Humber Teaching NHS Foundation Trust

Updated 14 May 2019

Not used

Updated 14 May 2019

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

• We rated well led for the trust as good. We rated effective, caring, responsive and well led as good across mental health and learning disability services. We rated safe as requires improvement.
• We rated nine of the trusts 11 mental health services as good and two as requires improvement, and whilst the rating for acute wards for adults of working age and psychiatric intensive care units remained as requires improvement, the safe key question was now rated as good. In rating the trusts mental health and learning disabilities as good we considered the previous ratings of services not inspected this time, and deviated from the ratings principles.
• We rated two of the core services as good that we inspected this time. Mental health crisis and health based place of safety services were rated as requires improvement at our last inspection in 2017 and was now rated good in all key questions.
• Six GP practices which had been inspected were rated as good in all key questions.
• The adult social care location at Granville court was inspected and rated in January 2018 and was rated as good in all key questions.
• The trust had a clear vision, strategy and vision. Staff knew and understood the trust’s vision, values and strategy, had opportunity to be involved of the development of these and understood how achievement of these applied to the work of their team. The trust board and senior leaders had the appropriate range of skills, knowledge and experience to perform its role.
• Staff felt respected, supported and valued amongst their local teams. Staff knew and understood the trust’s vision and values and their behaviours reflected these.
• Staff treated patients with compassion and kindness. They largely respected patients’ privacy and dignity and supported their individual needs. Staff understood how to protect patients from abuse and were trained to do so. Feedback we received from patients was positive. Friends and family test results were consistently positive.
• Staff were aware of what incidents they should report as adverse events and were and generally managed them well, they also knew what should be reported, their duty in reporting these and in meeting the requirements of the duty of candour.
• Patients could now access a mental health bed in a timely manner when in crisis. This meant that a bed was available when needed and that patients were not moved between wards unless this was for their benefit.

However:

• We rated community health services for adults as requires improvement in safe, effective and well led. This was the third inspection where this core service has been rated as requires improvement, and at this inspection effective has gone down one rating from good to requires improvement. This has led to an overall rating in community health services as requires improvement.
• There was improvement at our last inspection in the forensic and secure services leading to a rating of good over all. This improvement has not been sustained and has now been rated as requires improvement in safe and well led.
• Despite there being a programme of board visits to clinical areas and board members reporting that significant engagement was undertaken with staff, some staff reported that board members were not visible and staff did not always feel supported or listened to.
• Staff did not feel they were always consulted properly about changes to services. There were not always enough staff in all services.
• The electronic patient records system was slow and staff had developed paper records so they could access details about patients if they could not access the system when needed. The information that teams kept about patients in paper records was not consistent across the service. Staff did not always record details of safeguarding concerns under the designated section of the electronic patient record.
• There were some difficulties with works issues not being completed in a timely manner in the forensic services.
• Children and young people were waiting over 18 weeks to receive treatment in some areas.

Our full Inspection report summarising what we found and the supporting evidence appendix containing detailed evidence and data about the trust is available on our website – .

Updated 3 October 2014

Humber NHS Foundation Trust Child and Adolescent Mental Health Services (CAMHS) provide specialist assessment and treatment services to children and young people up to the age of 18 years who are experiencing significant emotional or mental health difficulties. These services are community based and there are no inpatient services commissioned.  Children and young people requiring an inpatient bed are referred out of area or in an emergency admitted to an adult ward. We found that the trust had not followed the required notification system to CQC when the latter had taken place.

The CAMHS services had recently undergone a period of review and transformation and were part way through the introduction of a new model when we inspected. The staff told us that as a result, some staff were unclear about their roles and what was expected of them and there was a lack of job descriptions. We found that the staff team were unsettled and wanted some processes and procedures to be clearer.  Staff also said that they received inconsistent advice from managers and had not felt involved in the consultation about the changes.

There were long waiting lists and staff told us that they were struggling to cope with the increased demands for CAMHS services. Staff felt anxious about their workload and the growing waiting list to receive a service. We saw that the trust risk register reflected the capacity and demand issues relating to the service and an action plan was in place. However, the impact of heavy caseloads meant that that staff were not completing some processes, for example reporting incidents.

Children and young people, their families and carers told us that CAMHS services made a difference and often helped them learn how to manage their difficulties once they were allocated a worker. They told us that staff were respectful and caring and we saw that staff were committed to providing a good service and were motivated to provide safe and effective services for children and their families.

