Overall we rated Hannah House as requires improvement because:

• There was limited documented evidence of sharing of learning from incidents. Eleven staff we spoke with were unable to provide examples of learning or changes in practice in response to an incident. The trust told us post inspection that learning from incidents takes place during clinical supervision and safeguarding supervision within the unit
• There were concerns over safeguarding training; there was a requirement for staff to be trained to level three and not all staff had received this traininig. Safeguarding supervision levels were 82% this was below the trust target of 90%.

• Not all medicines were being transcribed correctly and some medication being used had past its expiry date. Following a discussion with the trust an action plan was developed. This outlined areas for improvement with leads identified and clear timescales for actions to be competed.
• Staff sickness levels were high at 22% and as a result some short breaks had been cancelled. However, safe staffing levels were being maintained at all times.
• Staff appraisal rates were 75% this did not meet the trust improvement trajectory target of 85%.
• There was a lack of evidence in relation to staff skills and competence. The competency documentation was incomplete and some staff expressed concerns over this.
• The bed occupancy targets of 85% had only been met in four out of ten months. This had been impacted by the transition bed being occupied which required a staff to child ratio of 1:1. The unit was also closed on two occasions on the advice of the infection prevention and control team.
• Data was not collected on how many allocation requests were given to individual families and carers. Therefore the trust could not provide evidence that they were fair and equitable in the allocation of short breaks.
• Risks to the service were not clearly identified and escalated. There was a lack of management oversight in the unit because of sickness and vacant posts. There was an interim manager in post at the time of inspection.

However:

• There were detailed and clear escalation plans in place for each child if they became unwell whilst at Hannah House.
• There were clear plans in place to ensure the nutritional and hydration needs of children and young people were met.
• Children and young people’s needs were assessed and care was delivered in line with current legislation, standards and recognised evidence based guidance.
• Staff were passionate about the care they provided. Parents gave positive feedback and felt confident their children were safe whilst at Hannah House.
• Emergency access was always available for families if a crisis occurred.
• There were clear vision and values within the organisation and staff were aware of them.
• Staff reported good support from their line manager.

Professor Sir Mike Richards

Chief Inspector of Hospitals