Archived: Brook Dudley

We carried out an announced comprehensive inspection on 25 October 2016 to ask the service the following key questions; Are services safe, effective, caring, responsive and well led?

Our Key findings:

W e found the following areas of good practice:

• The registered manager was the safeguarding lead for the service and was trained to the required level 4 in safeguarding children and young people.
• There were processes in place to act on historic safeguarding concerns.
• Staff treated young people with dignity and respect and engaged with young people in a caring manner.
• Young persons' records were complete, contained relevant information, and were up-to-date.
• Staff completed risk assessments in relation to young people and these formed part of the patient history.
• Areas were visibly clean; staff washed their hands appropriately between each patient interaction and used personal protective equipment.
• Systems were in place to monitor medications with patient group directives (PGD) available when required.
• Staff followed appropriate assessment guidelines when supporting people under 16.
• Staff respected young people’s confidentiality when in the reception area.

However;

We identified regulations that were not being met and the provider must:

• The provider must ensure that all clinical staff who contribute to assessing, planning and evaluating the needs of the child or young person are trained to safeguarding at level three as recommended in the safeguarding children and young people : roles and competencies for health care staff by the Royal College of Paediatrics and Child Health, March 2014.
• The provider must ensure infection control training is completed by all staff providing direct clinical care and involved in specimen collection and transportation.
• The provider must ensure there is a local risk register in place to provide overview of local risks.

There were areas where the provider could make improvements and should:

• The provider should ensure that staff are up-to-date with their annual mandatory training and appraisals.

• Ensure that all incidents are recorded and their severity assessed when they meet Brook young persons incident reporting criteria.

• Consider a local audit programme with action plans, mitigations and specified timescales when the service is not meeting agreed standards.

• Consider how the “Mental Capacity Act 2005” and its codes of practice may be relevant to the service and how the service is complying with the principles of the Act.

• Ensure electrical equipment is tested for safety as per manufacturer’s guidelines.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with three requirement notice(s) that affected Brook Dudley. Details are at the end of the report.