Staff undertook thorough risk assessments using a variety of assessment tools.

Updated 14 May 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• There were inconsistencies in completion of risk assessments and care plans. In Scarborough and Ryedale, the appropriate templates were not yet on the electronic record and staff had not received training. Care pathways were not in place for specific conditions.
• There was no caseload management tool used to determine required staffing levels. Staffing levels at Whitby were low.
• Participation in audits and benchmarking was low. This had been identified at our last inspection and although the team at Whitby had started to introduce audits, others had not.
• Staff were not receiving regular documented supervision and appraisal compliance was low in some areas, particularly Whitby.
• Feedback from staff about leaders was mixed and there were questions about the experience of some leaders who were new in to post. Morale was variable and staff told us communication and engagement from senior management was poor, particularly with regards to the new services.
• Although the community services staff were all employed by Humber Teaching NHS Foundation Trust, staff did not see themselves as part of a wider team and there was little cross team working.
• Issues identified at our last inspection had not been fully addressed. Although there had been some changes made in the Whitby team, these were recent changes and needed to be fully embedded.

However:

• Staff provided compassionate care and treatment to patients. Patients and their families were encouraged to be partners in their care.
• The health trainers service had good outcomes and supported people to live healthier lives.
• The service worked closely with commissioners to plan and deliver services to meet the needs of the local population.
• Governance systems were in place, with regular meetings taking place that ensured relevant information was fed down to practitioners and up to board level.

Updated 10 August 2016

Overall rating for this core service:  Good

Overall, we rated the service as good because:

• Throughout the inspection, we observed staff delivering care to children and their families in clinic settings and in their own homes. We saw staff treat children and families with dignity and respect at all times. They were sensitive to the children’s needs, demonstrating kindness and compassion. We observed good relationships between the staff and patients and their carers.

• The service reported incidents and there were examples of changes in practice as a result of lessons learnt from incidents, for example, immunisation practices. There was shared learning as a result of serious case reviews.

• Staff received appropriate safeguarding training and had access to regular safeguarding supervision as required by national guidelines. Staff also undertook clinical supervision and received statutory and mandatory training. There were opportunities to access additional training to support their work with children.

• The service used an electronic record keeping system. This provided staff with up to date information about children, including safeguarding concerns. It allowed staff to share information with other practitioners in a timely way. The electronic system for patient records also allowed the service to monitor commissioned targets and patient outcomes.

• Children’s services used a range of evidence based systems and risk assessments to deliver appropriate care and promote patient outcomes. Staff had additional training opportunities. The service had implemented electronic record keeping in all areas, other than speech and language and occupational therapy, where it was being rolled out. This provided staff with up to date information about children, including safeguarding concerns. It allowed staff to share information with other practitioners in a timely way. The electronic system for patient records allowed the service to monitor targets and for teams to take action when commissioned targets and patient outcomes were not being met.

• There was integrated care between other agencies and services were planned to meet the needs of children and families.

However:

• There was a lack of staff and public engagement. This was a breach of regulations in the previous inspection and, although some improvement had been made, it continued to be a breach.

• Services did not have a programme of auditing to measure and improve the quality of care. Children were waiting over 18 weeks for speech and language therapy services. Action plans were in place to reduce the waiting lists.
• The trust had a children’s strategy, but staff were not aware of this and the trusts future vision of 0-19 services. There was limited engagement with identifying risks and reporting incidents by all the staff groups. Staff across the services were not clear about governance arrangements. There was a disconnect between the trust overview of training figures and the training figures recorded at team level.

Updated 10 August 2016

Overall rating for this core service:  Good

We rated community inpatient services as good because:

• Patients were positive about the care they received. We saw staff being respectful towards patients, and making sure that they were treated with dignity. Patients were involved in decisions about their care where possible.

• There was evidence to show that staff recorded and reported incidents, and completed risk assessment and risk management plans. Staff were familiar with the systems in place to report incidents that may affect the safety, health and welfare of patients and with the reporting system. Regular meetings to discuss lessons learned from incidents took place.

• Patient risks were assessed and plans developed to reduce them. Patients with individual needs were given the support they required. In addition, members of staff were identified as leads in learning disabilities and dementia.

