Stepping Stones Clinic

Updated 14 July 2023

Stepping Stones Clinic provides mental health care and treatment for children and young people on an out-patient basis.

At the time of inspection, the service had 1202 young people on their active caseload. The service also worked with young people over the age of 18 where needed, to support their transition to adult services. Of those young people open to the service, 134 were aged between 18 and 20.

The service provides assessment and treatment by a range of professionals, such as psychiatrists, psychologists, and psychotherapists.

The service provides care and treatment for young people in London, as well as those from other areas of the UK.

In most cases, the families of young people fund their treatment at the service, or funding is provided by insurance companies. However, the service had recently secured NHS spot purchasing contracts to provide outpatient treatment to young people within 2 areas neighbouring London.

Stepping Stones Clinic is registered to provide treatment of disease, disorder or injury.

There was a registered manager in post at the time of this inspection.

Stepping Stones Clinic was registered with the Care Quality Commission in July 2018 and was previously inspected in August 2019. The service was rated good overall, with the safe domain rated as requires improvement.

The service had 3 requirement notices issued under the safe domain:

• The service must ensure that all information concerning young people is stored in their care and treatment records. This must include results of physical examinations and investigations, the rationale for prescribing medicines and detailed risk management plans for young people. Regulation 17(2)(c)
• The provider must ensure that there is a system which staff who are lone working can use to summon urgent assistance. Regulation 17(2)(b)
• The provider must ensure that 2 professional references are obtained for clinicians contracted to work in the service. Regulation 19(3)(a)

At this inspection the requirement notices were being met.

What people who use the service say

We received feedback from 7 young people and 16 carers. Feedback was very positive. People told us the staff were kind, caring and professional. They told us they felt listened to, and appointments were not rushed. They felt staff were responsive to their needs and were easily contactable between sessions. We were told staff were flexible in being able to offer appointment times that suited their needs. Young people told us the staff made them feel at ease, which helped them being able to open up about their concerns. They told us staff validated their feelings and they did not feel judged.

One carer told us they would have liked more information on the conditions that their child had been diagnosed with. The same carer told us important risk information related to their child was not always shared with them.

Updated 14 July 2023

Our rating of this location stayed the same. We rated it as good because:

• The service provided safe care. Clinical premises where young people were seen were safe and clean. The number of young people on the caseload of the team, and of individual members of staff, was not too high to prevent staff from giving each young person the time they needed. Staff managed waiting lists well to ensure that young people who required urgent support were seen promptly.
• Staff treated young people with compassion and kindness, respected their privacy and dignity, and understood the individual needs of young people. They actively involved young people and carers in care decisions.
• In most cases, staff assessed and managed risks to young people and themselves well. When necessary, staff worked with young people and their families to develop crisis plans, this included the use of the service’s coping skills app. Staff followed good personal safety protocols. Staff had a good understanding of the safeguarding procedures within the service.
• Managers investigated incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave young people honest information and suitable support.
• Staff developed holistic care plans informed by a comprehensive assessment. Young people and carers told us they were involved in planning their care and treatment. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the young people.
• The team had access to a range of specialists required to meet the needs of the young people. 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. Managers provided an induction programme for new staff.
• Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people. They managed and recorded decisions relating to these well.
• Staff used recognised rating scales to assess and record severity and outcomes. Staff engaged in clinical audit to evaluate the quality of care they provided.
• Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service. They were approachable for young people and staff. Staff felt respected, supported and valued. They could raise any concerns without fear.
• The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

• When a new referral was received, there were no formal processes in place for these to be reviewed by a clinician. Administrative staff initially screened all new referrals. There were also no formal processes in place to ensure there was clinical oversight of the signposting of inappropriate new referrals and management of potential risk whilst a young person is awaiting their first appointment. Following the inspection, the service informed us they had implemented a process where a consultant psychiatrist reviewed all new referrals each day.
• In most cases, staff recognised incidents and reported them appropriately. However, we saw examples in a care record where incidents were documented, but were not reported in line with the service policy.
• Risk was generally documented well, however there were instances where risks had not been documented within the specific risk assessment table. This posed a risk that information could be lost and not shared with the young person’s GP. One carer told us they had not been informed of the all risk issues that related to their child.
• Whilst all young people had care plans, these were not written from the perspective of a young person and in general the care plan did not have a space to include their views.
• Most medicines were prescribed in line with national guidance, however, when a medicine was prescribed outside of the national guidance, the rationale was not always documented. We saw 1 example of a young person’s medicine being changed without the clinician reviewing the young person.
• The online record system did not always capture a young person’s protected characteristics, such as their ethnicity, religion, disability, and sexuality.

Updated 14 July 2023

Please see above for summary