intensive care unit who were not trained in the management of violence and aggression. Most staff employed in the acute ward and psychiatric intensive care unit were newly qualified and did not have the experience required when asked to lead shifts. The trust continued to report high levels of staff sickness and poor staff retention. The trust were aware of these issues but had failed to act in providing interim staffing arrangements to maintain safety.
  • The trust had not ensured that patients’ physical health needs and needs in relation to the monitoring of side effects of their medications were always managed safely and in line with national guidance. There was limited specialist input from pharmacy staff. The trust did not have a physical health strategy.
  • Staff did not always manage risks to patients well. In mental health wards for older people, falls risks assessments and associated management plans had not been completed adequately. On these wards, staff did not always complete the required observations of patients. In community mental health services, risk assessments were not always completed and/or updated and there was a lack of documented crisis planning.
  • Staff did not always record incidents of seclusion and restraint with the required detail in line with the Mental Health Act Code of Practice. This meant it was not possible to ascertain whether this was only used after attempts at de-escalation had failed. Staff had used non-approved restraint techniques in acute wards and the psychiatric intensive care unit.
  • The trust had a process for the reporting of incidents, and an incident management framework and investigation process. However, staff did not always recognise and report incidents accurately. This meant that the board had limited oversight of risks in front line services. The investigation process was complex, and the layers of reporting requirements had led to delays in making reports in a timely manner to the clinical commissioning group. Investigation reports were thorough, but the conclusion of reports was often that care was ‘good’ despite system errors. This meant that the trust was not able to make the required improvements where improvements were required. One of the four serious incident action plans we reviewed was poor quality.
  • The trust did not analyse and record the number of referrals made about safeguarding children and young people.
  • We issued a letter of intent to the trust because staff had allowed the admittance of four young people aged 16 – 17 to the psychiatric decision unit. Some of these young people remained on the unit overnight. Their accommodation was shared with adults and the required safeguards were not in place. The trust agreed to stop allowing this practice with immediate effect.

However:

  • Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. The trust held regular lessons learned events and annual safety events to share learning across the trust.
  • The trust worked well with other agencies to protect patients from abuse and provided safeguarding training.

Effective

Requires improvement

Updated 30 April 2020

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

  • We rated the effective key question as requires improvement in four of the five core services we visited and rated effective as good in forensic wards.
  • Care plans were not always person centred, they did not always reference the patient’s voice or opinion on their care and were not recovery orientated. There was a lack of evidence of discharge planning.
  • The trust did not undertake audits of the Mental Capacity Act and staff did not have all the tools they required to support patients when making best interest decisions.
  • The trust’s governance systems had failed to ensure that all staff received the appropriate supervision and appraisal necessary to enable them to carry out the duties that they are employed to perform. This was a concern at our previous inspection of the trust.
  • Teams did not have the full range of specialists required to meet the needs of patients. This included gaps in the provision of psychology, pharmacy, section 12 Doctors and occupational therapy in some services.
  • The trust did not offer training in the Mental Health Act to staff working in community mental health services.

However:

  • Staff used some recognised rating scales to assess and record severity and outcomes. They also participated in clinical and national audit, benchmarking and quality improvement initiatives.
  • Managers provided an induction programme for new staff.
  • The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • The trust had a mental health legislation committee to ensure compliance and monitoring of areas of responsibility under the Mental Health Act. Audits showed clear action plans which had made improvements. The training provided ensured that staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well.

Caring

Good

Updated 30 April 2020

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

  • We rated the caring key question as good in four of the five core services we visited during the inspection. In acute wards and psychiatric intensive care units, we rated caring as requires improvement.
  • Staff in front line services understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Staff we observed treated patients with respect, compassion and kindness.
  • Leaders were committed to working for the trust and cared about the communities in which the trust worked.
  • The trust encouraged the voice of patients and carers as partners in their care. They ensured that patients had access to independent advocates and staff informed and involved families and carers appropriately. The trust engaged with patients and their carers to involve them in services and received feedback to improve services.