• Staff were trained in safeguarding and mental capacity procedures, and were able to apply and discuss these appropriately.

• Complaints were handled in line with the trust’s policy.

• Information was displayed information about the trust’s vision and values and staff demonstrated they understood and put these in to practice.

• Services at Whitby Hospital had recently transferred to the trust (April 2016) and staff told us they had been communicated to well and kept informed of developments affecting the service. Performance information for this ward was not yet available through the trust.

• There were temporary arrangements in place at Withernsea Community Hospital to provide medical cover for the ward and the trust had advertised a tender to contract medical cover for the ward.

• However, although wards worked well together as a multidisciplinary team, there was limited access to therapy support at Withernsea Community Hospital. This affected the discharge of some patients.

• There were also problems with accessing medicines through the local pharmacy services out of hours.

Updated 10 August 2016

Overall rating for this core service: Good

Overall, we rated community end of life care as good. This was because:

• People were protected from avoidable harm and abuse. Although there were very few incidents reported, staff understood and fulfilled their responsibilities to raise concerns and report incidents. We found that learning from incidents was shared across teams and staff we spoke with were aware of the duty of candour.
• We found that staff we spoke with were aware of their responsibilities and took a proactive approach to safeguarding. Mandatory training was above the trust target overall, although there was low levels of compliance in some core subjects.
• We found that medication processes used by all teams kept patients safe. Access to equipment in people’s homes was good and the trust had systems to ensure timely delivery. Patient care records were mostly completed to a high standard. Staff adhered to infection prevention and control guidelines and the trust had robust systems in place for managing risks including major incident planning.
• We rated effective as good because people’s care and treatment was planned and delivered in line with current evidence-based guidance, standards, best practice and legislation. Patients were receiving advice about pain relief, nutrition and hydration.
• There was participation in relevant local, national and some international audits. The gold service framework was embedded across the locality. Staff were highly qualified, received timely appraisals, clinical supervision and were supported with further professional development. There was evidence of multi-disciplinary working across all teams. Consent to care and treatment was obtained in line with legislation and guidance, including the mental capacity act 2005.
• We rated caring as good because feedback we received from patients and those close to them was consistently positive about the way staff treated them and we observed consistently sensitive, caring and compassionate staff.
• Staff were highly motivated and inspired to offer care that was kind, promoted people’s dignity, and involved them in planning their care. We saw staff providing detailed explanations of procedures and thorough assessment of all needs and reassurance. Patients were supported emotionally. All staff were very responsive to the psychological needs, of not only patients but also those close to them.
• We rated responsive as good because services were planned and delivered in a way that met the needs of the local population. We saw that staff respected the equality and diversity of patients and their families. The needs of vulnerable people were taken into account when planning and delivering services and team worked collaboratively to provide this. Patients were able to access services in a responsive and timely way. In addition to this, there were no complaints about patients receiving end of life care.
• We found that services were well led because the teams providing end of life care had a clear strategy, vision and values, driven by quality and safety. Senior staff were visible and supportive to staff and patients. All staff we spoke with said that senior staff were very approachable. Leaders were actively engaged with staff, people who used services and their representatives and stakeholders.
• We witnessed the culture within teams as being team focused and positive. All staff we spoke with told us that they worked as part of a team and felt supported within their service. We saw good examples of positive staff and patient engagement.
• We saw numerous examples of innovation that the teams had been involved in. There was a strong focus on continuous learning and improvement at all staff levels. New care group structures had recently been introduced. Plans to ensure that governance processes were embedded were being introduced by senior staff in the service.

However, we also found that:

• Some policies were out of date.
• Some teams in community hospitals were not using the appropriate care pathway ‘caring for me advanced care plan’ for end of life patients.
• Low numbers of staff had attended mental capacity act training.
• Not all risks were identified on the care group or corporate risk register, for example out of date policies. Some identified risks had no evidence of mitigation to reduce the risk despite being on the register for many months. 

Updated 3 October 2014

Humber NHS Foundation Trust provides a range of inpatient and community services for people who have a learning disability (LD) or autism. These include community team learning disabilities (CTLD) services, Willow and Lilac inpatient assessment and treatment units, and Ullswater Ward, a forensic learning disabilities medium secure unit. The services are based at The Grange in Hull, Townend Court in Hull, Four Winds in the East Riding of Yorkshire and The Humber Centre for Forensic Psychiatry in East Yorkshire.

