Providence House and Moira House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed all the quality statements from this key question. The rating from the last inspection, was requires improvement. Our rating for this key question is good. There were effective governance systems and processes in place to ensure that the provider had appropriate oversight and monitoring of the care and treatment being provided to young people. The systems and processes in place did assist staff in assessing, monitoring, and improving the quality and safety of the services provided. We found systems to address ligature risks, patient risks and fire safety checks were always actioned or recorded. The delivery of quality care was assured by the leadership and governance. There were performance management and audit systems and processes in place which ensured managers had up to date information on the performance of the service. Risks identified within action plans were reviewed or actioned.

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 told us they felt supported and worked well with each other. They knew the managers well. Staff felt morale was good. This was a diverse workforce, and they felt there were no incidents of racism and they would be supported if they raised concerns about practices or individual behaviour.

At the last inspection concerns were raised that the service was not sufficiently preventing a closed culture from developing because they had ineffective practices for safeguarding and investigating incidents. Prior to the first assessment in April and the second assessment in July there had been a number of anonymous whistleblowing’s. Some of these contained information that was found to be inaccurate or about issues beyond the scope of the Care Quality Commission. On both assessment visits we were reassured those managers had put in place practices that had increased scrutiny of incidents and an increase in the quality of safeguarding practices. We looked at several incidents and found on each occasion managers had fully investigated, debriefed staff and the young person, and reported appropriately to the correct authority. We spoke with other safeguarding bodies, and they were satisfied with the reporting from the service.

The management team operated from a building a short walk from the wards but staff told us they attended the wards daily. During the inspection we saw managers and interacting with the young people. Managers knew the names of the young people and were approachable. Managers completed regular walk arounds of their services.

Staff were effectively managed and supported by managers. Training compliance was high. There were monthly team meetings for staff with a set agenda covering performance and concerns that staff might raise. Managers had addressed concerns about whistle blowing and had create a staff only relaxation area which had an anonymous reporting box. They had even employed an independent specialist and had hired rooms away from the provider where staff could attend and raise issues in complete anonymity. No member of staff had used that opportunity. Supervision figures were at 100%.

Staff felt there was a positive culture on the wards. Managers told us the multidisciplinary team worked well together. However, from the staff team meeting minutes we could see that staff had raised issues with atmosphere between colleagues with this being described as talking about other colleagues behind their backs. Managers has responded to this by reminding staff about professional boundaries. Staff also reported that they felt previous concerns about different staff members getting better shifts had been addressed.

The service also had a whistleblowing policy in place and had developed this further after the last inspection by developing opportunities for staff to report issues directly to the service and in an anonymous way. We saw from staff meetings that staff were not afraid to raise concerns if they had concerns about how they were treated be that unfavourable shift allocations or if they felt they were given inappropriate tasks.

Staff told us they enjoyed working at Providence and Moira House. Some issues had been raised anonymously but staff told us they felt confident that any issues raised would be listened to and considered. Managers had met with staff to ensure they were clear about their rights as employees, and that they understood they could raise any issue at any time.

Managers did unannounced out of hours visits to ensure standards were maintained and to offer support to staff working unsocial hours. There were several processes in place for staff to report any issues or complaints they might have, either in person or anonymously. Processes in place monitored the experiences of staff. Policies, procedures and quality assurance processes sought to consider specific cultural challenges or identify any shortfalls in the experience some staff received.

Managers acknowledged that the service had been through some quite significant periods of change in terms of new processes and systems. Since the last inspection Providence House and Moira House had become one service and become registered as a mental health service. They recognised the impact of the findings of the last inspection report which had driven those changes and focused managers attention on preventing closed cultures from developing. Managers had changed working practices, employed new staff to new roles to ensure safeguarding and incident investigations were of a good standard. They had increased training for the staff and introduced new working practices which had for a period put staff under pressure during the changes to the service.

There was a clear framework of what must be discussed in team meetings to ensure that essential information, such as learning from incidents, was shared and discussed. The provider had policies to guide staff in the day-to-day operation of the service. There was a standard agenda to ensure consistency, and meetings served a clear purpose and were well managed. Clear governance systems promoted good oversight. Governance was fundamental to service development and was informed by meetings of young people, carers and staff across the service, feedback from surveys, consistent audit and monitoring. Managers made necessary changes and ensured learning was disseminated. Governance and performance processes reflected best practice. They were effective and strong, they identified and addressed issues and were used to make improvements. Managers had ensured the wards were staffed to safe levels and young people were safe and treated kindly. Staff undertook or participated in regular clinical audits to ensure quality, such as care plans, risk management plans and medicines audits. The audits provided assurance and staff acted on these results when needed. Audit findings were dealt with in a timely manner. Staff understood the arrangements for working together and with other teams, external to the service to meet the needs of the young people.

Young people told us staff and leaders collaborated with health professionals and supported them with appointments. Several young people told us they felt that this placement was better than any other they had previously received care in. They were included in decisions not only in their care but also about the environment they lived in.

Managers could clearly explain and evidence collaborative working with local authorities who had placed the young people with the service. Safeguarding leads were clearly able to discuss safeguarding cases and how they worked with the local safeguarding board. Staff could explain safeguarding procedures and how they could be used to protect young people. Staff told us young people received regular input from community health professionals. They encouraged young people to access services and a number of them had received help with their individual health needs.

The service was able to demonstrate they had received a number of compliments from partners who had placed young people in the service. The service also used a number of local health providers to support the needs of the young people, and to help them progress in their recovery.

There were systems in operation to ensure the young people had regular physical health checks and these were recorded within the young persons records, and we could see they attended local surgeries when and if required.

Managers told us about the learning the organisation had done following the last inspection and how that had reshaped management structures and working practices. Managers had created and recruited to new roles to improve governance and learning.

Management had established new systems to ensure care was audited to improve the service. They told us how this has been implemented and was now established within the service. They recognised that a change was needed and how there has been a positive impact on how these auditing systems had helped improve the service.