Greater Manchester Mental Health NHS Foundation Trust

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

There was sufficient staff to support young people, and staff had the required skills, and training to support young people in their care. All staff had received an induction before working on the wards and they had received suitable training and supervision. Risk assessments were up to date and staff knew where to find current information about young people and supported them in accordance with care plans and risk management plans. Staff followed systems and processes to prescribe and administer medicines safely. Staff understood how to protect young people from abuse, had received appropriate training and worked well with other agencies to do so.

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 did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Young people said they were involved in the development of their care plans and risk assessments. They were invited to multi-disciplinary team meetings to discuss their care and chose to attend some of these meetings. The meetings included discussions about goal setting and how to support people to move forward in their treatment.

There were regular meetings for young people and staff to discuss care pathways, transitions and where changes to risk had occurred. Multi-disciplinary teams worked together to support young people to get the best out of their treatment. Staff told us and we observed that thorough handovers and debriefs took place to ensure information was shared about young people. This ensured that all staff that worked with the young people gained an up-to-date picture of their risks and how to support them.

We received concerns from partners prior to our assessment which we followed up during are visit. Our assessment provided assurance that systems, pathways and transitions were safe.

Processes that we observed were effectively managing the safety of young people on the wards. These included handovers, regular multi-disciplinary meetings, safety huddles and reflective practice sessions. Systems that we looked at also ensured a good use of information which was accessible to staff to enable them to deliver safe care, for example feedback from the review of incidents.

Young people on the wards told us they felt safe. Young people told us that staff had the skills to deal with violence and aggression and used these skills to good effect. There were some incidents of violence and aggression, and we felt that these were dealt with in the best way possible from the records we looked at and conversations we had with people.

Staff demonstrated a good understanding of 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 patient files, and staff shared safeguarding concerns in handover meetings.

We completed 5 Short Observational Framework for Inspection Observations (SOFIs) and observed that staff carried out observations in line with policy and each young persons prescribed observations. Staff appeared to have a good understanding of how to care for each young person and understood what each of their risk factors were. Staff worked hard to maintain an environment that felt safe and supportive for young people.

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. It was clear that senior managers were working hard to continually develop safeguarding processes to ensure they were relevant and appropriate.

Young people told us that they were involved in the development of their care plan and risk assessment and that they attended regular multi-disciplinary meetings with their staff when they wanted to. We saw evidence of young people’s involvement in some of their care plans and risk assessments. Carers that we spoke to said that they could be involved in the developments of their loved one’s care plans and risk assessments where they needed to be. Carers understood how to get involved and said that staff made efforts to keep them informed.

Staff demonstrated an understanding of how they engaged with young people and each other to manage risks. They told us that they knew how to access and had time to access information about young people’s risks and they told us that there were regular handover meetings and huddles where information was exchanged to help them understand risks. A small number of staff stated that they would like the opportunity to be more involved in the development of care plans and risk assessments. The senior management team told us that they were working on ways to involve more staff in this process, for example developing ways they could include their views in multi-disciplinary team meetings.

We reviewed 6 care records. Staff completed risk assessments for patients, these were updated very frequently and always updated when risk changed, for example following an incident or de-escalation. Risk assessments were good quality; were comprehensive and contained details on how to manage identified risks. There was a consistent thread of information in relation to risk that followed each patient that ensured staff were up to date, this included detailed discussions at handovers and multi-disciplinary meetings. The wards were also making use of one-page profiles for each young person which gave a summary of their care, risks and strategies to support them. These were particularly helpful for staff that were less familiar with the ward and the young people.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Young people gave good feedback about staff across the wards. Young people told us that there were enough staff on the wards and that they were there to speak to and support them when they needed it. They said that staff were able to support them in dealing with any conflict or disagreement on the wards. Young people did not raise any concerns about their ability to leave the ward or participate in activities. One young person told us that they did not always feel that some staff communicated effectively with them and one young person said they did not always feel comfortable on the wards because of the un-wellness of the some of the other young people.

Staff told us that staffing levels were at an expected and safe level. They told us that where gaps might appear because of sickness for example that they were easily filled. Staff said that there was always at least one qualified nurse on each ward, if not more. Staff said that the skill mix of their teams was helpful, there were enough skilled staff to respond to incidents and they attended quickly where needed. A small number of staff said that there were higher numbers of agency staff working on night shifts, but that this was improving. Bank and agency staff that we spoke to were familiar with the ward and how to support the young people. They were also suitably vetted to ensure they had the right background and skills to work on the ward.

During all our observations, we noted that staff were engaging with and responding to young people using the service. Staff were spending time with young people and where they were carrying out observations, they were doing so in a very engaging manner. Staff had an excellent rapport with young people, and it was clear that staff knew the needs of each young person very well. During our observations there was always enough staff on duty.

There were low levels of non-substantive staff working across the wards. All agency staff had completed an induction prior to working on the wards. We did not have any concerns about the skill mix of staff, they were suitably trained to carry out their roles. Supervision and appraisal compliance was 80% overall and this figure had been improving over the past 6 months. Staff said they received suitable support from their line managers and there was evidence of a range of different ways that staff could be supported, including group learning sessions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Young people understood their medicines and were involved in medicines reviews through multi-disciplinary team meetings. When we reviewed young peoples’ records, we found that they were always involved when making decisions about their treatment. There was evidence that young people had consented to treatment.

Staff reviewed young people’s medicines regularly as part of the multidisciplinary meeting and provided specific advice to young people and carers about their medicines. Staff carried out work to ensure that medicines continued to be administered in line with best practice and trust guidance.

Observations of staff administering medicines to young people showed this was carried out in a person-centred manner whilst treating the young people with dignity and respect. Appropriate checks of clinic equipment were carried out on a regular basis, including medicines storage, fridges and emergency equipment and medicines.

There were effective processes in place to ensure that medicines were administered safely. Staff had undertaken the necessary training to ensure they were competent to carry out these processes.