The trust had an effective system in place for reporting safety incidents. Staff knew about their responsibilities for reporting incidents and knew how to report them. There was also a system in place to make sure that incidents of potential or actual abuse were reported to the local authority safeguarding teams.

The service compiled and reviewed safety information from a range of sources including incident trends, safeguarding information and complaints.

Seclusion rooms at Willow assessment and treatment unit and Ullswater Ward were not fit for purpose and put people at increased risk. Staffing levels to maintain close observations were difficult at times on Ullswater ward. We found the noise levels of closing doors in corridors on Ullswater Ward could have a potential impact on people who required a low stimulus.

The service used evidence-based best practice and professional guidelines when people’s needs, however assessment tools being used such as GRIST were not specific to learning disabilities.

There were issues with IT systems in place for example psychiatrists had not received training in the electronic SystmOne , which resulted in hard copies of information being made available , this had the potential risk of outdated information being in circulation.

Staff in the community and inpatient services worked well together to make sure that the service met people’s needs. However Mental Health Act documentation was not always completed correctly. We identified common themes including staff not documenting people acting as statutory consultees in case records and outcome of capacity assessments not being recorded. People detained under the MHA also had access to an independent mental health advocate. We found that staff required further training in relation to the application of the Mental Capacity Act and DoLs.

People who used the service were positive about the staff and the care they received. Everyone we spoke with was happy with the way staff treated them, particularly in regards to kindness, dignity and respect.

The service had a safe and effective system in place to for managing referrals and there were some concerns about the management of waiting lists for CAHMS learning disability servcies. Access to some therapies was delayed, For example there was an eight month waiting list for psychology services.

Staff told us that they received information about the vision and strategy of the trust and were aware of the impact that had on their role. However staff did not have regular access to managerial and clinical supervision.

Staff also told us that there was a good working relationship within the team and with the management, including the chief executive and chairman.

Improvements had been made based on people’s feedback about the service.

Updated 3 October 2014

Humber NHS Foundation Trust provides substance misuse services, which are located across East Riding.

As part of this inspection of substance misuse services, we visited East Riding Specialist Drug Service, the Inpatient Alcohol Treatment Unit, and East Riding Partnership.

Overall, there was a high standard of individual-centred care which was assessed, planned and delivered individually.

There was an emphasis on recovery and staff were passionate about what they did.

Staff morale was very high and teams worked well together, especially when there was partnership working with the Alcohol and Drug Service and the clinics with the inpatient detoxification ward. Staff were proud of the care they delivered and felt supportive of, and supported by, their colleagues, management and the wider trust.

There were good facilities which were well-maintained, safe and secure.

Services were safe and effective with clear reporting procedures and systems in place to ensure staff were able to learn from incidents.

Updated 14 May 2019

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

• Staff identified risks for children and young people from referral, whilst on waiting lists and whilst in treatment. They put plans in place to decrease or mitigate the risks; this included crisis plans where appropriate. Parents, carers, young people and other professionals knew what actions to take if there was a deterioration in health. Staff responded appropriately and promptly if this occurred.
• Staff knew how to protect children and young people from abuse. They recognised when people were suffering from significant harm. Staff had good relationships with external teams to assess holistic needs and if required, knew how to make safeguarding referrals.
• Teams included a full range of specialists required to meet the needs of children and young people. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with external organisations to provide additional support.
• Staff treated children and young people with compassion, kindness, respected their privacy and dignity and understood individual needs. They actively involved them and their families and carers in care decisions. Children, young people and their parents or carers had good opportunities to provide feedback on the service and be involved in service developments.
• Staff offered flexible times and locations for appointments including weekends and evenings. They responded promptly and appropriately when contacted by children, young people or their parents and carers and took positive steps to encourage those who found it difficult to engage.
• Managers were experienced and had good knowledge of the service. Staff felt supported and valued; they felt able to contribute to service improvements and raise concerns if needed. Governance systems ensured information was shared effectively amongst teams and with external organisations.

However:

• The service had long waiting lists above the NHS constitution of 18 weeks. This was mostly in Hull for the attention deficit hyperactivity disorder pathway.
• Room space was limited in the Beverley location in East Riding.

