Announced inspection 1st to 4th November 2016. Unannounced inspection 17th November 2016.
During a routine inspection
When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.
Letter from the Chief Inspector of Hospitals
The Care Quality Commission (CQC) carried out a comprehensive inspection of East Coast Community between the 1st to 4th Novmeber2016, with an unannounced inspection on 17th November 2016.
This community enterprise company provides a number of NHS community services to the people of Great Yarmouth, Lowestoft and surrounding areas as well as some services across Norfolk and Suffolk. During our inspection we visited the a number of registered locations as well as a number of small clinics and services run across the provider.
Prior to undertaking this inspection we spoke with stakeholders, and reviewed the information we held about the provider. The provider had undergone change since its inception in 2011 including the reduction of the number of inpatient beds it provided alongside an increase in the provision of GP services. We visited the Beccles Minor Injury Unit (MIU) and found that this service was operating as an extension to primary care rather than an MIU as laid out in guidance. There was an ongoing consultation about the service.
We inspected three core service; community health services for adults,
Our key findings were as follows:
- An organisation that was changing to meet the needs and commissioning environment of healthcare in Great Yarmouth and Waveney and surrounding areas.
- Staff engaged with the organisation they worked for with over 70% owing a share of the company, above the average for a community interest company.
- There was an open culture for reporting incidents. Learning from incidents were identified and actions taken to reduce the chances of them reoccurring. However, we found that not all staff were made aware of learning from incidents.
- Good infection control, practices were evident across the services. Staff were aware of safeguarding principles and had the appropriate level of training.
- Mandatory training was above provider target in almost all areas.
- Care was evidence based and followed national guidance and best practice.
- There was effective multidisciplinary working throughout the services both within the organisation and with external professionals, services and partners.
- We found staff to be very caring. Patients were always treated with dignity and respect. We saw some examples of staff offering flexibility in their services to meet the emotional needs of patients.
- Friends and Family Test scores were positive across the series though sometimes on a low response rate.
- Services were designed to meet the needs of local people. Staff frequently flexed their service to meet individual needs of patients on an ad hoc basis.
- Access to services was good. There were drop in services for some clinics and other services such as Hospice at Home and community nursing seeing many patients within 24 hours of referral.
- Staff respected local leadership and felt well supported. They all spoke highly of senior management during the inspection though staff survey results showed they felt a lack of engagement from the executive team.
- There was a governance structure in place that enabled directors and senior leaders to monitor and manage risk, plan and strategise and provide assurance to themselves as well as stakeholders.
- There was a clear vision and strategy for the provider and its services. Senior leaders were aware of the risks facing the organisation which the strategy reflected.
We saw several areas of outstanding practice including:
- There was an increased use of self-management programmes in some services with a focus on patient outcomes.
- Staff in the hospice at home service demonstrated a sensitive, compassionate and caring approach to patients in their care. Staff gave us examples of how they went ‘the extra mile’ to meet each patient’s individual needs and preferences.
- There was increased integration of services particularly in palliative care and partnership working with acute trusts. The diversification into other services such as GP’s offered greater scope for the integration of services.
- Free baby life support training was offered by the health visiting teams.
- There was a breast feeding peer support team which offered support out of hours via telephone.
However, there were also areas of poor practice where the provider needs to make improvements.
The provider should:
- Ensure there is documentation regarding the distribution of multivitamins in line with the Governments “Healthy Start Programme”.
- Ensure completion of the child’s health record, “red book”, and note taking procedures when on home visits are consistent.
- Ensure the waiting area for children attending speech and language therapy (SaLT) at Shrublands is child friendly and children do not have easy access to stairs through a set of unsecured double doors.
- Ensure LAC are meeting targets for initial health assessments and annual reviews.
- Ensure staff were aware of audit outcomes such as harm free care.
- Ensure that all patients risk assessments are properly reviewed.
- Ensure all equipment is properly checked and calibrated.
- Ensure all staff are aware of incidents which have occurred across the CYP team and evidence sharing and learning from incidents.
Professor Sir Mike Richards
Chief Inspector of Hospitals