Providence House and Moira House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We assessed all the quality statements from this key question. the rating from the last inspection, was good. Our rating for this key question is good. Staff assessed the mental and physical health needs of young people on admission which meant staff had identified key physical health needs and developed a comprehensive care plan. The service provided a full range of treatment for the young people. All young people had a psychologist and access to therapy groups. Young people's care met their needs and reflected any protected characteristics. For example, care plans reflected dietary requirements due to health needs, and we saw examples of care plans recognising young people who identified as different genders to those assigned to them at birth Staff always supported young people to lead healthier lives. We saw outdoor activity encouraged. Staff offered activities and advice to support young people with healthy eating and to take more exercise.

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 assessed the physical and mental health of all young people on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected the young person’s assessed needs, and were personalised, holistic and recovery oriented. Young people told us staff took an interest in their individual needs and these were reflected in the diverse nature of activities while on leave for example horse riding or outdoor adventure activities.

Staff completed a comprehensive mental health assessment of each young person either on admission or soon after. Assessments considered the young person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. Assessments were up-to-date and staff understood people’s current needs. The needs of staff in relation to their health and wellbeing needs were addressed with a staff room away from the wards and external support available for staff who required emotional support.

Staff developed a comprehensive care plan for each young person that met their mental and physical health needs. The electronic record system allowed for more than one care plan to be prepared, and we saw that the care plans were comprehensive and being shared with the young people. Each care plan fed into a different aspect of care, allowing a holistic approach to nursing. Staff regularly reviewed and updated care plans when needs changed, and we saw young people’s care being discussed daily within the morning huddle. Care records showed that physical health assessments were on-going from admission, with weekly checks on weight, pulse, blood pressure and other aspects of physical healthcare, with the young person’s consent. Where patients refused to allow physical health checks these refusals were recorded and we saw where staff had recorded different approaches to encourage the young person to engage.

Young people confirmed they had regular health checks with staff measuring their weight, height and blood pressure. They had information and advice about their health, care and support and how that helped their care. They attended meetings about their care and saw that it was co-ordinated. Young people told us they felt that their care was individualised towards their needs.

Managers and staff stated that young people could access psychological therapies. There was a consultant clinical psychologists supported by psychotherapy, occupational therapists and assistant, teaching staff and positive behaviour support staff helping to delivery therapy-based care. We saw staff had made referrals to other services where needed, including podiatry, dieticians and chiropodists. Staff told us and the young people confirmed they received information about their treatment at multi-disciplinary team meetings and said they supported patients to understand their medicines if they were unsure about what they were taking or any side effects.

Managers carried out audits on a range of quality and treatment issues. These audits allowed managers to reassure themselves of the quality of assessments. Staff provided a range of care and treatment suitable for the young people in the service. Staff delivered care in line with best practice and national guidance. We saw a variety of activities for young people to engage with. We saw professional support with self-reflective groups which encouraged young people to understand how they regulated their emotions. Staff identified the young person’s physical health needs and recorded them in their care plans. Nurses were using standardised tools to carry out an assessment of the young people to understand their physical health needs. Care records showed that physical health assessments were on-going from admission, with weekly checks on weight, pulse, blood pressure and other aspects of physical healthcare, with the young person’s consent.

There were a number of different professionals who provided care for the young people. The young people told us that they felt all of them understood their needs and they all knew what progress they were making or if changes to their care had been agreed.

Staff held regular multidisciplinary meetings to discuss the young people and improve their care. They held multidisciplinary meetings, and these were structured around the needs of the young person. Staff made sure they shared clear information about the young people and any changes in their care, including during handover meetings. We also saw staff discussing young people’s welfare and staff were able to change observation levels immediately.

We saw that young people received care from a range of different staff or services, and it was co-ordinated effectively. All relevant staff and services were involved in assessing, planning and delivery of young people’s care and treatment and staff work collaboratively to understand and meet those needs.

We saw that staff had access to the information they needed to appropriately assess, plan and deliver care, treatment and support. There were plans for discharge and these showed the provider working closely with other external providers to ensure they reflected the young people’s individual needs, circumstances, ongoing care arrangements and expected outcomes. When young people were due to move between services, all necessary staff, teams and services were involved in assessing their needs to maintain continuity of care.

Young people told us they were supported to manage their own health, care and wellbeing needs by staff who understood their needs and preferences. They could tell us about how they were supported to change diets or to exercise. They told us their health and wellbeing needs were regularly discussed in meetings about their care and in one to ones with their named nurse.

Staff made sure young people had access to physical health care, including specialists as required. We saw that young people had accessed dentists and opticians. Staff met young person's dietary needs, and assessed those needing specialist care for nutrition and hydration. Young people told us that any religious or dietary needs were met with halal food and vegan diets supported.

Staff identified young peoples physical health needs and recorded them in their care plans. Nurses were using standardised tools to carry out an assessment of the young person to understand their physical health needs These health screening tools included NEWS2, Malnutrition Screening Tool (MUST), as well as assessments for diabetes, cholesterol and hypertension. Staff met the young peoples dietary needs, and assessed those needing specialist care for nutrition and hydration.

There were regular community meetings and young people told us they could make suggestions and offer solutions to issues. We saw from those minutes that staff responded to the young people’s requests and had arranged different activities because of those requests.

Staff told us they took part in clinical audits, benchmarking and quality improvement initiatives. Local audits took place such as audits of clinic room fridge temperatures, compliance with malnutrition screening, and infection control. Staff were also involved in service improvement projects in areas such as care planning.

Managers used results from audits to make improvements. The service had implemented a new audit procedure to improve quality assurance. Audits now covered reducing restrictive practice, record keeping and medicines management.

Only one young person was detained under the Mental Health Act with others detained under a Deprivation of Liberty Safeguard order (DoLS). Those young people understood their rights and had consented to treatment where appropriate. Those young people not detained understood they could leave at any time. The young people had easy access to information about independent mental health advocacy and they confirmed that they regularly attended, and they spoke to them.

Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. There was external Mental Health Act administration support and staff knew who to ask for support. The service had clear, accessible, relevant and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice.

Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles.

Staff stored copies of young people’s detention papers and associated records correctly and staff could access them when needed. We examined the mental health and DoLS paperwork and found them to be correct. Managers and staff made sure the service applied the Mental Health Act correctly by completing audits and discussing the findings. We looked at an audit that confirmed this. Staff gave young people all possible support to make specific decisions for themselves before deciding if a young person did not have the capacity to do so. Staff assessed and recorded capacity to consent clearly each time a young person needed to make an important decision. Consent to treatment and a young person’s capacity were clearly recorded in all records.