• Organisation
  • SERVICE PROVIDER

Locala Community Partnerships C.I.C. Also known as Kirklees Community Healthcare Services

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider

All Inspections

05 Nov to 07 Nov 2019

During an inspection of Community health services for adults

  • The service provided mandatory training in key skills to all staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service controlled infection risk well. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff identified and quickly acted upon patients at risk of deterioration. The service had enough staff with the right qualifications, skills, training and experience. The service managed patient safety incidents well. The service used monitoring results well to improve safety.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. Staff monitored the effectiveness of care and treatment. The service made sure staff were competent for their roles. All those responsible for delivering care worked together as a team to benefit patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However, we found the following issues that the service needed to improve:

  • The provider did not always ensure that information in relation to medicine allergies were clearly highlighted in patients’ care records.
  • Mandatory training compliance figures were low in some areas, particularly in relation to medical staff.
  • Staff only assessed and mitigated risk of patients when a risk actually presented and did not record any reviews of risk within care records.

05 Nov to 07 Nov 2019

During an inspection looking at part of the service

Our rating of the organisation improved. We rated it as good because:

We rated safe, effective, caring, responsive and well led as good. We rated all four of the core services we inspected as good overall. In rating the organisation, we took into account the previous rating of the core service we did not inspect this time.

  • We rated well- led for the organisation overall as good. The leadership, governance structure and culture within the organisation showed an open, effective and person-centred approach which was driving improvements to deliver good quality, patient centred care.
  • We saw a strong vision and set of values which were shared across the organisation. Staff in core services knew the vision and values and had the opportunity to input into them.
  • Locala had systems in place to identify learning from incidents, complaints and safeguarding alerts. Locala used safety summits to share information between teams and had recently enabled colleagues to access these through skype to improve attendance.
  • There was an open incident reporting culture, staff knew how to report incidents and there was evidence of learning from incidents; there were comprehensive arrangements and procedures for safeguarding and feedback we received from external stakeholders in relation to safeguarding was positive. Staff in core services demonstrated a good understanding of safeguarding and knew how to protect patients from abuse.
  • Robust arrangements were in place for identifying, recording and managing risks, issues and mitigating actions. Recorded risks were aligned with what staff said were on their ‘worry list’. Locala had a risk profile which identified their highest scoring risks, there were key performance indicators in place to monitor risk management and we could see that risk was discussed regularly at both board and committee meetings.
  • On the whole mandatory training compliance figures were good. Staff said they had access to both internal and external learning. Locala’s coaching programme had been shortlisted for the training journal awards in the category of best coaching / mentoring programme.
  • The organisation worked collaboratively with external partners to provide the highest quality of care. Locala was the lead provider for an innovative partnership which brought together five organisations and their 0-19 services to help ensure that all children, young people and families living in Kirklees will be healthy and resilient. Feedback from external stakeholders included recognition of Locala embracing new ways of working.
  • Across the four core services we saw that staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

However:

  • Although Locala had an LGBT staff network they had not yet developed a Black and ethnic minority or a disability staff network. Locala had recognised that there was a need to develop further staff networks however these were not yet in place.
  • In the community health services for adults, risk assessment reviews were not always documented on the electronic patient record. Staff were completing reviews of risk and these were discussed with the multidisciplinary team however documentation was not always updated in the risk document. In the children, young people and families service we saw some clinical records were not completed within the 24-hour timeframe. Records not completed within the 24-timeframe varied between 1% and 4%.
  • In the community health services for adults not all mandatory training was compliant with the organisational target.
  • In the children, young people and families service the 0-19 service in Kirklees had very high caseloads which were significantly above the organisations recommended colleague caseload.

05 Nov to 07 Nov 2019

During an inspection of Community health services for children, young people and families

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse. Staff controlled infection risks well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • In one of the services, staff had very high caseloads, which was affecting service provision as staff were completing some visits over the telephone rather than face to face. This was being monitored and risks were being mitigated through a system of identifying and prioritising families that were vulnerable or most in need of support.
  • We saw some environmental concerns including the lack of a radiator cover within a sensory room for children and some poorly kept cleaning records
  • Some of the records were not inputted onto the system within the 24 hours timescales required.