Updated 10 August 2016

We rated Community mental health service for people with learning disabilities as good because:

• Staff regularly risk assessed patients whilst on the waiting list across all services. Staff weighted caseloads to ensure caseloads were not excessive. Incidents were discussed during team meetings and appropriate debriefs took place with both staff and people who used the service. Facilities at Townend Court and Four Winds were safe and suitable to use for their intended purpose.
• Staff took the Mental Capacity Act into account at all services. The speech and language therapy team had devised a script to aid communication and ensure that staff gave people every opportunity to participate in capacity assessments. Patient assessments took place within 6 weeks of initial referral and prior to patients being added to the waiting list. Staff across all the services followed the National Institute of Health and Care Excellence guidance, which included recent transitions guidance. Staff had regular supervisions and appraisals were up to date. Specialist training was available and staff were keen to continue their development. Multi-disciplinary team meetings were effective across all services and decisions made were evident in people’s care files.
• Patients and their family members reported they received an excellent service. Staff treated patients with dignity, respect and were supported by staff who understood their needs. Patients were involved with their care and staff used innovative methods to enable people to engage with their care.
• Staff made contact with patients whilst on the waiting list and staff managed the list well. Staff prioritised urgent referrals. Information was available in various formats, interpreters were used and some staff were trained in British sign language. Team meeting minutes had a British sign language ‘sign of the week. Staff helped patients to complete patient passports and health check documents, which assisted patients when visiting or being admitted to hospital. There was a policy in place to manage complaints. Patients and their families knew how to complain.

• Staff spoke highly of the local management including the care group director. Managers investigated incidents and where appropriate they made to procedures. Staff understood the trust visions and values and these were integral to the way they worked. The service had introduced iPads to assist patients to be involved in their care and care planning.

However:

• Waiting lists were unacceptable with the longest wait being 94 weeks
• The environment at the children’s community team for learning disabilities Victoria House was not appropriate. The building was in need of redecoration and repair. Interview rooms contained out of use equipment. Not all areas were clean. There were no fixed or portable alarms available for staff. Staff had not made a safeguarding referral for an incident witnessed at Hull community team for learning disability.
• There were staff vacancies at Hull and Four Winds community team for learning disability which impacted on the length of time patients had to wait for an allocated worker.
• Staff said the use of both System One and Lorenzo was difficult to manage, information on Lorenzo was not always updated. Staff working at Four Winds reported difficulties in ensuring records were updated on the day of the patient visit.
• Whilst generally managers had sufficient authority to carry out their roles, they reported delays of up to four months in recruiting staff to vacancies which was as a result of the recruitment process. Some staff members reported incidents of bullying, which they felt managers had not adequately dealt with until recently.

Updated 10 August 2016

We rated community-based mental health services for older people as GOOD because:

• patients had risk assessments in place which were reviewed regularly. Risk management was practised in daily and weekly multi-disciplinary meetings

• there were good safeguarding practices in place. Staff knew how to identify abuse and raise concerns

• there were lone worker protocols in place that staff understood and adhered to

• staff received regular supervision and appraisal and felt supported in their role

• staff assessed the physical health of patients at the initial contact and managed physical healthcare in collaboration with the patient’s GP. Shared care protocols were in place to support this

• care was being delivered in line with the Mental Health Act and Mental Capacity Act

• care was delivered in partnership with patients and carers. Patients and carers were involved in decisions about care and treatment. Care plans were personalised and holistic

• feedback from patients and carers was positive. They described a good service with caring and skilled staff

• standard operational procedures were in place to manage waiting lists. Waiting list initiative teams were being used to reduce waiting times and numbers

• there were processes in place to prioritise referrals and respond to urgent referrals. Urgent referrals could be seen within either four or 48 hours
• a range of information was available for patients and carers. This included information on diagnosis and available services and support.

However:

• there were waiting lists in place for some teams. There were two teams with waiting times of 40 days and one team with a waiting time of 66 days.

• not all teams were compliant with mandatory training

• not all staff had received training on the Mental Health Act and Mental Capacity Act

• there was no routine monitoring of performance for the single point of access service. However we were being told this was being considered as part of the service review

• not all staff felt engaged in the service transformation programme. This meant that there was a level of uncertainty about the future and how services would work.