However:

  • In acute wards and the psychiatric intensive care unit, staff did not always treat patients with kindness and compassion. Staff had used non-approved restraint techniques with some patients.
  • The trust had not always maintained contact with patients and their families during or following the investigation of serious incidents.
  • In mental health wards for older people, two of the care records we reviewed had a care plan which contained punitive or insensitive language.

Responsive

Requires improvement

Updated 30 April 2020

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

  • We rated the responsive key question as requires improvement in three of the five services we visited, and good in forensic wards and community mental health services for adults of working age.
  • The design, layout, and furnishings of inpatient services did not support patients’ treatment, privacy and dignity. Not all patients had their own bedroom with an en-suite bathroom and could not always keep their personal belongings safe. Seclusion suites were overlooked and did not always contain a bed.
  • There were lengthy waiting lists in community services. This included delays to Mental Health act assessments in the community and in health based places of safety.
  • The trust did not always manage beds well and this impacted on the ability of community services to fulfil their function. Staff reported lapses and delays when completing Mental Health Act assessments due to bed availability.
  • The trust treated concerns and complaints seriously and investigated them, however this was not always done in a timely manner in line with the trusts own policy.

However:

  • The trust were able to meet the needs of all patients who used the services including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.

Well-led

Inadequate

Updated 30 April 2020

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

  • In response to our findings, we issued a warning notice to the trust under Section 29A of the Health and Social Care Act. This limited the rating of this key question, to a rating of inadequate.
  • We rated the well-led key question as inadequate in three of the five services we visited and requires improvement in the two other services.
  • Local leaders did not ensure that risks in front line services were always escalated appropriately to ensure action by senior leaders.
  • There were several governance processes which did not operate effectively in the services we visited. This included processes for managers to deliver and monitor compliance with maintaining skilled staff via mandatory training, supervision and appraisal. The required audits were not in place for leaders to measure the quality of service delivery and compliance with legislation and guidance.
  • In community services, governance systems had not measured all risks to patients. This included a lack of access to emergency equipment, and a lack of monitoring of waiting lists.
  • We found recording issues in all the services we visited in relation to; the management of risk, care planning, the recording of incidents and the appropriate recording of seclusion incidents. This meant that not all staff had maintained a contemporaneous patient record.
  • Local leaders had not ensured that there were systems in place to ensure staff were able to monitor the physical healthcare needs of patients.
  • The management of staffing was a concern across all the services we visited. Managers had not ensured that services were delivered safely, with the correct number of suitably qualified staff. This had a direct impact on the quality of care, the availability of specialist staff and had resulted in significant delays in accessing treatment.

However:

  • Local leaders had a good understanding of the services they managed. They were visible in the services they managed and approachable for patients and staff. Staff felt that they had good relationships with local leaders. However, local leaders did not always escalate risks and concerns about the safety of their services to more senior leaders in the organisation to allow risks to be managed and mitigated.
  • Staff felt able to raise concerns without fear of retribution and the majority were aware of how to contact the trust’s freedom to speak up guardian.
  • Other than in mental health wards for older people, and in crisis services, staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Teams had access to the information they needed to provide safe and effective care and most used that information to good effect.
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

Inadequate

Updated 22 October 2020

Sheffield Health and Social Care NHS Foundation Trust provides inpatient services for older people with mental health problems. The service is available to people over the age of 65 years old who have or may have a mental health illness and who live within the boundaries of NHS Sheffield Clinical Commissioning Group. The service is accessed primarily via the trust’s community mental health services for older people. The service also accepts referrals via adult and older people liaison psychiatry services and emergency referrals in consultation with the trust’s on-call registrar team.

