Ellern Mede Moorgate Also known as Oak Tree Forest Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection we rated this key question inadequate. The service was in breach of legal regulation in relation to safe care and treatment and staffing. The service had made improvements and is no longer in breach of regulations. This meant people were safe and protected from avoidable harm. 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 told us they knew how to raise concerns and staff within the service were responsive. Family members we spoke with told us that the manager was very approachable and was always available to listen to the views and concerns of both the young person and their families. We were also told that families could speak with the doctor and could have regular meetings with the psychologist. Family members we spoke with told us service actively sought feedback and felt they were kept informed, as much as possible.

Most staff told us they felt able to raise concerns and felt positive about how approachable and proactive senior managers were. Staff told us that sharing information and continuous learning was implemented through various forms which included handovers, morning meetings, team meetings and safety huddles. Incidents were reviewed daily, and complaints were investigated thoroughly with outcomes and feedback given to all involved.

Staff had recognised incidents, reporting them appropriately and managers had good oversight of incidents within the service. Since the last inspection, the service had implemented daily risk meetings. Provider risk management meetings were also held to share information and good practice. The service reported 13 serious incidents between April and November 24 which we reviewed, and appropriate actions were taken. Feedback from family and young people were considered and complaints were investigated and resolved with actions put in place where required. The provider was implementing the Patient Safety Incident Response Framework (PSIRF) which sets out the NHS’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. This involves all professions to develop psychologically safe cultures and flexible and transparent approaches to learning responses and investigation.

Young people were involved in their care and discharge plans, and they were always encouraged to attend meetings to share their views. Families were invited to meetings when the young person had given consent to share their views.

The service had been closed to admissions since the last inspection. The service was also in the process of a service transformation, so we were unable to assess the referral and admission process during this visit. However, staff and leaders gave examples of collaborative working with services to keep people safe while protecting their rights.

Partners had regular engagement with the provider in a variety of meetings. Partners regularly attended multi-disciplinary meetings and other relevant care planning and review meetings. Feedback from partner organisations was positive about the services involvement with other services to discharge people effectively and safely from the service.

Discharge planning was discussed weekly in multi-disciplinary meetings which were attended by a range of individuals and young people were encouraged to attend. Care records and client notes demonstrated young person and family involvement in their care journey. Young people were supported to have extended leave, visits to and relationship building with potential placements.

Young people told us they felt safe and cared for and comfortable to raise any issues with staff or hospital management. Families also told us that they were kept informed, knew who to speak with if they had any concerns and were invited to relevant meetings.

Staff we spoke with told us they knew who to raise and report safeguarding concerns to. All staff completed Safeguarding Children training and were 95% compliant with this training and for Safeguarding adults training, staff were 98% compliant. All staff also completed training in multi-agency public protection arrangements (MAPPA) and Prevent duty training to help prevent terrorism and extremism in which staff were respectively 100% and 97% compliant. We received feedback from the safeguarding and patient safety lead for the provider. They spoke about reflective practice sessions with the staff team and desensitisation with the staff, launching a PSIRF process for safeguarding and patient engagement and patient led work to ensure individual needs are met.

We observed positive interactions between young people and staff and young people appeared well engaged and relaxed. We observed 3 multidisciplinary meetings during inspection and observed that staff discussed the appropriate use of and reducing levels of supportive observations.

The provider had effective systems, policies, and processes in place to ensure that staff identified and reported concerns. The 4 care plans included a section to capture any safeguarding concerns. The service had regular meetings with the local authority and had an agreed process to follow in terms of safeguarding concerns and these would be discussed monthly in the meeting. The service had a monthly reducing restrictive practice group and had young person involvement in these meetings. The service regularly reviewed restrictions and banned items. Since the last inspection, several restrictions had been addressed including introducing fob access to bedrooms, individual searching was risk assessed, and young people could bake without having to eat the baked goods.

We spoke with 3 young people and 2 family members who told us they felt safe on the wards. Young people were involved in weekly community meetings where they were asked about safety on the ward. Young people had access to an independent advocacy service. The service worked with partner organisations to support young people’s access to the community or to maintain relationships by using effective risk management.

Staff told us they completed a restraint reduction network approved training course. At the time of our assessment the providers restraint training had a compliance rate of 93%. Young people were assessed and reviewed by specialists, which were part of the team such as occupational therapy, physiotherapy, and dietician. Young people were also referred to speech and language therapy, when appropriate.

All young people had up to date risk assessments and were included in developing least restrictive management plans to manage risks. Risk assessments were reviewed weekly in multidisciplinary team meeting or after an incident. These reviews involved the young person and their families or advocate. We also reviewed pre and post leave risk assessments to ensure the risks to young people were adequately assessed prior to them leaving the hospital. The post leave risks assessment enabled feedback to be captured and if there were any concerns during the leave from the hospital this was highlighted and reassessed. Restraint was only ever used as a last resort. All restrictive interventions were reviewed daily and the service kept accurate records. Between 01 August 2024 – 17 November 2024 the service had recorded 370 episodes of restraint. 73% of these restraints were categorised as left and right hand holding. The provider had implemented processes to reduce restrictive practice, one example was the use of a recognised approach to addressing challenging behaviours for a young person involved in several incidents. This intervention reduced incidents from 147 incident in August 2024 to 16 incidents in November 2024.

