The Care Quality Commission (CQC) has published a report following an inspection of child and adolescent mental health (CAMHS) wards, provided by Sheffield Children’s NHS Foundation Trust in July.
CQC carried out an unannounced focused inspection of three wards – Sapphire Lodge, Emerald Lodge and Ruby Lodge, due to concerns about the quality of services being provided to children and young people.
As not all areas within each domain were inspected, CAMHS was not re-rated following this inspection and the overall rating remains as good. It also remains rated good for being effective, caring, responsive and well-led. Safe remains rated as requires improvement.
The overall rating for Sheffield Children’s NHS Foundation Trust remains as good.
Sarah Dronsfield, CQC’s head of hospital inspection, said:
“When we inspected the child and adolescent mental health (CAMHS) wards at Sheffield Children’s NHS Foundation Trust, we found a number of concerns around the safety of care being provided to vulnerable people, and so the safe domain remains rated requires improvement for this service.
“There had been a recent serious incident where children and young people had managed to abscond while on escorted leave, which could have put them at serious risk of harm during a time when they were especially vulnerable. 'The use of restraint had increased due to the complex nature of the needs of people admitted to the service. It was encouraging that after the inspection, the trust brought in a specialist review team to reduce the level of restraint and minimise injury.
“We found there wasn’t always enough nursing staff to meet young people’s therapeutic needs but the trust have taken some action to improve this. By reducing bed numbers on all three wards, moving staff around and using agency staff when needed. The trust are now in a better position to give people the attention they need.
“Since our inspection, the trust has started to make improvements to make sure vulnerable children and young people receive safe care. We will continue to monitor them closely and return to check on their progress.”
CQC inspectors found:
- Shifts did not always run with sufficiently experienced staff. Managers were qualified nurses and allied health professionals, however they did not all have backgrounds in child adolescent mental health services
- Staff morale was low, especially on Sapphire Lodge. Staff told us they did not always feel respected, supported or valued. Staff morale was impacted by staffing pressures and COVID-19
- Facilities were not always fit for purpose. On Sapphire Lodge the clinic room was also being used as the nasogastric feeding facility. The clinic room was an inappropriate environment for this purpose and did not provide an appropriate level of dignity and privacy
- Feedback from children and young people and their families was mixed. People on Sapphire Lodge provided mainly negative feedback and expressed concerns about staffing levels and attitudes. People on Emerald Lodge were positive about the service and staff
- The trust’s processes for the management of risk and performance had identified concerns in relation to this service prior to our inspection, but timely action had not been taken.
However:
- Wards were clean. Staff followed infection control policies including those related to COVID-19
- Staff completed risk assessments for each patient on admission and reviewed this regularly, including after any incident
- Staff had completed and kept up to date with mandatory training. The mandatory training programme was comprehensive
- Ward managers were registered mental health or learning disability nurses, the trust’s head of nursing was a children’s nurse and one senior leader was a qualified social worker with a background in child and adolescent mental health services.
Full details of the inspection are given in the report published on our website.
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Read the report: Child and adolescent mental health wards