The trust provides two wards for older people with mental health problems:

  • Dovedale ward is an 18 bedded ward for older men and women who require hospital care for acute functional mental health conditions. This may include the acute phase of a severe mental illness such as schizophrenia, bi-polar disorder or severe depressive disorder and for those with a dual diagnosis of severe mental illness and drug/alcohol, or learning disability, or people with personality disorder and acute mental health needs. The ward is based in the Michael Carlisle Centre in South-West Sheffield. Patients can be admitted voluntarily or detained on the ward under the Mental Health Act.
  • Ward G1 is a 20 bedded (funded for 16) ward for the assessment and treatment of older men and women with organic mental health conditions such as severe dementia and associated challenging or highly distressing behaviour. Ward G1 is divided up into two areas, G1a and G1b. The ward is based in Grenoside Grange Hospital in North Sheffield. The majority of patients are detained on the ward under the Mental Health Act.

We did an unannounced focused inspection of the wards for older people with mental health problems, this was because we issued a warning notice at our previous inspection in January 2020. The warning notice detailed that the trust must:

  • Improvestaff compliance with appraisals, supervisions and mandatory training.
  • Ensure that patients’ physical health needs weremetand medication side effects monitored.

  • Ensure that patients were cared for in environments which are private and dignified.
  • Ensure that systems and processes are in place which were operated effectively to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users in receiving these services.

We did not rate the core service at this inspection. We looked only at those areas detailed in the warning notice where we had significant concerns and wanted to check that the service had improved.

On the day of the inspection there were 11 patients on Dovedale ward, all detained under the Mental Health Act. There were 11 patients on G1 ward, of which ten patients were detained under the Mental Health Act and one patient was voluntary.

Prior to the inspection, we reviewed all the information we held about the service.

During the inspection visit, the inspection team:

  • spoke with both ward managers;
  • spoke with seven other staff members;
  • reviewed the risk management plans of 12 patients;
  • reviewed the observation records of 12 patients;
  • reviewed the seclusion records of six patients;
  • attended a staff safety huddle;
  • looked at a range of policies, procedures and other documents relating to the running of the service.

We found:

  • Since our last inspection, both wards had made improvements. Staff had implemented these improvements during the COVID-19 pandemic which affected both wards impacting on their substantive staffing levels.
  • The service provided safe care. Staff assessed and managed risks well and received the basic training to keep patients safe from avoidable harm. The wards supported patient’s privacy and dignity and no longer relied on dormitory accommodation. Staff monitored patients’ physical health and the effects of prescribed medications.
  • Managers ensured staff received training, supervision and appraisal.

Mental health crisis services and health-based places of safety

Inadequate

Updated 22 October 2020

Sheffield Health and Social Care NHS Foundation Trust provide a range of mental health, learning disability and substance misuse services to the people of Sheffield.

The trust has four teams that make up the crisis services and they operate one health-based place of safety, which can accommodate two people and a Psychiatric Decisions Unit which can accommodate up to 10 service users. This inspection focussed on the Psychiatric Decisions Unit based at the Longley Centre.

We carried out an unannounced focussed inspection of mental health crisis services and health-based places of safety because we took enforcement action by issuing a warning notice following our previous inspection in January 2020. We did not rate the core service at this inspection. We looked only at those areas detailed in the warning notice where we had identified significant concerns and wanted to check that the service had improved. Our inspection looked at specific areas of the safe, effective and well-led key questions.

During the inspection visit, the inspection team:

  • spoke with three patients who had recently used the service
  • spoke with the service operational manager
  • spoke with five other staff members including nurses and support workers
  • reviewed the risk management plans of four patients who had recently used the service
  • looked at a range of policies, procedures and other documents relating to the running of the service.

We found:

  • The trust had addressed the safety concerns identified in the warning notice issued following the last inspection by making improvements to the physical environment of the Psychiatric Decisions Unit, implementing processes to keep young people safe, and ensuring staff completed their mandatory training.
  • The trust now ensured staff received an annual appraisal and regular ongoing supervision.
  • Our findings from the other key questions demonstrated that governance processes had improved and operated effectively at team level to manage performance and risk well.