Updated 14 May 2019

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

• Staff completed and updated risk assessments for each patient and used these to understand and manage risks individually.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
• The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
• Staff assessed the physical and mental health of all patients on admission. They developed individual care plans and updated them when needed.
• Staff provided a range of treatment and care for patients based on national guidance and best practice.
• Managers made sure they had staff with a range of skills needed to provide high quality care.
• Staff from different disciplines worked together as a team to benefit patients.
• Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice.
• Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity, and supported their individual needs.
• Staff involved patients and those close to them in decisions about their care, treatment and changes to the service.
• The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
• The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

• Compliance with clinical supervision was low.
• There continued to be difficulty for the service to access medication out of hours due to the trust’s contract with the community pharmacy.
• Staff did not always have access to equipment to enable them to complete physical health monitoring whilst on community visits.
• Two of the meeting rooms at Miranda house did not have obscure glass to promote privacy and dignity for patients who were completing an assessment.
• Staff reported a lack of confidence in the trust to support them in raising concerns.

Updated 1 February 2018

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

• The trust had acted upon our feedback from our previous inspection of this service and there had been improvements in the quality of patient care.
• Safety was high priority for staff and the leadership team. There were measures in place to ensure the safety and quality of the service was monitored and that any changes required were acted upon in a timely manner. Patient risk was closely monitored and risk assessments updated on a regular basis. Staff protected patients by reporting incidents and raising safeguarding concerns.
• Patients received effective care and treatment. Staff were trained in the Mental Health Act and Mental Capacity Act and worked to their principles. Care plans were holistic and highly personalised and contained the voice of the patient. Patient needs and wishes were clear, and all patients had a clear discharge plan.
• The staff team were passionate about ensuring patients had a voice and were involved in the service. We observed staff who were kind, caring, respectful and compassionate. Staff made efforts to communicate with patients in complex circumstances and provided high quality individualised care for all patients. Patients and carers spoke highly of the service and the staff team.
• The service was responsive to the needs to patients. The service was tailored to ensure each patient was treated as an individual and services were delivered according to patients’ individual needs and choices. The staff team were significantly focussed on patient discharge and had found innovative ways to ensure patients could be safely discharged from hospital settings and enabled to live fulfilling lives in the community. The service ensured that patients were able to maintain close relationships with people who were important to them.
• The service was well-led. The staff team spoke highly of senior leaders and told us that they felt respected and valued. Governance systems in place ensured the safety of staff and patients. The service was focussed on continuous improvement and encouraged staff to take part in research and specialist training opportunities to enhance their skills and increase the quality of patient care. Staff spoke of a culture which was open, honest and supported them in their role.

However:

• The service continued to have difficulties with meeting optimum safe staffing establishment levels.
• Although the overall mandatory training rate for the service was 76%, not all staff had completed all of the required areas of mandatory training. Where the service was reliant on temporary staff, the trust did not ensure that these staff were trained to the same level of permanent staff to ensure the safety of patients.
• Areas of the ward which contained ligature points were not entirely risk assessed.
• The service allowed outpatients to use inpatient clinic rooms and this was not risk assessed or discussed with patients.
• Staff did not always adhere to guidance in the Mental Health Act and Mental Capacity Act Codes of Practice. This meant that seclusion and long term segregation reviews were not always completed on time, and that one patient did not have a best interests meeting for a restrictive care plan.
• Some areas of the units required re-decoration and were not entirely clean.

Updated 14 May 2019

Our rating of this service went down. We rated it as requires improvement because:

• There were not always enough staff to maintain safer staffing levels on the wards. There was a frequent reliance on occupational therapy staff to support safe staffing levels. Patient leave was often cancelled due to staffing levels.
• There were not always timely responses to carry out maintenance and repairs on the wards. Showers on Ouse ward and one of the laundry rooms within the service had been out of use or awaiting repair since November 2018. Offensive graffiti on a window in Derwent ward had not been reported for repair or replacement.
• Governance processes did not operate effectively at ward level and across the service. There were ineffective systems in place to monitor actions from incident investigations and learning from incidents was not routinely shared with staff.
• Staff did not always document that required reviews had taken place for patients in seclusion. Whilst in seclusion, patients did not have personalised emergency evacuation plans in place.
• Staff observed all visits between patients and their family members and friends. This was not individually risk assessed.
• Carers did not always feel well supported, involved or informed about their loved one’s care.

