The Care Quality Commission
  • Community
  • Community healthcare service

Solutions 4 Health - Barnet

Overall: Inadequate read more about inspection ratings

Winston House, 2 Dollis Park, London, N3 1HF (020) 3633 4049

Provided and run by:
Solutions 4 Health Limited

All Inspections

11 & 12 September 2023

During a routine inspection

Our rating of this location went down. We rated it as inadequate because:

  • Five out of 14 parents and carers we spoke with during the inspection site visit, and 5 people who contacted CQC independently during the inspection process expressed concerns about difficulties getting in touch with staff, and long waits to be seen leaving them feeling unsupported to manage health concerns about their babies/children.
  • Despite significant improvements in safeguarding and governance systems at the service, as required in the warning notices issued in June 2023, further work was needed to fully address the breaches of regulation and to ensure that improvements were embedded and sustained. We found some on-going concerns with the management and oversight of children and families transferring into the service, and those with safeguarding concerns. This meant that children and families who were potentially vulnerable or high risk might not be identified or supported in a timely manner.
  • We found that a small number of children and family safeguarding concerns were not managed appropriately when children transferred in and out of the service. Some families were not being seen and reviewed in accordance with the timescales expected in the provider's own policy, placing them at risk of avoidable harm.
  • Despite improvements, the service leaders had not ensured that the assurance systems in place were robust enough to monitor, identify and address risks that impacted on patient safety, and staffing decisions did not impact negatively on families within the local population.
  • Despite a requirement made at the inspection in November 2022, between April and June 2023, the service had only been able to provide a 6 to 8 week review for 21% of infants. The 6 to 8 week check is a vital part of the Healthy Child Programme and missing this might mean that families’ needs would not be identified, including any mental health needs. Over this 3 month period, only 28% of babies received a 12 month review, and 30% received a 2 to 2.5 year review by the age of 3 years.
  • Following recent reductions in staffing just prior to the current inspection, the service was proposing a further reduced model particularly impacting on the universal pathway. If accepted this would include no psychosocial contact, reductions in breastfeeding support, continuing non-provision of 6 to 8-week visits for families unless they were identified as high risk, and virtual 1 year reviews for babies assessed as lower risk. This model had not been accepted by the service commissioners and staff we spoke with were concerned about the ramifications of this on vulnerable families in the borough.
  • Whilst client records had improved as required at the inspection in November 2022, there were some gaps in the information recorded in some of the cases we reviewed.
  • As required at the inspection in November 2022, the provider had worked hard to improve staff morale. However, following recent changes to the staffing of the service, staff reported low levels of morale and concerns about their job security.
  • There had been improvements in provision of supervision to staff members as required at the inspection in November 2022, although further work was need to increase attendance at clinical supervision sessions.
  • Most parents and carers we spoke with were not clear about how to complain and give feedback to the service.

However:

  • As required at the inspection in November 2022, staff had received mandatory training in key skills, and understood how to protect children and young people from abuse. The service controlled infection risk well, and the service was notifying CQC of incidents as appropriate. The service managed safety incidents well and learned lessons from them.
  • As required at the inspection in November 2022 staff had undertaken level 3 safeguarding training for adults and children and were receiving regular safeguarding supervision.
  • The service had appointed a specialist education needs and disability (SEND) lead and was working to improve the offer for children in the area. Staff had completed training in Autism and SEND.
  • When staff did see families, staff treated children and young people with compassion and kindness. Parents and carers spoke highly of individual staff who had supported them. Staff advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

As a result of the concerns we identified we issued the provider with 2 Warning Notices under Section 29 of the Health and Social Care Act 2008. The provider had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We require the provider to make the necessary improvements and be compliant with the regulation by 24 November 2023. You can see full details of the regulations not being met at the end of this report.

4 and 5 April 2023

During an inspection looking at part of the service

We did not re-rate the overall service following this inspection. It remained requires improvement overall. At our inspection in November 2022, we rated the domain of safe as inadequate. We rated effective, responsive and well-led as requires improvement. Caring was rated as good.

This was a focused inspection that covered specific aspects of safe and well-led only.

  • The service had made progress in addressing most of the concerns identified in the last warning notice issued in November 2022, but further work was needed to fully address the breach of regulation and to ensure that improvements were embedded and sustained. We found on-going concerns with the management and oversight of children and families transferring in and out of the service. This meant that children and families who were potentially vulnerable or high risk might not be identified or supported in a timely manner.

