Archived: SSAFA Care CiC CRT/AVS Service

Updated 11 January 2017

SSAFA Care CIC (the provider) provide a seven day acute visiting service and clinical response team 'SSAFA Care CiC CRT/AVS Service' to the population of Leicester City, West Leicestershire and East Leicestershire. Three separate services are commissioned with three different Clinical Commissioning Groups. A clinical response team service is commissioned by Leicester City CCG and also with East Leicestershire CCG, a seven day acute visiting service is commissioned by West Leicestershire CCG. All three services operate from one office which is located in the Grace Dieu Ward, Loughborough Hospital, Hospital Way, Loughborough, Leicestershire, LE11 5JY. Services began operating across Leicester City in 2013, across West Leicestershire in 2014 and across East Leicestershire in early 2016. Twelve vehicles are used by this service to visit patients in their own homes and are parked overnight in a secure area of the hospital.

The clinical response team provides services for the population of Leicester City and East Leicestershire from 8am until 8pm seven days per week. The seven day acute visiting service provides services for the population of West Leicestershire from 9am until 5pm Monday to Friday and from 9am until 8pm on a Saturday and Sunday.

The service employs nine staff which includes an assistant director of urgent community services whose main base is located in Doncaster and a clinical lead that is based at the location where services operate from. Each day, a team co-ordinator is on duty. The service employs mainly agency staff who provide emergency care practitioner duties including minor illness and minor injury and also dispense medicines to patients in the community.

GPs across all three CCGs triage their own patients and refer them directly into these services by telephone. A call taker records the details of the referral in paper format and allocates the patient for a visit by an ECP. Calls are received using mobile telephones and the service uses laptops which give all staff who are trained, access to a clinical system enabling staff to access patient care records to update details of visits when they have been undertaken.

At the time of our inspection, the provider was not registered correctly with the CQC. The location where services operated from had not been registered appropriately with CQC.  Their statement of purpose had not been updated to reflect these services being provided.  The provider addressed this immediately following our inspection.

Updated 11 January 2017

We carried out an unannounced focused inspection of SSAFA Care Community Interest Company (CIC) on 3 October 2016. This inspection was carried out because we had received information which indicated potential concerns. This information was in relation to a seven day acute visiting service and clinical response team service 'SSAFA Care CiC CRT/AVS Service' which is provided from an office located in the Grace Dieu Ward, Loughborough Hospital, Hospital Way, Loughborough, Leicestershire, LE11 5JY. The information shared with CQC indicated potential concerns about the safe management, storage and security of medicines, including medicines stored in vehicles used by this service. Information also indicated potential concerns in relation to medical equipment used by this service and located in vehicles. Other information provided indicated potential concerns in relation to information governance and security and the management of patient identifiable information and also regarding the suitability and qualifications of clinical staff employed by this service and of clinical staff provided through external agencies.

Our key findings across all the areas we inspected were as follows:

• The provider was not registered correctly with the CQC. The location where services operated from had not been registered appropriately with CQC. Their statement of purpose had not been updated to reflect these services being provided.

• Medicines were not stored or managed safely and appropriately. Medicines were permanently stored in vehicles overnight and were exposed to large variations in temperature which could alter the effectiveness of these medicines. Some medicines were found to be out of date. There was no stock control system in place for medicines transferred from the main stock to the vehicles. The medicines management policy was out of date and did not refer to this location.

• Patient group directives (PGD’s) were in use however, not all staff working under these PGDs had signed them. There was no evidence of authorisation of these PGD’s within the organisation for use by the organisation.

• Clinical items and equipment was not stored or maintained appropriately. For example, some items were permanently stored in vehicles overnight such as a defibrillator which had been exposed to large variations in temperatures. Some clinical items were out of date such as defibrillator pads.

• There was not an effective process in place in relation to infection control. Sharps bins were stored in vehicles overnight in the boot and on passenger seats. Some sharps bins were found to be more than three quarters full which was against best practice and national guidance in relation to the safe disposal of sharps, and increased the potential risk of a sharps injury. The safe use of sharps policy dated 2014 had not been reviewed and was not relevant to this service/location. We observed that some clinical waste stored in vehicles was not in clinical waste bags.

• Patients were at risk of harm because systems and processes were not in place to keep them safe. There was no process in place to ensure that staff provided by recruitment agencies were suitable to perform the duties expected of them or that appropriate inductions, security and identification checks were carried out before commencement of shifts. No driving licence checks were carried out for agency staff.

• There was not an effective system in place for the reporting and investigation of incidents or lessons learned as a result.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the provider was comparing its performance to others; either locally or nationally.

• Not all risks to staff and patients were assessed and well managed. The provider did not have a risk register in place in relation to this service or location. Not all staff had a lone worker risk assessment carried out. The lone worker policy was out of date. We did not see evidence of adequate security measures in place for lone workers when working in the community and visiting patients alone.

• There were limited policies and procedures in place. Those we did see such as infection control, lone working and medicines related polices were either out of date and/or did not refer to this service/location.

• There was no evidence of formal clinical supervision, mentorship and support in place for all members of staff including staff provided through agencies.

The areas where the provider must make improvements are:

• Review governance arrangements including systems for assessing and monitoring risks and the quality of the service provision such as implementing a system of clinical audits, gaining assurance of the suitability, professional registration, training requirements and qualifications of all staff including agency staff and effective processes for the induction of new staff and clinical supervision, mentorship and support for all staff including agency staff.

• Ensure all staff complete all mandatory training requirements.

• Ensure that there are appropriate systems in place to properly assess and mitigate against risks including risks associated with infection prevention and control and emergency situations including risks associated with lone workers.

• Ensure a process is in place for identification checks and driving licence checks for members of staff.

• Ensure that there are appropriate systems and processes in place in relation to the safe management of medicines, PGDs, clinical equipment and clinical supplies.

• Ensure effective governance arrangements are in place in relation to information governance including systems to monitor patient identifiable information and update and quality of patient information into electronic patient care records.

• Ensure that patient safety alerts (including MHRA) are received by the practice, and then actioned if relevant. Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Ensure there is effective clinical leadership in place and a system of clinical supervision/mentorship for all clinical staff.

• Embed processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

In addition the provider should:

• Ensure policies and procedures are delivered consistently across the service.

• Ensure an effective process is in place to collect and act upon feedback from staff and service users.

On the 14 October 2016, the Commission served an urgent notice of decision to impose conditions upon the registration of this service provider in respect of a regulated activity. The following conditions were imposed:

• A supernumerary member of staff is on duty at the Grace Dieu Ward, Loughborough Hospital, Loughborough, Leicestershire, LE11 5JY where the clinical response team and seven day acute visiting service operate from, 7 days per week, in addition to the current workforce. This is to provide clinical leadership, oversight and management support to all staff on duty and to support the delivery of required improvements.

• To provide the Commission with an update on progress against your action plan received on Tuesday 4 October 2016 and further review of your action plan during a quality assurance meeting on Thursday 13 October 2016, by the 28th day of each month along with supporting evidence.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice