Hertfordshire Partnership University NHS Foundation Trust’s child and adolescent mental health service has been rated requires improvement, following a Care Quality Commission inspection.
The inspection was undertaken to assess whether improvements had been made to the service, which is based at Forest House in Radlett.
CQC’s previous inspection of the service identified significant shortcomings, which led to it being rated inadequate. Following that inspection, CQC also served the trust a warning notice requiring it to improve care at Forest House.
The latest inspection found enough improvement had been made for the service to be rated requires improvement. It has also been rated requires improvement for being safe, effective, caring, responsive to people’s needs and well-led.
Due to this improvement, the warning notice has been lifted.
The inspection was not wide-ranging enough to update any overall ratings for the trust. It remains rated outstanding overall.
Craig Howarth, CQC head of hospital inspection, said:
“I am pleased to see improvement at Forest House, but more work is needed to ensure all children and young people using the service receive the right care and support.
“This includes reducing the service’s reliance on bank and agency staff, as a lack of regular staff makes it harder to provide consistent high-quality care to people.
“However, leaders had improved their oversight of the service, and they supported staff well – which has had a positive impact on the care patients received.
“We’ve told Hertfordshire Partnership what it must do to improve the service further.
“We continue to monitor it, including through future inspections, to assess whether progress is sustained and embedded.”
The inspection found:
- The ward had no call bell system for children and young people. This could cause a delay in an emergency
- When secluding patients in their bedrooms, staff on one identified occasion attempted to clear a patient’s bedroom but, due to the risk of assault, were not able to clear the room of items which may have been used by the patient to cause harm
- The ward depended upon bank and agency nursing staff to meet its patients’ needs, although bank and agency use had improved since the last inspection
- Not all staff had reported incidents in line with trust policy. The trust addressed this when it was bought to its attention. However, the system for reviewing incidents had improved in the months preceding the inspection
- There were vacancies within the therapy team, although this had improved since the last inspection. Recruitment was ongoing
- Feedback from young people, and their carers and relatives, was mixed. Some concerns had been raised around inconsistent care, due to the levels of bank and agency staff used, particularly in evenings and over weekends
- There had been occasions when children and young people had not had access to outside space due to the ongoing refurbishment of the unit.
However:
- Managers supported staff with appraisals, supervision and opportunities to update and develop their skills
- Staff understood how to protect children and young people from abuse, and the service worked well with other agencies to safeguard patients. This was evident in clinical records
- Staff used systems and processes to safely prescribe, administer, record and store medicines
- Staff used de-escalation techniques to avoid using restraint. Patients were only restrained when de-escalation failed, and when it was necessary to keep the child, young person or others safe
- Staff gave children and young people all possible support to make specific decisions for themselves before deciding a child or young person did not have the capacity to do so.