Providence House and Moira House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We assessed all the quality statements in the safe key question and found it to be good. The provider had previously been inspected and safe was rated as requires improvement. Our rating for this key question is good. There were safety policies in place to make sure the environment was safe for young people to be assessed in. We toured the environments of the wards and found them to be well maintained. There were effective systems and processes to protect people from abuse and neglect. Staff understood how to protect young people from abuse and had received appropriate training. Staff completed risk assessments for young people.

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.

We spoke with six young people during the site visits. The young people we spoke to were generally positive about the staff and felt that they were treated kindly and in a caring manner by staff supporting them. We observed mostly positive interactions between staff and young people. The young people told us they generally felt safe on the wards and described feeling informed and involved in their care and treatment. Patients were aware of how to raise any concerns or complaints and felt confident that they would be able to do so. We saw these complaints were recorded and feedback given on the resolution of those complaints.

All staff had received an induction, which included a fortnight of shadowing other staff members. Staff, including domestic staff told us they received debriefs and staff felt they were able to raise concerns.

At the last inspection gaps in the providers ability to record safeguarding’s and investigating incidents had been identified. On this assessment we found the provider had put in place systems for managing the young people’s safety incidents which were in date and contained relevant guidance for staff. Managers investigated incidents and there was evidence they disseminated learning amongst staff via learning events, briefings, and newsletters. We reviewed several incident reports and found them comprehensive in detail.

We saw that care and support was planned and organised with people, together with partners and communities in ways that ensured continuity. The views of the young people who used the service were listened to and taken into account.

All the young people at Providence and Moira House were under the care of local authorities who had parental responsibility. We saw regular updates with local authorities regarding plans for discharge. There were daily meetings to discuss daily activity and identify issues that required action. Staff told us that thorough handovers and debriefs took place to ensure information was shared about young people. Handovers were recorded and we saw they covered all the young persons activity that day, incidents that had occurred and changes to care implemented due to those incidents.

We saw that partners were consulted on all care decisions and attended regular meeting to discuss the care of the young people.

Discharge meetings took place with individual care co-ordinators to identify barriers to a yooung persons discharge, there was one instance of delayed discharge and we examined this and the delay was a lack of an appropriate placement being found by the care co-ordinators.

Young people reported feeling safe on the wards and that they felt that they could raise any concerns with staff or managers. They were mostly aware of how to raise a complaint and described that they would feel confident in doing so. Young people reported that they had mostly not experienced violence or aggression whilst on the wards. Where there were incidents of aggression, they told us they felt staff had dealt with them professionally and appropriately. Staff worked with local authority care co-ordinators to discuss responses to incidents and agreed care plans following incidents. Young people understood what actions staff would take to support them if they became agitated.

Following the previous inspection managers had put new systems in place. They could describe how safeguarding was managed on the wards and how any potential issues were escalated. Managers and staff were aware of who to contact if they needed any guidance or advice in relation to safeguarding. Managers reported that relationships with local safeguarding partners were generally positive. Managers could describe the current open and ongoing safeguarding issues on their wards. Staff understood how to safeguard young people and knew who to go to, to raise a safeguarding concern. There was evidence of staff raising safeguarding concerns in young peoples files, and staff shared safeguarding concerns in handover meetings.

We did observe staff and we saw staff interacting positively with the young people. All the staff members we spoke to were aware of safeguarding and could outline what role they were performing and the safeguarding risks present.

Safeguarding policies for children and adults were in place and up to date and staff had received adult and children safeguarding training at a level appropriate to the needs of the service. Minutes from meetings contained evidence that managers had considered safeguarding concerns during governance meetings. Staff training compliance was 100% and managers had attended level four safeguarding training. Managers were trained to level 5.

Young people told us they were always involved in the development of their care plan and risk assessment and a number of them told us about how staff had individualised their care plan at their request. Both young people and staff told us they had always had one to one sessions. We saw evidence of care plans reflecting guidance from care co-ordinators, for example providing pocket money or agreeing how a particular young person might address their own appearance.

Staff told us that they always had time to read a young person’s risk assessment and that they identified risks by reading the handovers and observation notes. Handovers on the two wards were consistent with each other and contained all relevant information to support young people effectively.