However:

• Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding
• Staff developed holistic, recovery-oriented care plans informed by comprehensive assessments. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
• Ward teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received supervision and appraisal. Ward staff worked well together as a multi-disciplinary team and with those outside the wards who would have a role in providing aftercare.
• Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
• Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients in care decisions.
• Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharges were rarely delayed for other than a clinical reason.

Updated 1 February 2018

• The ward relied on bank and agency staff and staffing levels were often below the required establishment. Mandatory training rates for basic life support was low and the rotas did not identify how many staff on each shift had completed life support training. Staff did not always document that they carried out checks on resuscitation equipment.
• Staff did not document up to date patient risk assessments and safety plans or share information about risks consistently at their daily handovers

Updated 1 February 2018

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

• The service had made improvements following feedback from our previous inspections. Maister Lodge had senior nurse cover for all day shifts and agency nurses were required to have the skills appropriate to the patient group. The ward now complied with safe medicines management.
• There were good patient risk assessments on each ward. The service provided a safe environment and managed risks well. Patients told us they felt safe. Risk assessments included monitoring of existing and potential physical health risks. At Maister Lodge, all patients had a bespoke risk assessment.

• Staff understood that the use of restraint was a last resort. They used de-escalation and low levels of restraint to manage incidents of aggression wherever possible. Staff ensured they documented episodes of seclusion, restraint, and rapid tranquilisation in accordance with trust policy. The ward took part in the trust restrictive interventions reduction programme and reported incidents of restraint appropriately.
• Patients on Maister Lodge had detailed, personalised care plans, which included information about physical health needs. Patients felt involved in decisions about their care. Staff gathered information from families and carers to produce an ‘all about me’ record for patients with cognitive impairment. This reflected a patient’s history and preferences and contributed to their care plan.
• There was effective multi-disciplinary team working with regular reviews of patients care and treatment needs. We saw an improvement in staff adherence to the Mental Health Act, with detention papers and associated records completed appropriately. Staff understood the application of the Mental Capacity Act. They recorded best interest decisions including when significant decisions were made for patients who lacked capacity.
• Patients, families, and carers appreciated and spoke highly about the quality of care and treatment the service provided. Staff involved patients in decisions about their care where possible. They engaged with and supported families and carers where appropriate. Staff contacted families and carers with updates on patient progress, held regular carers meetings, and invited them to reception meetings.
• The service accommodated patients in local beds rather than send them out of area. When Millview Lodge was full, they admitted patients to Maister Lodge until a bed became available. Staff worked towards home discharges for patients on Mill View, implementing the correct levels of support to make this possible.
• Activities were available although the way staff offered activities varied between the two wards. At Millview Lodge, staff offered group activities, in which the current patient group did not always choose to participate. At Maister Lodge, activities were ad hoc and individualised. The ward was currently implementing plans to improve the provision of activities for their patient group.
• Internal changes within the service had led to a positive change in culture. Staff focused on the needs of the people using their service, providing high quality patient centred care, which reflected the trust’s vision and values. Senior managers were committed to improving the environment at Maister Lodge and promoting best practice in dementia care.

However:

• The service could not always fill shifts. In particular, when increased staffing levels were required to meet changes in patient presentation. They relied on bank and agency staff and their own staff to fill shifts on a regular basis. This meant staff prioritised patient safety over individual staff clinical supervision and mandatory training needs.
• The trust had redecorated Maister Lodge and replaced broken furniture nevertheless the ward required a major refurbishment to make it appropriate to the needs of the patient group. Refurbishment plans had been in place since the previous inspections in 2016. The ward expected these plans to go ahead in October 2017.
• Both wards experienced delays in discharging patients. This was due to the lack of availability of suitable placements followed by delays in securing funding packages for patients.
• Systems and processes for reporting supervision were not robust. The system relied on staff remembering to sign the team’s supervision chart. Ward managers completed a survey with information from the chart but received no feedback.

Updated 14 May 2019

Our rating of this service stayed the same. We rated it as requires improvement because:

• Staff did not always develop patient care plans which were holistic, recovery-oriented and personalised. Staff did not always carry out an assessment to determine if patients needed a personal alarm. They did not always adhere to the principles of the Mental Capacity Act when patients had capacity to make decisions for themselves and they did not always complete patients consent to treatment in a timely way.

• Staff did not have appropriate information for patients who identified as lesbian, gay, bi-sexual or transgender. Some of the measures the trust had taken to protect patients’ privacy and personal details were not always effective.