We identified that:

  • Not all children and family safeguarding concerns were managed appropriately when children transferred in and out of the service.
  • The service leaders had failed to ensure that the assurance systems in place were robust enough to monitor, identify and address risks that impacted on patient safety.

However:

  • Staff had undertaken level three safeguarding training for adults and children and were receiving regular safeguarding supervision.
  • The service now had a specific policy in place that guided staff on how to respond to bruising injuries in non-independent mobile babies.
  • Staff confirmed that the culture within the service had improved, they were well supported and could raise any concerns without fear of victimisation.

As a result of the concerns we identified, we issued the provider with two warning notices under Section 29 of the Health and Social Care Act 2008. The provider had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We require the provider to make the necessary improvements and be compliant with the regulation by 30 June 2023. You can see full details of the regulations not being met at the end of this report.

16, 22 and 23 November 2022

During a routine inspection

We had not previously inspected this location. We rated the service as inadequate for safe, requires improvement for effective, responsive and well-led and good for caring. This was because:

  • The service did not have robust safeguarding systems and processes in place in order to ensure children, young people and their families were appropriately assessed, reviewed and identified risks were managed. Children transferring into the service were not always seen within the timeframe set out in the provider’s own policy and the care of families identified as vulnerable or high risk was sometimes poorly managed. Staff who held a clinical caseload did not receive regular safeguarding supervision to discuss and reflect on their clinical practice. The concerns identified increased the risk of children and their families coming to avoidable harm.
  • The service did not have robust governance and assurance systems in place to monitor the quality and safety of the service and respond quickly to areas that required improvement. Although senior leaders knew most areas of the service that needed to improve, they were not clearly sighted on the extent to which children, young people and their families were put at risk due to inconsistencies in clinical practice and ineffective systems in place. The provider did not have effective arrangements to ensure that all notifications were submitted to external bodies as required.
  • The service did not offer all mandated checks required by the Healthy Child Programme (HCP) to families on the universal pathway. The service was experiencing demand and capacity issues that meant they could not deliver every aspect of the HCP to universal families including the mandated six to eight-week check. The six to eight-week check is a vital part of the HCP and by not seeing new parents and carers there was a risk that their full needs would not be identified, including any mental health needs.
  • Staff did not always complete records in sufficient detail. Some patient records lacked important information and there was an inconsistent approach to the recording of clinical decision making. The lack of clear record keeping increased the risk of important information not being shared and potentially missed.
  • The service did not ensure staff received regular clinical supervision. The provider did not collect data relating to the completion of clinical supervision. Some staff we spoke with told us that they had not received clinical supervision since the provider took over the service in April 2022. The lack of consistent clinical supervision meant that staff did not have an opportunity to assess and reflect on their performance and seek support where required.

However:

  • The service recognised that parts of the service needed to improve and had employed external consultants to support the service with the changes. The provider had employed external consultants to work with staff to improve morale and identify new ways of working. The health visiting service was being reviewed by an external specialist. The school nursing service was implementing a new model of care called The Lancaster Model.
  • The service was committed to improvement and ensuring the service met people’s needs. The service had purchased a small bus that was being adapted so that the health visiting service could be delivered to children and families out in the community. The service envisioned the bus to be placed at shopping centres and popular venues across Barnet as a way of engaging more families.
  • The provider was recruiting more staff into essential roles. The service had employed a perinatal specialist health visitor and a specialist lead for the maternal early childhood sustained home‐visiting programme also known as MESCH. The service had also employed an auditor who would be responsible to enhance the services quality assurance processes as well as being the Freedom to Speak Up Guardian.
  • Staff across the service were dedicated to improving the health and wellbeing of children, young people and their families. During the inspection, we observed caring and positive interactions between staff and families.
  • The service had a clear vision of where it wanted to be. Staff had attended a team vision planning workshop. The workshop was an opportunity for the health visiting team to set out their future ways of working and build their vision together.

As a result of the concerns we identified we issued the provider with a Warning Notice under Section 29 of the Health and Social Care Act 2008. The provider had failed to comply with the relevant requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We require the provider to make the necessary improvements and be compliant with the regulation by 13 January 2023. You can see full details of the regulations not being met at the end of this report.