05 Nov to 07 Nov 2019

During an inspection of Community dental services

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
  • Staff provided good care and treatment and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • The waiting times for an initial assessment were excessive. As of November 2019, there were currently 501 children on the waiting list for an assessment (including new referrals received). The service was fully aware of this and was taking action to reduce the waiting times.
  • Improvements could be made to the audit process to ensure audits of dental care records are relevant to dentistry.
  • An audit of antimicrobial prescribing had not been carried out.

05 Nov to 07 Nov 2019

During an inspection of Community health sexual health services

This is the first inspection of the sexual health core service. We rated it as good because:

  • The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service. 
  • Staff provided a holistic patient centred approach to planning and delivering care and treatment, proving high quality care. All staff were actively engaged in monitoring the effectiveness of the service to improve quality and outcomes for patients. Innovative and evidence-based techniques were used to improve the service. Staff development was a priority for the service and there was evidence of strong collaborative working.  
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. 
  • The service had the individual needs of patients central to the planning and delivery of care. Services were flexible and used innovative approaches to ensure the services met the needs of people needing them. There was active engagement with other agencies to support those most vulnerable to access services at the right time and there was a proactive approach to understanding the needs of those using the service. Work had been done and was ongoing to ensure people could access services in a timely way. 
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff had common values and felt respected, valued and supported. Staff were clear about their roles and accountabilities They were focused on the needs of patients and adopted innovative approaches to continually improve patient care. The service engaged well with other organisations within the community to plan, develop and manage services

However:

  • Recording systems at times did not provide managers and staff with key management information. This included the monitoring of staff sickness and its impact on appointments and clinic times, the delayed recording of medical sessional staff mandatory training course completion and clinic cleaning log form which did not provide for full recording in line with policy.
  • There were some environmental safety concerns as nurse call alarms were not within easy reach of patient examination couches in all location inspected to help nurses in the event of an emergency. At Huddersfield, the reception area did not provide patients with privacy when checking into their appointment and some paintwork was flaking with a risk to infection control.
  • Staff were not aware of a service strategy or vision and some complaints were not managed in a timely manner or in accordance with the policy.

11-14 October 2016, 27 and 28 October 2016 and 4 November 2016

During a routine inspection

We inspected Locala Community Partnerships Community Interest Company (“Locala”) from 11-14 October 2016. We undertook unannounced inspections on 27 and 28 October 2016 and 4 November 2016. We carried out this inspection as part of the Care Quality Commission’s (CQC) comprehensive inspection programme.

We inspected the following core community health services:

  • Community adults services
  • Community inpatient services
  • Community dental services
  • Community services for children, young people and families

In relation to each core service that we inspected we asked if the service was safe, effective, caring, responsive and well-led.

We sampled services provided from a range of locations across the Kirklees and Calderdale areas.

We did not inspect GP services, sexual health services or primary dental services provided by Locala during this inspection.

As a result of this inspection, we have rated the four core services that we inspected. We have not rated Locala as a provider for each of the five key questions or given an overall rating because we did not inspect how well-led the organisation was in relation to all the services that it provides.

Our key findings were as follows:

