Brook Burnley

We found the following areas of good practice:

• Safeguarding procedures were robust and staff had received the appropriate level of safe-guarding training and were compliant with national guidance. There was regular safeguarding supervision for staff. Mandatory training levels were good with all members of staff compliant with training on the day of the inspection.
• There was an organisational approach to the reporting and grading of incidents. Staff at Brook Burnley were confident to report incidents and there was feedback of learning to staff.
• Staffing levels were adequate though there had been a vacancy. Staff from other clinics and agency staff, who had previously worked for the service, addressed most of the staffing shortages. There was a business continuity plan that had been updated following an information technology failure in 2016.
• There were policies and procedures for patient treatment that followed national guidance and these were reviewed annually. Staff were assessed as competent and were being trained to deliver level two sexual health services.
• There were examples of multi-disciplinary team working including with children’s and adolescent mental health services and other organisations in the statutory and voluntary sectors.
• There was a focus on the health and well-being of children and young people and staff worked with a number of agencies and organisations to improve their outcomes.
• The consent procedures of the clinic were robust and staff had received training in the mental capacity act.
• Children and young people who used the service were treated with privacy and dignity. There was a holistic approach to the health and well-being of children and young people.
• Feedback from children and young people was positive and they were full of praise for the service.
• There was a counselling service which was run by staff and volunteers; this service had made a great impact on some of the children and young people who had accessed it.
• The clinic opened on a number of days including Saturdays, access to the service was good for all potential patients and referral processes included self- referral. Information was also available via a website, which was user friendly and appropriate for the age group accessing the service.
• Information for patients was available in various formats and met the needs of people with a learning disability or poor literacy skills and those whose first language was not English.
• The clinic was responsive to patient feedback and had started to provide appointments at different times following feedback from children and young people.
• Information about how to complain was available in a number of formats and complaints were well managed and learning shared.
• The service had a vision and strategy, which staff were aware of and the culture of the service was open with a strong focus on the rights of children and safeguarding.
• There were clear governance structures in place across the organisation and a data analytics tool which provided audit and activity data to the service managers to monitor and improve services, where appropriate.
• Public engagement with children and young people was very strong with the organisation being the “voice of the young person.”

However, we also found the following issues that the service provider needs to improve:

• Reported risks were not always current and relevant and risk assessments that had been completed were not always acted upon.
• We had concerns about the checking and recording of medicines as we found evidence that medicines were not checked and recorded according to the organisational policy.

Following this inspection, we told the provider that it should take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.