We reviewed 6 care records. Staff completed risk assessments for young people. These were comprehensive and updated either after a multi-disciplinary team meeting or after an incident. We found incidents were recorded within risk assessments. We found that care plans and risks assessments contained detailed guidance to often complicated behaviours. Staff we spoke with were able to describe the risk the young person presented to themselves or others. Staff told us that they had time to read risk assessments and that they identified risks by reading the handovers and young person's observation notes.

Young people were happy with the environment and that it resembled a house as opposed to a hospital ward. They liked that they did their own catering in partnership with the staff.

Staff told us that managers conducted regular environmental as well as ligature audits and we saw evidence that these had been completed and managers had discussed the results in senior management meetings.

Providence and Moira House are two almost identical modern built houses, purposefully designed. The environment was well maintained. However, on our second visit we did find some damage which had been caused by a young person and not yet repaired. Managers were able to provide evidence that goods and repairs had been commissioned to take place in the near future. Young people did not generally raise any concerns in relation to the safety of the environment. Each young person had their own bedroom with en-suite facilities, there was a communal kitchen and dining area as well as rooms for therapies to take place. The classroom was located a short walk from the wards in a different building.

During the assessment we reviewed both environmental and ligature risk assessments. These were generally well written. Staff knew about any potential ligature anchor points and mitigated the risks to keep the young people safe. For example, staff were assigned to a static observation post on the landing leading to the young people's bedrooms and staff could tell us the necessity for conducting observations. Staff had completed fire risk assessments for all buildings, and there were fire evacuation plans specific to each ward. All young people that needed them had personal emergency evacuation plans (PEEP) in place. Electrical and Gas checks were in place. Staff had easy access to alarms and young people had easy access to nurse call systems. All bedrooms were fitted with alarms. Staff always carried personal alarms on them.

Young people told us they had regular one to one session with their named nurse and we saw they had copies of their care plans in their bedrooms. Young people told us, and we observed, that leave and activities were rarely cancelled. We observed staff, including Occupational Therapists and their assistants, escorting young people on leave. Staff told us staffing levels were good and they felt safe and able to support the young people.

Staff told us that staffing levels were good, although there were still challenges as both wards were busy, staff felt they always had time to provide one to one support or support a young person’s leave. This supported what young people told us. Staff also told us that the staff team was supportive and that they received debriefs following incidents. There was a full complement of staff, for example, occupational therapists and psychology support.

We saw that staff did engage with the young people, we saw them cooking meals with the young people as well as completing activities. All staff could describe the young people and the needs, likes and dislikes of that young person.

Overall, the service had seven vacancies, five for health care assistants, a clinical psychologist and an assistant psychologist. All these posts were being actively recruited too. In three months less than 10% of shifts had been covered by bank or agency staff. The service also had a consultant psychiatrist, consultant psychologist, psychotherapist, assistant psychologist, occupational therapists and assistant, social worker and teacher as well as practice development nurse, positive behavioural support practitioner and a activity co-ordinator to support the nurses and support workers. The service had low sickness rates at 1.6% over 12 months and a 100% compliance with all training.

The young people we spoke to did not raise any significant concerns in relation to the cleanliness of the wards or about infection prevention and control.

Staff followed infection control policy, including handwashing. They told us that they washed their hands to prevent infection, and that personal protective equipment was available. Managers had put in place audits to ensure staff cleaned all areas when required to do and bedding and other soft furnishings were replaced according to the providers policy.

During the inspection we saw continuous cleaning activity, and young people told us that the wards were always clean and tidy, especially bathrooms and eating areas.

Staff made sure cleaning records were up-to-date, and the premises were clean. We reviewed cleaning rotas and spoke with cleaning staff; they were able to show us up to date and comprehensive records.

Young people understood their medicines and most felt involved in medicines reviews through multi-disciplinary team meetings. When we reviewed young people’s records, we found that they always involved them when making decisions about their treatment.

Staff reviewed the young people’s medicines regularly as part of the multidisciplinary meeting and provided specific advice to young peoples and those with parental responsibility about their medicines.

Medication cupboards were not over-stocked, and medication was in date. Emergency drugs were available and within date. Oxygen and resuscitation equipment, including defibrillators, were all maintained and recently checked. Staff checked, maintained, and cleaned equipment. Clinics were clean, tidy, and equipment requiring calibration had stickers to show when it was last checked. Sharps boxes were all in date, and not overly full.

Medicines are appropriately prescribed, supplied and administered to the young people in line with legislation, current national guidance and in line with the Mental Capacity Act 2005.