  • Locala’s systems for identifying, investigating and learning from incidents were not robust. There were several examples of this, including an incident that was not identified as a serious incident until several months after it occurred and that was incorrectly deemed to have been unavoidable.
  • The duty of candour requirements were not embedded across the services that we inspected and compliance with the duty of candour requirements had not been monitored by the Board until September 2016.
  • The organisation had safeguarding policies and procedures in place for safeguarding vulnerable adults and children. Safeguarding training rates were variable across the core services we inspected. A serious safeguarding adults incident had occurred in June 2016 which highlighted that some staff in the community adults team had not recognised safeguarding concerns that had been raised by patients and subsequently had not known what action to take. This had resulted in a delay in the organisation taking the appropriate action.
  • We identified significant concerns regarding assessing and responding to risk on Maple Ward. This included falls and venous thromboembolism risk assessments not being completed and national early warning scores not being calculated when it was clinically appropriate to do so.
  • We were not assured that governance and risk management arrangements were robust and we were concerned that there was an insufficient focus on quality within the organisation. Revised governance and risk management arrangements had been introduced shortly before our inspection. However, many of these changes were not fully embedded and it was too early to see whether they would lead to improvements. We saw several examples of serious patient safety issues not being identified or escalated through the governance structures appropriately.
  • We found a mixed picture in relation to the culture of the organisation. This was reflected in the variation in responses in the June 2016 staff survey across the four business units.
  • Mandatory training compliance rates were variable across the four core services that we inspected.Locala had a trajectory that Nurses in the integrated community care teams were not being provided with individual clinical supervision.
  • Appraisal rates were low in the community adults and community inpatient services.
  • Staffing levels were appropriate in the majority of services that we inspected. However, staffing shortfalls were a significant issue in the integrated community care teams, which delivered planned and unplanned care to patients. Staffing issues had been particularly acute in these teams in the period August to October 2016.
  • A number of the infection prevention and control (IPC) policies and procedures were out of date. There were capacity issues in the infection prevention and control team, which meant that the IPC audit schedule hadn’t been followed in all the services that we inspected. We observed staff following IPC practices during the inspection.
  • Care and treatment was evidence based across the services that we inspected. Staff had access to policies and procedures and other evidence-based guidance via the organisation’s intranet. Policies, procedures, assessment tools and pathways followed recognisable and approved guidelines.
  • There was an agreed clinical audit programme in place for 2016/17. Locala had identified that there were gaps in required levels of quality assurance and clinical governance that may lead to poor standards of clinical quality and had commenced a programme of work to address this.
  • The services we inspected participated in a number of audits to measure patient outcomes. We generally saw evidence of good patient outcomes in the services that we inspected, with the exception of Maple Ward where national audit data had not been completed during the reporting period for this inspection. In some instances we did not see evidence of action plans in the community dental service to address the outcomes of audits.
  • Across the services staff used technology to enhance the service they provided to patients, however there were issues with the connectivity of mobile technology which meant that information was not always available to staff when they needed it..
  • Throughout our inspection the majority of patients and relatives informed us they felt involved in care options, decision making and planned treatment. Staff took time to explain the care being administered and to ensure that patients and relatives understood what was happening.
  • Patients were generally able to promptly access care and treatment in the services that we inspected. There were waiting lists for patients to access some services in the integrated community care teams and some visits were being delayed as a result of staffing shortfalls.
  • There was no dementia or learning disability strategy in place. However, Locala had received an award in 2015 from a local voluntary group specialising in dementia care in recognition of the work to become dementia friendly. We saw some good examples of staff and services responding to the needs of people in vulnerable circumstances.

There were areas of poor practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that there are robust procedures in place to ensure that incidents, including serious incidents and never events are correctly identified and reported and are comprehensively investigated and reviewed at an appropriate level within the organisation.
  • Ensure that learning from incidents and complaints is shared and embedded across the organisation.
  • Ensure that the duty of candour process is effective and embedded in practice across the organisation.
  • Ensure that at all times there are sufficient numbers of suitably skilled, qualified and experienced staff, taking into account patients’ dependency levels.
  • Ensure that all staff have completed mandatory training and role specific training.
  • Ensure that infection prevention and control policies and procedures are reviewed and in date.
  • Ensure that the infection prevention and control audit programme is followed and actions are identified and implemented in a timely manner when issues are identified through the audit programme.
  • Ensure that staff are up-to-date with appraisals and staff attend clinical supervision as required.
  • Ensure that there are in operation effective governance, reporting and assurance mechanisms.
  • Ensure that there are in operation effective risk management systems so that risks can be identified, assessed, escalated and managed.
  • The provider must have systems in place, such as regular audits of the services provided, to monitor and improve the quality of the service.
  • Ensure that staff have undertaken safeguarding training at the appropriate levels for their role.
  • Ensure that there are appropriate systems in place in the community adults service to ensure that patients are prioritised and seen promptly in accordance with clinical need. In addition, the provider must ensure that the governance and monitoring of such systems is operated effectively to enable the identification of any potential system failures, and to take action so as to protect patients from the risks of inappropriate or unsafe care and treatment.
  • Ensure that staff competency is robustly assessed in the community adults service.
  • Ensure that timely clinical risk assessments are undertaken and recorded and care plans are developed and recorded that are reflective of the patient’s needs for patients on Maple Ward.
  • Ensure that clinical risks are promptly identified and appropriately monitored on Maple Ward, including the calculation of National Early Warning Scores, as clinically appropriate.
  • Ensure that patients who self-medicate on Maple Ward have been appropriately risk assessed.
  • Ensure that patients having venous thromboembolism prophylaxis on Maple Ward are appropriately assessed as per current best practice guidance.
  • Ensure that a paediatric nurse is available to provide recovery care for children receiving dental treatment under a general anaesthetic, as recommended by the Royal College of Nursing.

