Ellern Mede Moorgate Also known as Oak Tree Forest Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection we rated this key question requires improvement. The service was in breach of legal regulation in relation to person centred care. The service had made improvements and is no longer in breach of regulations. This meant people’s outcomes were consistently good, and people’s feedback confirmed this. At this assessment, the rating has changed to Good.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Young people we spoke with told us the service involved them in the planning of their care and treatment. Individuals confirmed they had input from psychology and occupational therapy, physiotherapy and speech and language therapy, were appropriate. One young person we spoke with did not always feel like concerns regarding their physical health were taken seriously. Other young people we spoke with were positive about physical health monitoring and external appointments were managed well.

Staff told us that they took care to communicate with the young people in a way that is easily understood. Staff used communication aids for a young person who was non-verbal to enable effective communication. The service could also use interpreter provision for people whose first language is not English as well as British Sign Language interpreter provision. Staff told us that young people inclusion in least restrictive intervention management plans, were used regularly to identify young people's preferences.

Staff completed a comprehensive assessment of each young person and the 4 care records we reviewed included information on the individual’s needs and preferences to ensure the care was person centred. Care plans identified physical health needs and physical health monitoring such as the use of national early warning score charts, height and weight charts, hygiene, bowel and menstruation charts, patient repositioning and exercise and physical activity charts. We also saw evidence of use of Ashtons side-effect monitoring scale, when appropriate. However, we observed that some of these charts were not always completed as per the care plan and there was a lack of clinical audit regarding this. Young people with identified needs, including a diagnosis of Autism Spectrum Condition had regular sessions with the autism lead who recorded 1-1 sessions of support with social snacks, visits, and activities.

The service held weekly community meetings for young people and the service ensured people had access to activities and local community groups. The service also invited relatives to meetings and kept them up to date on any activity or changes within the service.

Since the last inspection, the services psychological therapy had improved. Staff told us that a formulation pathway had been embedded, psychology attended and actively contributed to care plans and risk assessments and multi-disciplinary team meetings. We were given examples of approaches undertaken to reduce incidents and develop strategies to support young people with past traumas. Staff we spoke with also told us their development needs were identified during supervision, and they were encouraged to learn about new approaches and attend training that could improve the way care was delivered to people.

We saw evidence that people’s needs were met in line with current guidance. Multi-disciplinary team discussions involved the young person and their family in decision making and planning care and treatment. Care plans we reviewed included the monitoring required for individual’s physical health however, records showed that this was not always carried out as per the care plan. The service had audits in place to ensure staff provided evidence-based care and treatment, including treatment under the Mental Health Act 1983. Restrictions on young people were regularly reviewed to maximise their independence.

Young people were invited to attend meetings about their care. Relatives we spoke with felt involved and gave feedback that they were invited to meetings.

Staff told us that meetings in place were effective for sharing information internally. The service had introduced additional meetings such as the daily risk meeting and the weekly risk meeting which included all the providers services for sharing and learning. The service had effective working relationships with external teams and organisations. We received feedback from an external holistic therapy service, independent advocates and the provider collaborative, who told us that the enhanced monitoring following the last inspection had developed an open and transparent relationship.

During our assessment we observed 3 multidisciplinary meetings which were attended by a range of professionals including doctors, nurse, social worker, psychologist, physiotherapist, autism lead and dietician. The meeting agenda included updates from the nursing team regarding observations, nutrition, leave, activities, and physical health. Updates from the other disciplines and service user feedback were shared and plans and actions for the following week.

We reviewed minutes of meetings from weekly MDT weekly, handover meetings, safety huddles and daily risk meetings. The external advocacy service produced a monthly report which we reviewed. Case notes indicated evidence of external appointments and input from speech and language therapy, where appropriate. Discharge planning was collaborative with the young person and fully involved the social worker who arranged visits and meetings with potential placements and providers.

Young people we spoke with told us their health needs were met and were positive about activities available, which were tailored to individual needs. Young people attended weekly community meetings to discuss activities.

Staff we spoke with understood the importance of ensuring people's needs were met, including their physical health. Young people were having regular sessions with psychology, dietetics, and occupational therapy as part of their holistic programme of recovery. There were several planned activities on the wards including art and crafts, cooking and baking, animal therapy, life skills group and celebrations and events.

Young people's physical health needs were assessed and documented within care plans. Care plans showed that people were encouraged and supported to make healthier choices and promoted a healthier lifestyle.

The staff team supported young people, and they attended meetings with a range of different professionals involved in their care to discuss their progress.

We spoke with the leaders of the service who told us that since the last inspection, several new meetings had been introduced. Clear outcomes and actions from meetings were communicated to all staff by introducing a meeting on a page document and policy on a page highlighting key points for staff.

The provider conducted a survey between December 2023 and January 2024 which captured young people’s experience and actions taken to make improvements. Young people’s progress was monitored through daily morning meetings and weekly multidisciplinary team meetings.

Both young people and carers told us they were able to raise concerns and complaints, and these were acted on. Relatives and young people told us they are given information regarding their rights. Young people had access to advocacy. The independent advocate we spoke with told us that young people were supported to maintain relationships and understood their rights.

Staff we spoke with had a good understanding of consent including the Mental Capacity Act. Young people were supported to communicate and make decisions to enable the service to deliver person-centred care and treatment in line with people's best interests. This included the use of a communication aids for young people who could not verbalise.

During our site visit observations showed good interactions between staff and people and staff promoted independence to deliver person centred care and treatment.

Training records showed staff received training in Mental Capacity Act and the Deprivation of Liberty Safeguards and the training matrix showed 97% compliance. We looked at 4 care records which demonstrated consideration of a person’s capacity to consent. Capacity assessments were carried out as appropriate and were both time and decision specific. The service conducted regular reviews for young people who required non-consensual nasogastric feeding, a modified diet and the use of safety interventions and the rationale was clearly documented in records. Care plans stated that Section 132 rights should be read every 28 days for detained patients however records showed this was inconsistent.