We found that services provided by the provider were safe.

• There was a positive and open culture around reporting of incidents and learning was shared throughout the various professional teams.
• There was a high standard of safeguarding supervision being completed and staff were aware of their roles and undertook regular training. Learning from serious case reviews had been widely shared and actions implemented to address any identified shortfalls.
• The service regularly reviewed and updated their policies to ensure they were in date and in line with the latest guidance. Relevant and current evidence-based guidance, standards, best practice and legislation was used to develop how services, care and treatment were delivered.
• There were various examples of outstanding multi-disciplinary working. This included co-located teams sharing practice and information and providing support to colleagues and other partners working in the community.
• Staff provided compassionate care and treated families and children with respect. Feedback from families about the various professionals was consistently positive about the caring and professional approach provided.
• In general services reflected local needs and were flexible in providing continuity of care and choice. The provider discussed the changing demand and needs of certain services with commissioners in order to review provision.
• Children and their families were generally able to access services in a timely way for assessment and treatment. Services were appropriate and were within national referral to treatment time targets for appointments.
• There was an effective governance framework to support the delivery of the strategy and good quality care. Monthly performance data for each service was reviewed and shared with staff and management and a quarterly report shared with the joint commissioning board and the performance and quality board.
• Leaders understood the challenges to good quality care and could identify the actions needed to address them. Managers said they were empowered through the leadership of the service which enabled them to use their initiative and see work through to completion.
• Staff felt valued and respected. All staff we spoke with felt they were appreciated for the role they performed. There was a strong emphasis on promoting the safety and well being of staff. Measures were taken to protect the safety of the staff when working alone within the community.

However;

• The out of hours on call system for the children's complex care team relied on just two senior staff to provide this seven days a week.
• The provider had completed a number of audits of different records and identified the recording of consent needed improving.
• Paediatric therapy, specifically occupational and speech and language therapy and the TaMHS service (Swindon Targeted Mental Health Service) had long waiting times for appointments and treatment. They were unable to currently meet the demand on their services within the target time for appointments.