Professor Sir Mike Richards

Chief Inspector of Hospitals

11-14 October 2016, 27 and 28 October 2016 and 4 November 2016

During an inspection of Community health services for adults

Overall, we rated this service as inadequate because:

  • There were significant nursing and therapy staff shortages in the integrated community care teams, which were having an impact on patient care. There were concerns about the lack of robust governance, oversight and monitoring of this situation. There was also a lack of robust governance in relation to incidents and concern about the lack of learning from incidents. The service demonstrated some evidence based care in the various teams and performance against some national and locally set targets was good. However, there was a lack of benchmarking of performance both within the organisation and externally. There was no clinical supervision of nursing staff within the integrated community care teams and the appraisal rates were low. The systems for checking staff competencies were not robust.
  • There were a number of services with waiting lists of patients requiring assessment and treatment. There was no dementia strategy and there was a lack of provision for people who did not have English as their first language. However, the service had a range of specialist services to meet the different needs of people in the locality.
  • Risk management and governance processes were not robust and plans to improve services were often not in place or lacked deadlines for actions to be achieved. There had been a lack of staff engagement at a time of significant change in the service. Planning for the changes had not been robust and action plans for this did not include actual or potential risks. There were gaps in policies and guidance for staff and there was little oversight or audit to ensure policies were followed. The recovery plans to address waiting lists were not robust and in some situations there were no plans in place to recover the position. Senior managers were not visible to staff and many staff felt they were not listened to. However, there were positive messages from some staff who enjoyed working for the organisation. There were some innovations in working with the third sector.

However:

  • Staff in all teams were working very hard to provide a quality service to patients and their carers or families. We saw examples of outstanding care in some services. We saw patients and relatives were treated with dignity, respect and compassion. We observed staff reassuring patients and relatives and there was an empowering approach to patient care in some services. Feedback about the staff and the service from patients and families was mostly positive.

11-14 October 2016, 27 and 28 October 2016 and 4 November 2016

During an inspection of Community health inpatient services

Overall, we rated this service as inadequate because:

  • The timing and pace of change within the organisation and intermediate care unit had a negative impact on the quality of care provided.
  • Patient’s risks were not consistently assessed and monitored to ensure that they were safe and received appropriate intervention and support. This included the risk of falls, venous thromboembolism (VTE), diabetes and epileptic seizures. We could not be assured that these patients were consistently receiving safe care.
  • A computerised patient care record system had been introduced before staff had completed training on the system, which had resulted in staff not having access to the information that they needed to assess and monitor patient care. There were gaps in records and inconsistencies in the care documentation. The ward staff were experiencing difficulties in sustaining a safe and effective service that met people’s needs.
  • Staff did not follow the correct procedure when carrying out an investigation into a fall. They graded the fall as unavoidable. A further investigation was undertaken several months after the incident and the correct process was followed. The fall was graded as avoidable. This meant that the service had missed opportunities to address patient safety concerns in the period between the first and second investigation.
  • Systems were in place to report safeguarding incidents. However, staff had not identified or taken action about a patient who may have been at risk of self-neglect.
  • There had been several staff and local management changes, which had meant that staff had not had formal supervision or appraisal.

However:

  • There were infection prevention and control systems in place to help reduce the spread of infection.
  • Staffing levels had recently been reviewed and had been determined using National Institute for Health and Care Excellence (NICE) guidance.
  • Multidisciplinary assessments were also carried out prior to the patient going home. This ensured patients’ needs were met and they were not delayed.
  • The service had started to use a monitoring tool for pain and four patients we asked told us they received pain free care.
  • The service scored higher than the national average in the ward PLACE audit for maintaining the privacy and dignity of patients.
  • They positively made changes following feedback from people who used services.

