Northern Devon Healthcare NHS Trust RBZ Community Health Services for Adults Quality Report
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Northern Devon Healthcare NHS Trust RBZ Community Health Services for Adults Quality Report Raleigh Park, Barnstaple, Devon Ex31 4JB Tel: 01271 322577 Date of inspection visit: 2-4 July and 7-8 July 2014 Website:[email protected] Date of publication: 11 September 2014 This report describes our judgement of the quality of care provided within this core service by Northern Devon Healthcare Trust. Where relevant we provide detail of each location or area of service visited. Our judgement is based on a combination of what we found when we inspected, information from our ‘Intelligent Monitoring’ system, and information given to us from people who use services, the public and other organisations. Where applicable, we have reported on each core service provided by Northern Devon Healthcare Trust and these are brought together to inform our overall judgement of Northern Devon Healthcare NHS Trust 1 Community Health Services for Adults Quality Report 11 September 2014 Summary of findings Ratings Overall rating for Community Health Good ––– Services for Adults Are Community Health Services for Adults safe? Good ––– Are Community Health Services for Adults Good effective? ––– Are Community Health Services for Adults Good caring? ––– Are Community Health Services for Adults Good responsive? ––– Are Community Health Services for Adults> Good well-led? ––– 2 Community Health Services for Adults Quality Report 11 September 2014 Summary of findings Contents Summary of this inspection Page Overall summary 4 Background to the service 5 Our inspection team 5 Why we carried out this inspection 5 How we carried out this inspection 5 What people who use the provider say 6 Good practice 6 Areas for improvement 7 Detailed findings from this inspection Findings by our five questions 8 3 Community Health Services for Adults Quality Report 11 September 2014 Summary of findings Overall summary The Northern Devon Healthcare NHS Trust provides The services provided safe and effective care and community healthcare services to a population of around treatment to people who lived in their own homes, or 484,000 and provides services at any one time to attended clinics run by the trust. Staff were able to report approximately 6,000 patients who live in their own incidents to the trust and found action was taken to homes. The care and treatment is provided under the address issues, although they had not always received regulated activities, including: diagnostics and screening, feedback regarding the outcome. The community teams family planning, nursing care and treatment of disease, promoted the control of infection and followed trust disorder and injury. We visited community teams based policies to prevent the spread of infection. in South Molton, Holsworthy, Bideford, Exmouth, Ottery Staff were aware of how to report any safeguarding St Mary, Honiton, Tiverton, Exeter, Crediton, Sidmouth concerns and support was available to them through and Okehampton. dedicated members of staff and their managers. We spoke with 129 members of staff, including Staffing levels were sufficient to ensure patients received community nurses, occupational and physiotherapists, care and treatment in order to meet their assessed care specialist nurses, managers, healthcare assistants and needs, although there were vacancies in some staff administrative staff to understand their experiences of teams. Lone working systems were in place locally to working within the trust. ensure the safety of staff where they worked alone in a We contacted and spoke with 76 patients and 12 relatives department or clinical area. of patients, to seek their views of the service provided to Identified risks to patients and staff during the provision them. of community care services were recorded on both local The inspection teams included CQC inspectors, specialist and trust-level risk assessments. Action had not always advisers in community nursing, palliative care specialist been taken promptly to address the risks. nurse, rehabilitation therapist, Allied Healthcare Integrated team working was evident across the area and professionals, a sexual health nurse, community matrons staff were positive about their roles, both within their and a GP. local team and across the wider multidisciplinary team. During the inspection, we looked at patient-care We observed some areas of outstanding care and documentation and associated records, observed care in treatment during our inspection visit. We found a day patients’ homes and clinics and spoke with staff and service for patients with dementia care needs provided patients individually and as part of groups. excellent care, support and treatment. A community Patients made positive comments about the service nurse-led clinic provided responsive care and treatment provided to them. to patients who were able to attend the clinic, thus promoting independence and providing good clinical Community services for adults provided by Northern outcomes for patients. Multidisciplinary team meetings Devon Healthcare NHS Trust were judged as good overall. identified care needs for individual patients and ensured these were met by appropriate staff. 