The hospital fully involved young people to control potential risks within the ward environment. Young people were encouraged to comment on the environments in community meetings and specifically asked if they felt safe on the ward. Families and carers told us they were involved in the young person’s care, where consent allowed. The hospital offered phone calls and visiting, families and carers were asked to join multi-disciplinary meetings and invited to attend a carers event.

Hospital managers carried out monthly hospital checks and reviews. Safety issues were identified and addressed as part of these processes. Staff had easy access to alarms and young people had easy access to nurse call systems on the ward. Clinic rooms were fully equipped with accessible equipment and emergency drugs that staff checked regularly. Feedback from the occupational therapist informed us that they had completed a checklist for autism friendly environment to identify any areas that required improvement.

Risks within the environment were managed well with the use of CCTV and observations to manage individual risks. A ward tour and check of the environment and equipment was undertaken during our onsite activity. We found that fire extinguishers were not contained in lockable boxes and therefore could be accessed by anyone in the building. The service had risk assessed these and had an action plan in place to rectify this. We carried out a check of the clinic room environment and emergency bag, and we found no concerns with this equipment. Separate rooms were available for Nasogastric Tube feeds and other treatments. Staff had access to a range of equipment to support young people such as hoists and wheelchairs.

The hospital had an audit schedule in place which included completion of a health and safety environmental audit and ligature risk assessments. However, we found some inconsistencies between documented procedures and processes and staff practice with the use and maintenance of ligature cutters. Young people had personal emergency evacuation plans (PEEPs) in place however we were not assured that these were being completed in line with policy and staff raised concerns about this. On the first day of our onsite inspection these could not be located. The procedure was to update these monthly. When we reviewed the PEEPs, they had been completed in September and the next completion was the day of our onsite inspection. The occupational therapy team completed risk assessments of young people and considered how to keep people safe.

Young people and relatives we spoke with, raised some concerns regarding staffing, in particular changes in the staff team which impacted on building a therapeutic relationship. However, they did tell us staffing had improved recently. Young people told us that they had regular opportunities to meet with all members of the multi-disciplinary team.

Leaders were committed to ensuring staffing was safe and robust. Staff told us that staffing levels were good relative to the number of young people in the service. Vacant positions within the multi-disciplinary team had been filled since the last inspection, such as the psychologist and the service used bank and agency staff, when necessary to ensure safe staffing figures. Staff told us they received appropriate training and regular supervision.

We observed good levels of staffing during the inspection and there was enough staff to meet the needs of young people, including activities, engagement, and Section 17 leave.

The provider had made improvements to ensure they had enough qualified, skilled, and experienced people. The provider did not have any current vacancies. Some shifts were filled by locum agency nurses who were familiar and regular to the service. However, in the 6 months prior to our assessment, sickness rates were high at 45% and in the same period turnover of staff was 29%. The mandatory training programme was comprehensive. The provider monitored mandatory training and alerted staff when they needed to update this, and the hospital was 97% compliant with training overall. All courses had a completion rate above 81%. Staff had regular supervision, and all staff received annual appraisals and those currently at work were up to date.

We received feedback from 3 young people and 2 relatives who did not raise any concerns regarding the risk of infection. Young people told us that there was regular cleaning on the wards and relatives told us that the rooms they saw were always clean.

Staff we spoke with were aware of infection, prevention and control requirements and policies. Staff told us there was a nominated person every shift for ensuring good infection, prevention, and control standards such as hand washing, glove wearing and aprons as well as practicing bare below the elbows.

During our ward tours we observed the communal areas and bedrooms to be clean and well maintained.

The provider had some effective systems and processes in place to ensure they managed the risk of infection. Domestic staff carried out regular cleaning of the hospital. Training statistics for indicated 98% compliance with infection, prevention and control training and hand hygiene training.

People were aware of their medicines and staff discussed them with them. Relatives told us if they had any questions about medication they could speak to the doctor.

Staff followed systems and processes to prescribe and administer medicines safely. Medicines were reviewed during the weekly multi-disciplinary team meetings. Medicines reconciliation was completed regularly, and relevant observations were completed dependant on individual treatment plans. Staff reviewed the effects of each young person’s medicines on their physical health according to National Institute for Clinical Excellence (NICE) guidance.

Medicines and prescription charts were stored securely in the clinic room. Fridge temperature checks were all recorded and within accepted ranges and sharps bins were labelled with date of assembly. Cupboard checks identified some excess stock medicines.

An external specialist pharmacist visited the hospital every 2 weeks to review prescription charts as part of their regular audit process and we reviewed the audit report from these visits. We saw evidence of a reduction in medications prescribed and not being overused. We found some discrepancies and inconsistencies between documented procedures and processes for disposal of drugs no longer required. We also saw that it was identified as part of the pharmacy audit process that the service had an overstock of medications and this highlighted disposal of unwanted drugs. The service had ordered new pharmaceutical waste bins for the disposal of unwanted drugs.