11-14 October 2016

During an inspection of Community health services for children, young people and families

Overall, we rated this service as good because:

  • There had been no never events or serious incidents reported between April 2015 and August 2016. Incidents were investigated and reported in line with policy. We saw evidence of the service sharing learning with staff and there was evidence of changes to practice in response to serious case reviews. There was a broad understanding of the duty of candour and evidence of it being implemented. Staff were experienced in safeguarding children and recognising risk, and safeguarding supervision took place on a regular basis. Staffing levels and caseloads were appropriate for the services provided and were in line with commissioned levels. However, there had been problems recruiting staff in children’s therapy services resulting in capacity issues. The risks had been mitigated by temporary actions.
  • Staff practised evidence based care and treatment and there was good evidence of effective multi-disciplinary working within the service and with external partners. There were clear and accessible routes into other services. Information technology supported mobile working and a single electronic patient record that was accessible to the multidisciplinary team. Immunisation rates and health visiting performance indicators met the expected targets. We saw optimum completion rates of health assessments for vulnerable children including looked after children and youth offenders. Most staff groups in the service had appraisal rates of between 90% and 100% and the overall rate for the service was 88%. Staff were aware of the principles of consent and we observed this in practice when attending clinics and home visits.
  • We observed compassionate care being delivered in clinic, school and home settings. Children used the word ‘kind’ frequently in their feedback on care. Parents told us that they felt they could ask for advice and trusted the information that they were given. The Family and Friends test results demonstrated that children, young people, carers and parents were extremely likely or likely to recommend the service.
  • Staff we spoke with had a clear focus on the needs of children, young people, carers and parents. The service planned and delivered services that met the requirements of current child health programmes. Therapy services including physiotherapy, occupational therapy and speech and language therapy, achieved 100% of assessments and interventions starting within 18 weeks. We saw that there was consideration of the diverse communities and public health needs. There was access to translation and interpreting services and staff were aware of local links into services for new migrants and the lesbian, gay, bisexual and transgender community. Services were easily accessible for children and their families and there was flexibility in how these were provided to suit individual need. There were minimal complaints about the service and these were dealt with in a timely manner.
  • The service vision and aims were aligned with the corporate vision and staff were passionate about delivering a high quality service. The governance structure had been revised and was in the initial stages of implementation. Executive and service level leadership was visible and open to staff engagement. There was evidence of surveying staff regularly and acting upon negative feedback. Staff were involved in decision-making to support the significant changes planned to integrate health visiting and school nursing services. There was strong engagement with families and children in the community and evidence of acting upon feedback.

However:

  • We noted and reported safety and cleanliness issues in the child development centre to management, which were acted upon immediately. There were no child-friendly furnishings or decorations except in the playrooms. Alternative accommodation was being sought at the time of inspection and this issue was listed as a service risk.
  • We observed medicines for several children being prepared for administration at the same time in a clinical area. This was highlighted at the time of inspection and procedures were changed immediately as a result. We confirmed that practice had changed during the follow-up unannounced inspection.
  • Lack of capacity in the therapy services meant that follow-up appointments could be delayed.
  • The escalation route for risks from front-line staff to the board and the criteria for submitting a risk for escalation were not clear.

11-14 October 2016

During an inspection of Community dental services

Overall, we rated this service as good because:

  • Dental services were effective and focused on the needs of patients and their oral healthcare. We observed examples of clinicians and teams working together effectively in the service. The service was reviewing its referral system and integrating a triage process to ensure patients received care by the appropriate clinician and at a clinic that met their needs.
  • Systems for identifying, investigating and learning from patient safety incidents were in place. There was evidence that lessons learnt from incidents and complaints were shared across the teams.
  • Infection control procedures were in place and audits had been carried out. The environment and equipment were clean and well maintained.
  • Staff told us they felt supported by their managers, they were informed of the future strategy of the service and had the opportunity to participate in the planning. There were governance systems in place.
  • The focus of staff was to provide a positive and caring environment, where patients were at the centre of all they do.
  • Patients told us they had positive experiences of care at each of the clinics we visited. Patients, families and carers felt well supported and involved with their treatment plans and staff displayed compassion, kindness and respect at all times. We saw examples of staff caring for families and not just the patient. Patients and their families were appropriately involved in and central to making decisions about their care and the support needed. Staff used imaginative ways to engage younger patients in care.

However:

  • The service provided treatment in a hospital setting under general anaesthetic to children, but did not provide paediatric nursing staff to support children’s recovery from anaesthetic in the recovery area in all of the hospital settings. This is recommended by the Royal College of Nursing (2013) to ensure safe paediatric care.
  • Staff are required to undertake level two safeguarding children training, however overall only 19% had received this training as of August 2016. The organisation had a trajectory to achieve 100% compliance by 31 March 2017.