• Governance processes were not effective in ensuring staff applied policy and practice consistently across the service and it was not always possible to tell from audit reports what improvements were required. The trust had not reviewed minimum staffing levels for the service. Staff did not feel supported or listened to by senior leaders.

• Staff did not always receive timely feedback when the trust investigated serious incidents. They did not have a robust system in place to share lessons learned with staff from incidents and complaints from across the wider trust.

However:

• They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.

• The service provided safe care. Overall, the ward environments were safe and clean. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.

• The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.

• Staff treated patients with compassion and kindness. They respected their dignity and understood the individual needs of patients. They involved patients and families and carers in care decisions whilst maintaining patient confidentiality.

• The service managed beds well so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

Updated 1 February 2018

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

• The service had enough staff with the right qualifications to keep people safe from avoidable harm and abuse and to provide the right care and treatment. They identified risks and recorded actions on how they would manage, reduce or mitigate them. They had effective systems to safely store and dispense medications.
• The premises used were clean, well maintained with a welcoming atmosphere. There was a variety of locations offering patients a choice of where to be seen.
• The service was continually improving to provide a recovery focussed treatment system. Staff delivered psychosocial interventions to encourage a patient’s improved health and wellbeing. Peer mentors provided patients with additional support and encouragement to commence their treatment journey.
• Patients felt involved in their care. The service met their individual needs and families and carers were involved if this was agreed. They were able to give feedback on the service and knew how to complain. Information relating to health, support groups and activities in the wider community was available and displayed.
• Staff showed a caring and respectful attitude. They were committed in their roles and embraced the service’s vision.
• Governance systems provided managers with a clear oversight of the service’s performance. They recognised and took responsibility where improvements were needed and involved patients, staff and commissioners in discussions. Managers and staff from the service were involved and committed to continual improvements

However:

• Staff did not review a patient’s recovery plan or review clinical interventions in line with best practice. Interventions on recovery plans lacked detail to enable a patient to clearly understand how or when they could achieve a goal.
• Staff did not have timely access to patient information agreements.

Updated 1 February 2018

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

• Patients, carers and family members were pleased with the service. Patients felt respected and involved in their care and treatment.
• The trust had introduced a number of initiatives to improve the standard of clinical governance.
• Staff knew how to report incidents using the online incident reporting system.
• Consultant psychiatrists and psychologists were readily available in all the services.
• Staff adhered to the trust lone working policy and they had not experienced any incidents.
• Staff carried out a comprehensive assessment of each patient, which included mental and physical health needs.
• Staff had regular supervision and appraisals.
• Staff supported patients to get involved in the local community. Bridlington service provided a therapy garden to support patients in therapeutic activities.
• There was a culture of openness and transparency and good team support among the managers and staff.

However:

• The trust target for six mandatory training courses had not been achieved.
• Some premises were in need of refurbishment and redecoration.
• The interface with prison in reach services for obtaining medical information about offenders was not working satisfactorily.
• Incidents had increased and had not always been investigated and documented appropriately.
• The transfer of Pocklington to a different trust had led to uncertainty and low staff morale.
• Precise caseload weighting was often not carried out.

Updated 3 October 2014

Humber NHS Foundation Trust provides long stay, rehabilitation inpatient mental health services for adults aged 18 to 65 years old.

People who used the services said that they felt safe. Staff understood how to escalate and report any concerns. They also assessed, monitored and managed the risks people posed very well.

The wards were clean and welcoming, and the standard of decoration was generally very good. There were systems in place to assess and monitor the safety of the environment. However, we found ligature risks on some doors within St Andrews Place.

All the people we spoke with told us that they were happy with their care, and felt supported and well-cared for by staff. We found the care staff provided to be outstanding. The multidisciplinary teams worked well together to plan and deliver care, and there were some excellent examples of how staff engaged and included people, for example in developing their care plans.

We found a care plan for one person who was admitted informally to St Andrews Place stated ‘Leave to be agreed with the MDT (multidisciplinary team)’. This practice did not comply with the Mental Health Act Code of Practice because it did not reflect the person’s lawful right to leave the ward at any time, and could lead to the person being detained unlawfully.

Staff at St Andrews Place assisted people to prepare meals however; we found they had not received training in basic food hygiene. There were no plans in place for staff to receive this training.

The service had some governance structures in place, which were used on all the wards.