The Specialist Health Team for People with Learning Disabilities

Updated 6 January 2023

The Specialist Health Team for People with Learning Disabilities is made up of staff from a range of health care professions. The team comprises community nurses, speech and language therapists, physiotherapists, clinical psychologists, music therapists and drama therapists. The service provides health and wellbeing support to people with learning disabilities. The service provides this support to clients at two locations, and within their own homes, care homes or supported living services. The service also works directly with professionals within GP practices, hospitals, care homes and supported living services to support people with learning disabilities. The service has a registered manager and is registered to provide the regulated activity – Treatment of disease, disorder, or injury.

The service was last inspected in May 2021 when we rated it as Requires improvement overall, requires improvement for Safe, good for Effective, Caring and Responsive, and inadequate for Well-led.

This service was inspected as the core service 'Community mental health services for people with a learning disability or autism' as this was the best fit in terms of CQC methodology. We have used the term ‘clients’ throughout this report as this is the preferred term chosen by people using the service.

What people who use the service say

Clients and carers told us that staff treated clients with compassion and kindness and provided help and advice when they needed it. Clients told us that staff were polite, friendly, kind and helpful. Carers told us that staff provided social stories, counselling and reading material to help them and clients understand their diagnoses, care and treatment.

The only issue raised by carers was that waiting times for support could be improved. They were very satisfied once they saw the team’s health professionals, but described long waits earlier in the year for psychology, before they were seen. Waiting times had improved more recently with recruitment of locum staff to vacant posts.

Carers described the physiotherapy support and aquatherapy provided as a very valuable service, which was person centred and individualised to each client. They particular praised the flexibility of the service, and how accommodating it was to clients’ individual needs. They noted that staff took time to get to know clients individually, and what worked better for each client. They said the physiotherapy service had exceeded their expectations, making sessions a fun experience for clients to get the best out of it.

Carers said that staff provided flexible appointments for clients at times that suited them, and block booking sessions when needed to fit around their other commitments. They noted that staff would come out to see clients in their own homes if they were unable to attend the centre.

Carers of a client receiving rehabilitation support, spoke highly of the support provided, gradually reducing as improvements were made, and with no pressure to discharge the client until they were ready.

Carers were grateful for the support they had received during the peak of the Covid-19 pandemic, with staff checking in to ensure that clients were ok, and offering advice remotely, or in person as needed.

Updated 6 January 2023

Our rating of this service improved. We rated it as good because:

• Clients, family carers and employed carers we spoke with gave very positive feedback about the service. They described caring and professional staff often going above and beyond their expectations. They were particularly positive about the aquatherapy sessions provided. Supported living services were very positive about the service provided to clients, and support and training provided to staff teams.
• Significant improvements had been made since the previous inspection in May 2021 particularly to the governance of the service. There was an improved system for monitoring staff compliance with mandatory training. Improvements had been made in the service’s risk management systems, and monitoring, and evaluation of the team’s performance. The team had developed a clear protocol for following up on clients who missed appointments, an improved system to collect feedback from clients and stakeholders, and staff were clear about which incidents should be notified to the CQC.
• There were systems in place to share any lessons learned from incidents, complaints, concerns and safeguarding, although there had been very few incidents and no complaints in the last year. All staff and managers were clear about how to navigate and review clients’ care and treatment records and staff knew where to store them.
• There had been some improvements in the referral process to the service, making it easier for clinicians to make referrals through a single point of access. The criteria for referral to the service did not exclude clients who would have benefitted from care.
• The number of clients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each client the time they needed.
• Staff understood how to protect clients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff followed good practice with respect to safeguarding.
• Staff provided a range of treatment and care for clients that was informed by best-practice guidance and suitable to the needs of the clients. They ensured that clients had good access to physical healthcare and supported them to live healthier lives. Staff developed treatment plans in collaboration with clients, families and carers.
• The teams included or had access to the full range of specialists required to meet the needs of the clients. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
• Staff felt respected, supported and valued. They said the provider promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.

However:

• There were insufficiently rigorous systems in place to record individual risks for clients using the service, and review these regularly.
• Improvements were needed in infection control procedures for the service to ensure that there were clear protocols for storing and laundering hoist slings, and reviewing staff compliance with infection control protocols.
• Staff did not have training in basic life support, to support clients in the event of an emergency.
• The service notice board at the Sutton Inclusion Centre, was not easily accessible to clients and carers, and there were no leaflets available in reception about health issues for clients/carers to access. The service did not routinely share how feedback from clients and carers was used to improve the service
• Although decisions made in clients’ best interests were recorded, these were not always dated.
• The auditing of service delivery could be further developed.

Updated 10 September 2021

Sutton Health and Care 0-19 Children’s Service

We did not rate this service as we only looked at two key questions and we had not previously rated the service for all five key questions.

• The service had not submitted required notifications, for example any abuse or allegation of abuse in relation to a service user to the CQC, without delay. The service had not submitted any notifications to the CQC since the service opened in 2019.
• The service did not have a robust staff training records system in place so managers could not track completion.
• Lone working procedures were not robust. Staff told us that they had their own ways of ensuring their safety such as informally messaging colleagues via their mobile phone or telling a colleague when carrying out a home visit. The clinic rooms at Tweedale Children’s Centre did not provide access to a panic alarm system and staff did not have access to a personal panic alarm that they could wear in the building or whilst working in the community. Following the inspection, the provider told us that they had plans in place to trial a personal panic alarm system and implement the devices by July 2021.
• The service did not have robust plans in place to address the frequent occurrence of health visiting staff making initial contact with families who had experienced a miscarriage or child bereavement, despite the service being aware the issue had been ongoing for some years. This meant that there was an ongoing risk that expectant mothers and their families may be contacted by the team, leading to unnecessary distress, and upset that could have been avoided.
• Incidents were not routinely discussed in team meetings. We reviewed samples of team meeting minutes from November 2020 to March 2021 and were unable to find evidence that teams discussed learning from incidents. Some staff were not aware of any learning from incidents.

However:

• All families we spoke with were positive about the service. Families told us that they felt they had received a good service and the health visiting staff supported them. The service received positive feedback to their family survey in August 2020.
• The service had ensured that they had set up effective safeguarding systems to ensure that vulnerable children and their families were supported when the COVID-19 pandemic started. Staff worked hard to ensure children and families who were at risk were allocated to a health visitor.
• Staff ensured that they maintained a good standard of record keeping. Whilst we found a small number of gaps in patient records, mostly all records we reviewed provided important information relating to a child, young person, and their family. Safeguarding supervision records were comprehensive and of a high quality.
• Staff created new ways of sharing advice and support with families whilst the service were unable to offer face to face appointments and school nurses were unable to visits schools during the peak of the pandemic. The school nursing team had set up their own social media to reach young people.
• The service had a clear ambition for future ways of working. Senior leaders had a vision to become an integrated service and was in the initial stages of implementing an integrated model of care called ‘Our Shared Children’s Plan 2021-2023’. At the time of our inspection, the service was focused on supporting staff wellbeing and morale following a difficult year due to the COVID-19 pandemic.

Updated 6 January 2023

See above section