4 Community Health Services for Adults Quality Report 11 September 2014 Summary of findings Background to the service The Northern Devon Healthcare NHS Trust operates Services provided by the trust include community nursing across 1,300 square miles and provides adult community services, therapy services, such as occupational therapy care services to people in their own homes. There are and physiotherapy, complex care teams which consist of nine integrated health and social care community multidisciplinary teams and Hospital at Home® services. clusters, spanning Torridge, North Devon, East Devon, Exeter, Mid Devon and West Devon. Community-based and specialist staff also work from GP surgeries, community hospitals and in people’s own homes. Staff work in 14 teams across the county. Our inspection team Our inspection team was led by: The inspection teams included CQC inspectors, specialist advisers in community nursing, a palliative care specialist Chair: Jan Filochwski recently retired Chief Executive nurse, a rehabilitation therapist, Allied Healthcare from Great Ormond Street Hospital for Children NHS professionals, a sexual health nurse, community matrons Foundation Trust and a GP. Team Leader: Mary Cridge, Care Quality Commission (CQC) Why we carried out this inspection We inspected this core service as part of our comprehensive Wave 2 pilot community health services inspection programme. The trust is an aspirant Foundation Trust. How we carried out this inspection To get to the heart of the care that people who use this Exmouth, Ottery St Mary, Honiton, Tiverton, Exeter and services’ experience of care, we always ask the following Okehampton areas. During the visit, we held focus five questions of every service and provider: groups with a range of staff who worked within the service, such as nurses, doctors, therapists, • Is it safe? administration and management staff. We talked with • Is it effective? people who used services during visits to their homes, at • Is it caring? clinics and by telephone. We observed how people were • Is it responsive to people’s needs? being cared for and talked with carers and/or family • Is it well-led? members and reviewed care or treatment records of Before visiting, we reviewed a range of information we people who used services. We met with people who used held about the core service and asked other services and their carers, who shared their views and organisations to share what they knew. We carried out an experiences of the core service. We carried out an announced visit on 2, 3 and 4 June 2014 to staff teams unannounced visit on the 7 and 8 of July 2014 to staff based in the South Molton, Holsworthy, Bideford, teams based in the Crediton and Sidmouth areas. 5 Community Health Services for Adults Quality Report 11 September 2014 Summary of findings What people who use the provider say During our inspection, we visited patients in their own kind and friendly,” as well as, “The care I have had has homes with community staff and met with patients in been excellent, they are never in too much hurry to clinics. We talked to them to seek their views of the answer any questions I have, or give the help I need.” service they received. We also telephoned patients who Patients also said, “I don’t know what time they are received care and treatment from community staff. In coming, but it’s generally in the morning. I am always total, we spoke to 76 patients and/or their relatives. told if they are going to be late and come in the afternoon. They are very reliable.” Patients made positive comments regarding their care and treatment. They said the staff were kind and helpful, One patient commented on the nurse-led clinic at Exeter spent sufficient time with them to meet their needs and hospital and said, “I can make an appointment when it’s performed their jobs well. Specific comments included: convenient to me, my wound has improved greatly since “We cannot fault the nurses, the service couldn’t coming here and [the staff] are just so kind and caring to improve. We have had support from night nurses when me.” we needed extra help,” and, “The staff are wonderful, very Good practice • In some community teams, the multidisciplinary team complex care, rehabilitation and Rapid Response were co-located. In all of these areas, staff were teams, social workers, hospice workers, voluntary positive about how well the multidisciplinary team sector and GPs. The meeting reviewed patients with worked together and how this benefited the patients complex care and support needs with a purpose of to receive a holistic service from different health and ensuring their care needs were met at home, on social care professionals. discharge from hospital, or if they required a hospital • The out-of-hours community nursing team provided a admission. good service to patients and provided effective and • The Rowan Unit Day Centre, in Ottery St Mary, for responsive services to patients.