This inspection was an announced focused inspection carried out on 5 July 2018 to confirm that the provider had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection between 10 and 13 July 2017.

The July 2017 comprehensive inspection was carried out in partnership with Her Majesty’s Inspectorate of Prisons (HMIP) under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions in accordance with our published methodology. CQC issued one Requirement Notice under Regulation 9 of the Health and Social Care Act (Regulated Activities) Regulations 2014 to Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). This can be found in Appendix 2 of the joint inspection report. The joint inspection report can be found at:

https://www.justiceinspectorates.gov.uk/hmiprisons/wp.../Holme-House-Web-2017.pdf

This focused inspection report covers our findings in relation to those aspects detailed in the Requirement Notice dated 5 December 2017 and findings published in the joint report. We do not currently rate services provided in prisons.

Our key findings at this focused inspection were as follows:

• The trust had taken positive action to improve the delivery of mental health services.

• All referrals made to the mental health team were triaged on receipt and allocated to a mental health practitioner within 24 hours. Assessments now took place within a week.

• Care plans were now well developed and showed evidence of patients’ involvement in their planned care.

• Clear timescales for continuation of patient care were recorded in care plans; all had been reviewed to ensure follow up assessments; and future appointments were documented.

• Caseload management had improved significantly and was monitored and discussed by staff and managers at both individual and team meetings.

• Managers had made improvements to recording systems and patient information templates to ensure a consistent approach.

At a previous inspection we found concerns with the provider's arrangements for medicines. We carried out this inspection to check whether action had been taken to address these concerns. We found that improvements had been made to make sure that people were prescribed medication safely.

We spoke with a number of people who used community services or were carers from across the Trust’s geographic area, during a focus group session. We also spoke with one person on site at a community mental health team location.

Some of the people we spoke with reported a good level of support and care. For example one person told us, “The difference it’s made to my well-being is exceptional." A carer told us, “Advance statements work really well. My stepson and his father wrote one together and this is on his file”. However, some carers reported to us they felt excluded from decisions about care and support for themselves as carers.

We found overall people experienced care, treatment and support that met their needs and protected their rights.

We found the teams we visited worked in cooperation with a number of different partners to protect and promote the health, welfare and safety of people who used the service.