During out visit to the Zone we met with people who used services, spoke with staff on duty and reviewed six care records and three staff files. We found people were involved in decisions about their care and treatment and staff understood the principles of the Mental Capacity Act (2005) which ensured people's human rights were respected.

Care and treatment was provided in accordance to people's needs. There was evident in the care records which considered people's physical, mental health and social needs. Evidence of health and social care professional’s involvement was apparent. Risks were assessed and updated if people's needs changed.

The premises were suitably and comfortably furnished and the health and safety of the staff and service users was taken into account.

There were robust systems in place to ensure that before staff began working in the Zone that they were safe and trained to look after the people.

The Zone monitored there service provision on a regular basis. One comment “The service is very young person led with young people at its heart.” This demonstrated that the Zone valued the feedback from the young people using the service.

The Zone provides information, advice and support to young people who have early psychosis or severe emotional distress.

During our inspection we spoke to three people who used the service, five members of staff and the chief executive. People who used the service were very happy with the care and support that they had received. One person said, “This service has changed my life so much. I can’t imagine what I would have done without it”. Another person said, “The staff have helped me loads”.

People told us they were involved in the planning of their care and the reviewing of their progress. People could choose where they wished to receive their support. This could be at the services registered location or within the community.

We saw that people’s needs were assessed and care was planned and delivered in a manner that met their individual needs.

People were protected against the risks of abuse because staff understood people’s individual risks and were aware of the appropriate procedures to report any concerns.

Staff received the required support and training to enable them to meet people’s needs.

We saw that there was an effective system in place to enable people to give feedback and complain if they were unhappy with their care and treatment.

We rated The Zone as requires improvement because:

• There was a long waiting time for the Icebreak service (for clients with difficulties relating to personality disorder). All Icebreak clients had a fixed two-year treatment time regardless of their individual needs. The provider did not monitor whether this timeframe was effective, the wellbeing of clients on the waiting list for Icebreak or that appropriate health care professionals monitored clients who had self-referred to the service. The Zone was in the process of redesigning the Icebreak service to reduce the number of clients on the waiting list.
• Children and young people, who might be unaccompanied (from the age of 13 years) shared a waiting room with adults who could be distressed or may exhibit challenging behaviour. There were no clear procedures or policies to enable staff to protect children or adults from challenging behaviour. Staff did not always have access to alarms when consulting with clients in the building.
• Staff reused Paleperidone (a medicine used to treat schizophrenia) which should only be given to the client it has been prescribed for. This was against good practice guidance and the provider’s policy.
• There was a lack of incident reporting, investigation and learning from incidents which could help prevent future incidents. Staff did not know the full range of incidents they should report.
• Staff had not all completed training in the Mental Capacity Act and did not understand their responsibilities under the Act. There was no policy on the Mental Capacity Act. Clients and carers were not aware of advocacy services available to them.
• Staff working in the Insight service (for clients experiencing a first episode of psychosis) had not had appraisals or performance reviews and therefore had not had the opportunity to discuss their goals and development.

However

• The service was fully staffed and staff sickness and absence rates were low. Staff received supervision and training for their roles, they were driven and motivated to provide good care. Staff said they enjoyed their jobs and had good job satisfaction.
• Clients said staff treated them with respect and dignity and that they were professional, helpful, kind and caring. Clients could contact the service while they were on the waiting list for advice and signposting information. Staff reached out to clients who missed appointments in case it was a sign of a decline in the client’s mental health.
• Safeguarding policies and procedures were in place. Safeguarding is the action that is taken to promote peoples’ welfare and protect them from harm. Staff completed safeguarding training to help them keep clients safe. Staff made safeguarding alerts when needed.
• Care plans and risk assessments were of good quality. Clients and staff wrote care plans together and they included goals and information on physical health and wellbeing. Staff kept care plans up to date. Families and carers were involved in clients’ care if the client wanted.
• The service followed best practice guidelines by offering effective talking therapies. Staff ran a variety of groups that clients liked and found helpful. Teams included a range of mental health disciplines to meet the needs and preferences of clients.
• The service had good working links with other agencies to help it provide holistic care. Staff liaised with GPs and other health professionals to support clients’ physical and mental health needs. Staff provided employment, housing and benefits support for clients.