However:

  • There was low compliance with some mandatory training courses due to the impact of the COVID-19 pandemic.

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

Inadequate

Updated 22 October 2020

We did not re-rate this core service during this inspection. We found evidence that the service had improved.

Sheffield Health and Social Care Trust provides three acute mental health inpatient wards for adults of working age and one psychiatric intensive care unit. The wards can provide care and treatment for up to 64 patients. Services are provided at the Michael Carlisle Centre and Longley Centre as follows:

The Michael Carlisle Centre;

  • Burbage Ward – 19 bed mixed sex ward (Includes five detox beds)
  • Stanage Ward – 18 bed mixed sex ward

The Longley Centre;

  • Maple Ward – 17 bed mixed sex ward
  • Endcliffe psychiatric intensive care unit – 10 bed mixed sex ward

The service was able to admit patients who were detained for treatment under the Mental Health Act (1983), those with deprivation of liberty safeguards in place and informal patients. Most patients were detained under the Mental Health Act at the time our inspection, there were no patients with deprivation of liberty safeguards.

The inspection was undertaken between 25 August 2020 and 27 August 2020. We visited all four wards during this inspection as part of our focussed inspection of this service.

We conducted this focussed inspection due to serious issues raised at the last inspection in January 2020. At that inspection we issued enforcement action to the trust to tell them they must make improvements to improve the quality and safety of care.

We previously inspected the acute and psychiatric intensive care unit services in January 2020 and the service was rated as inadequate overall. We rated the service as inadequate in the safe and well led key questions and rated the service as ‘requires improvement’ in the caring, effective, and responsive key questions.

At the last inspection we issued warning notices. We found the trust to be in breach of regulations within the Health and Social Care Act (Regulated Activities) Regulations 2014 for the following reasons:

  • The trust must ensure that patients are cared for in environments which are private and dignified. This includes the removal of dormitory accommodation and ensuring the seclusion suites and CCTV cannot be overlooked and that patients’ access to toilet facilities is appropriate. (Regulation 10)
  • The trust must ensure that staff undertake physical health monitoring with all patients. This includes monitoring of long term health conditions, monitoring after the use of restrictive interventions, monitoring of the side effects of medication, and monitoring patients’ physical health needs in line with national guidance whilst undertaking inpatient detoxification. (Regulation 12)
  • The trust must ensure that it addresses the fire risk associated with patients smoking inside the wards. (Regulation 12)
  • The trust must ensure that the premises used for seclusion are suitable for the purpose of which they are being used, properly used, properly maintained and appropriately located for the purpose they were being used. They must be in line with the Mental Health Act Code of Practice. (Regulation 15).
  • The trust must ensure that staff report all incidents, including all incidents of rapid tranquilisation and restraint.
  • The trust must ensure that staff maintain an accurate and contemporaneous record of patient care including seclusion records in line with the Mental Health Act Code of Practice. (Regulation 17)
  • The trust must ensure that staff do not use non-approved restraint techniques including the use of mechanical restraint and in line with the trust’s own policy (Regulation 13)
  • The trust must ensure that it is able to meet the needs of all patients admitted to the ward and ensure that patients with complex needs which staff are unable to cater for are not admitted. (Regulation 9)
  • The trust must ensure that sufficient numbers of experienced and suitably qualified staff are available on all shifts, and that staff are able to manage the high acuity of the ward. (Regulation 18)
  • The trust must ensure that all staff complete mandatory training. (Regulation 18)

We reviewed each of these breaches of regulation as part of this inspection.

Since the last inspection we have received further information that has raised concerns about the ongoing safety of the service.

During this inspection, we inspected the core service and only the safe key question. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity.

