ADHD 360 Head Office

We carried out an unannounced comprehensive inspection at ADHD360 Head office in response to concerns received from external stakeholders, people using the service and anonymous whistleblowers.

Our key findings were:

• The provider did not have safe processes and procedures to manage and monitor blank controlled drug prescriptions. We were told on the day of the inspection that more than one person had access to the key safe to obtain keys to a variety of filing cabinets including those containing blank controlled prescriptions in the building. We were not able to determine if any prescriptions were missing.
• We were told following the inspection that staff who had access to the controlled prescriptions did not have the personal identity number of the prescriber. This was not an adequate control measure, if the scripts were stolen, they could be passed on to someone else externally who knows the personal number for other prescribers working for another service. Controlled drug prescriptions are not dispensed in a particular locality, so can and are transported to different areas of the country.
• Managers and the primary dispenser undertook audits into prescribing practice; however, we saw several examples where audits had identified where there were discrepancies about the dose, strength or formulation of prescriptions which did not describe management actions with the prescriber. We also saw instances where prescriptions were not signed or dated, this is a legal requirement.
• We were told not all staff had access to the incident recording and management system, this meant there was potentially a delay in putting measures in place to minimise the impact of the incident.
• Managers did not always ensure staff treated patients with dignity and respect. We saw an entry in complaints meeting minutes whereby patients who had made more than one complaint were cited as “repeat offenders".
• Managers provided a monthly update of learning points from complaints and incidents.
• Managers did not always respect staff; we saw multiple examples whereby staff had been discussed in meeting minutes. Examples included “keeping an eye,” “not working well,” “procrastinates a lot” and “sending defensive and rude emails” all the staff were named.
• Managers did not have sufficient oversight or recognised the risks posed by the lack of systems to manage blank controlled drug prescriptions.

However

• We looked at 15 care and treatment records, the provider aimed to mirror the National Institute for Health and Care Excellence (NICE) best practice guidelines, with nurse specialism and internal training. The provider assessed needs and delivered care in line with relevant and current evidence-based guidance and standards and patients’ immediate and ongoing needs were assessed. Individual care plans recorded where clinicians had prescribed outside British National Formulary limits. The decisions were based on clinical judgements and the rationale was clearly recorded and approved only when reviewed by a senior clinician. We saw environmental modifications to reduce the impact of ADHD symptoms were discussed as well as specific clinical needs and mental and physical wellbeing.

• We saw multiple examples of additional training for staff including cardiovascular management in ADHD, assessment and treatment of children, teens and adults with ADHD and Asperger’s Syndrome and attachment and trauma. We also saw that several staff had attended international conferences and events.

• Monthly drop-in sessions for staff looked at themes for detailed discussion for example, managing risk, physical health, and safeguarding.

• The provider understood the needs of their patients and improved services in response to those needs. The service had employed a patient enablement worker who provided coaching and family support for those with ADHD. Patients also had access to group support, access to work and benefit advice masterclasses.

• There were processes for providing all staff with the development they needed. This included supervision and career development conversations. All staff received regular bi-annual appraisals in the last year. Staff were supported to meet the requirements of professional revalidation where necessary. Clinical staff and admin staff were considered valued members of the team.