Archived: Care And Support Partnership Community Interest Company Also known as SEQOL

Updated 17 November 2016

The Care and Support Partnership Community Interest Company was established in October 2011 and uses the trading name SEQOL. At the time of the inspection, SEQOL carried out work on behalf of Swindon Clinical Commissioning Group and Swindon Borough Council, providing adult community services to a population of 220,000 in both the urban and more rural areas of Swindon. The community adult nurses were split into four teams, each containing staff with a different skill mix and covered a particular area of Swindon. The community nurse team ran a 24 hour, seven days a week service, offering patients a twilight shift until 10pm and a night service from 10pm until 8am. The community adult nurses that worked the night shift were based at the urgent care centre. The podiatry service was a clinic that ran five days weekly.

This report focuses on the two teams which cover community adult services: community nursing and podiatry. The community nursing team provides care and treatment to patients in the community in their own homes, whilst the podiatry team runs regular clinics in a local health centre.

The local commissioning group had recently completed a tender process for the community services provided by SEQOL in Swindon. As a result of this process the provision of community services will be provided by another organisation from October 2016.

During the inspection, we reviewed 11 patient records and met with 19 members of staff including executive board members, service managers, specialist nurses, community nurses, community matrons, health care assistants, paramedics, podiatrists and administrators.

Updated 17 November 2016

Updated 17 November 2016

Care and Support Partnership Commnuity Interest Company (trading name SEQOL) provided services for intermediate care, reablement, learning disabilities, dermatology, acute urinary retention, specialist nursing, phlebotomy, rapid response and wheelchair services. However, we carried out a specific focused inspection of only the district nursing and podiatry services provided by Care and Support Partnership Community Interest Company (SEQOL) as a result of concerns we had received about these services. Our findings are reflected in the report.

We did not rate the service following the inspection, as this was a focused inspection concentrating on specific areas of the service.

We inspected the key questions of safe and well led.

We found improvements were required regarding the safety of the service. These included the following:

• The incident reporting categorisation was not clearly defined and not all staff had access to the incident reporting system to record incidents. Reporting procedures, such as defining learning outcomes were not completed and there was a lack of evidence to demonstrate learning was being shared and actions implemented to improve community nursing practice.
• Staff found the incident reporting system difficult to access when they were working out in the community and found the reporting form a challenge to complete.
• There were insufficient community nurses of all levels of skill mix to ensure the care and treatment needs of patients were met. The organisation did not use an acuity tool to determine the correct skill level and mix of staff required to manage with the complexity of patients cared for.
• There were deficits in training and education in the community adult nursing team. Several staff said that the training was not consistently delivered to meet their needs and they were not able to access training as they needed it.
• Despite a lone working policy being available, there was no clear lone working procedure followed by members of the community nursing team. Procedures differed between the teams and did not ensure that staff returned safely from all of their community visits.
• There had been an increase in the number of patients experiencing harm in relation to falls, pressure ulcers and urinary tract infections between the reporting period January to June 2016. The wound improvement project introduced in May 2016 with the support of the tissue viability team, aimed to provide training to address the shortfalls in care provided by with regards to pressure ulcers, some of which were categorised as serious incidents. The community nursing service did not have access to the most appropriate wound dressing products to use on patients and were required to do the best they could with what was available
• Patient care records and risk assessments were not completed fully and were not consistently up-to-date.
• There was no continual monitoring of safeguarding referrals to ensure early identification of trends and themes.

However, we also found that:

• There was an effective system to identify mandatory training needs used by the podiatry department.

• Staff were clear around their role in reporting safeguarding concerns and how they would go about reporting a safeguarding issue.
• The tissue viability team were supporting the community nurses by helping to improve knowledge and skills to identify, categorise and treat pressure ulcers.

We found improvements were required regarding the leadership of the service:

• There was a lack of regular reporting of incidents and complaints at senior management meetings. There were inconsistencies amongst the leaders of the community nursing team in addressing performance issues and ensuring actions following incidents and complaints were embedded into practice
• Community nurses felt supported by their immediate line managers but felt disengaged from senior management.
• Risk to the community nursing service regarding staffing and themes, and trends around pressure ulcers had not been identified as risks and reported on the clinical risk register. There was very poor compliance with completion of community nurses’ yearly appraisals and inconsistent supervision and one to one support.

However, we also found that:

• Staff in the podiatry department felt valued, respected and listened to.
• Leaders in the podiatry department understood the importance of staff engagement to improve the quality of the service provided.
• Team meetings took place regularly to ensure staff were aware of organisational updates and relevant information.

• The culture of the organisation and the staff who worked there was one of a committed workforce who strived to provide a caring and compassionate service.