Before the inspection visit, we reviewed information that we held about the service. During the visit, the inspection team:

  • looked around all four wards, including the external areas
  • looked at the seclusion room on each ward
  • checked all clinic rooms
  • reviewed a sample of seclusion records, restraint records and rapid tranquilisation records for patients
  • reviewed a sample of incident reports
  • reviewed a sample of patients’ physical health monitoring records
  • spoke with the ward manager, deputy ward manager or senior operational lead for each ward
  • spoke with nine patients and six carers
  • interviewed eleven other staff including pharmacists, nurses, a psychologist and support workers
  • looked in detail at the risk assessments of 16 patients
  • looked at policies, procedures and other documents relating to the running of the service.

We found that overall issues had improved since the last inspection. However, there were still some areas of concern where changes the trust had made required further embedding. This included issues relating to staffing, the environments, timely actions following incidents, physical health monitoring, restraint and privacy and dignity issues.

Forensic inpatient or secure wards

Requires improvement

Updated 30 April 2020

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

  • Not all risks were documented on the ligature risk audit and not all staff were up-to-date with all their mandatory training. The service did not monitor the numbers of staff on shift that had been trained in immediate life support. Minimum numbers of staff on the night shift on the rehabilitation ward were not always sufficient to ensure safety in an emergency.
  • Not all care plans were holistic or recovery orientated. Staff could not always find information easily on the electronic patient record as they recorded things in different places.
  • The trust did not collect enough information to monitor the service, like whether medical staff received supervision and appraisal and how many child safeguarding referrals the service made. The service did not monitor and audit adherence to the Mental Capacity Act
  • Staff did not always monitor the temperature of the food fridges and freezers in the occupational therapy kitchens and some liquid medicines were not stored in line with good practice.

However:

  • The ward environments were safe and clean. The wards had enough nurses and doctors during the day and staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding adults.
  • Staff developed treatment plans informed by a comprehensive assessment. They provided a range of interventions suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in audit to evaluate the care they provided.
  • 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 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 understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

Community-based mental health services for adults of working age

Requires improvement

Updated 30 April 2020

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

  • The service did not always provide safe care. Not all clinical premises where patients were seen were safe and clean. Staff did not record the assessment and management of patient risk well. Staff had not completed and kept up to date with mandatory training.
  • Staff did not develop holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. Not all patients could access a Mental Health Act assessment in a timely manner. Staff had not received training on the Mental Health Act.
  • Staff did not always involve patients in care planning and risk assessment and did not seek their feedback on the quality of care provided. Staff did not always involve patients and give them access to their care plans.
  • The average waiting time for psychological treatments in the Mental Health Recovery Service South team was more than the Royal College of Psychiatrists recommendations of 18 weeks. The clinic room at the Mental Health Recovery Service South did not have a dignity curtain in place where patients received depot injections. Staff did not always follow up patients who missed appointments.
  • Telephone systems were not operating effectively to ensure that people are able to get through to the service they use by telephone easily. The information technology infrastructure did not work well. Governance systems were not always effective in identifying and acting on the concerns and risks within the service. Staff did not feel respected, supported or valued by senior management.

However:

  • The service had enough staff, who knew the patients to keep them safe from avoidable harm. Staff responded promptly to sudden deterioration in a patient’s health when they were aware of changes. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • Staff ensured that patients had good access to physical healthcare and supported them to live healthier lives. Managers supported staff with appraisals and supervision. Managers provided an induction programme for new staff. Staff from different disciplines worked together as a team to benefit patients. Teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff treated patients with compassion and kindness. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition. Patients could give feedback on the service and their treatment. Staff supported, informed and involved families or carers.
  • The service was easy to access. Staff assessed and treated patients who required urgent care promptly and patients who did not require urgent care did not wait too long to start treatment. The service met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.
  • Leaders had the integrity, skills and abilities to run the service. The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. Staff felt respected, supported and valued within their local teams and by their local leaders. The monthly governance report provided a wide range of oversight and managers were aware of many of the issues we identified.

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.

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:

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.