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Inspection Summary


Overall summary & rating

Good

Updated 29 June 2017

We found the following areas of good practice:

The staff culture of overwhelming pride in their work and desire to provide a service with children, young people and their families at the centre.

The organisation had systems and processes in place to keep patients free from harm. Patients were protected from the risk of abuse and avoidable harm.

Infection prevention and control practices were in line with national guidelines. Staff kept clinical records accurately and securely in line with the Data Protection Act 1998. Medicines were stored appropriately and administration was in line with relevant legislation.

There was good demonstration of multidisciplinary working within the organisation and with external agencies such as local acute care providers and adult social care.

Staff treated patients with kindness, compassion and respected patients' dignity at all times. We saw staff involving patients and their families in decision making about their care and providing emotional support with great depth of understanding.

We saw good local leadership with an open and transparent culture. There was clear vision and focus on the delivery of excellent quality of care. Staff were positive about their experience of working in the organisation and showed commitment to achieving the provider's strategic aims and demonstrating their stated values. The senior management were visible and regularly engaged with staff and patients.

However, we also found the following issues that the service provider needs to improve:

The organisation should review the Healthy Child Programme to identify the improvements required in order to ensure targets are met.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Inspection areas

Safe

Good

Updated 29 June 2017

We rated safe as good.

  • The organisation provided us with the incidents reported with evidence of learning achieved and the resulting changes in practice that took place. Staff gave us examples of how they reported incidents and the feedback they received. Staff informed us that they were encouraged to report incidents to enable learning as an organisation.
  • Staff understood and fulfilled their responsibility to raise concerns and report incidents and near misses. Incidents were investigated and staff were aware of the Duty of Candour regulation.
  • The organisation monitored the services’ safety record locally, organisationally and in line with national guidance.
  • The provider gave safeguarding sufficient priority and staff knew how to escalate safeguarding concerns. Staff were aware of their responsibilities with regard to the protection of people in vulnerable circumstances.
  • There were systems, processes and standard operating procedures in infection control that were reliable and kept patients safe. There were arrangements to prevent the spread of infection and compliance with these was monitored.
  • There were adequate supplies of appropriate equipment that was properly maintained to deliver care and treatment and staff were competent in its use.
  • Staff demonstrated good medicines storage, management and administration. There were systems that ensured patients' medicines were given safely, on-time and according to the prescription.
  • We found patients' records were complete and accurate and there were systems to identify patients whose condition may be deteriorating to allow early intervention.
  • The organisation had sufficient numbers of appropriately trained staff to provide safe care to patients. The majority of staff had completed the provider’s mandatory training programme.
  • Staff understood their responsibilities and adhered to safeguarding policies and procedures. There was a clear pathway for reporting and dealing with child protection and safeguarding concerns.
  • Staff used an electronic record system. It was secure and easy to navigate. We reviewed five electronic records and found they were detailed, up to date and included all clear information to indicate outcomes of assessments and treatment plans.
  • The service for children, young people and their families had effective infection prevention and control procedures in place. Clinic areas we visited during the inspection were visibly clean and there was evidence of good waste segregation. We observed staff using alcohol hand sanitiser between patients and we saw them cleaning equipment with disinfectant wipes.

Effective

Good

Updated 29 June 2017

We rated effective as good.

  • Staff were competent to perform their roles and were encouraged to develop their skills further. Staff received a comprehensive induction to the organisation as well as regular clinical supervision and appraisals.

  • Policies and procedures reflected best practice, such as National Institute for Clinical Excellence (NICE) and other guidelines. The care delivered was evidenced based and there was participation in national audit programmes.

  • The organisation had policies and procedures to ensure multidisciplinary and multi-agency work took place. Additionally, there were arrangements to support young people who were transitioning to school and to adult services.

  • MCH had an on-going, comprehensive audit programme, which monitored areas for quality and improvement regularly.

  • Staff had a good knowledge of the law relating to consenting children to treatment and involved parents and carers in treatment planning and goals.

  • Care and treatment reflected current national guidance. There were formal systems in place for collecting comparative data regarding patient outcomes.

  • Staff worked with other health professionals in and out of the organisation to provide services for patients. Patients were cared for by staff who had undergone specialist training for the role and who had their competency reviewed.

  • Patients’ pain, nutrition and hydration needs were assessed and addressed in line with national guidance.

  • There were arrangements that enabled patients to access advice and support seven days a week, 24 hours per day.

  • Patients provided informed, written consent before commencing their treatment. Where patients lacked capacity to make decisions, staff were able to explain what steps to take to ensure relevant legal requirements were met.

However:

  • Not all locations used by MCH staff had computer terminals at which staff could access patient records.

Caring

Good

Updated 29 June 2017

We rated caring as good.

  • Staff provided sensitive, caring and individualised personal care to patients. Staff supported patients to cope emotionally with their care and treatment as needed.

  • Patients commented positively about the care provided from all staff they interacted with. Staff treated patients courteously and with respect.

  • Patients felt well informed and involved in their procedures and care, including their care after discharge.

  • Patients' surveys and assessments reflected the friendly, kind and caring patient centred ethos. Our observations of care confirmed this.

Responsive

Good

Updated 29 June 2017

We rated responsive to be good.

  • Services operated at times that allowed patients to access care and treatment when they needed it.

  • There were a variety of mechanisms to provide psychological support to patients and their supporters. For example those with spiritual needs, requiring bariatric equipment, patients whose first language was not English, or support for people living with dementia or learning disabilities. This range of services meant that each patient could access a service that was relevant to their particular needs. 

  • There were systems to ensure that patient complaints and other feedback was investigated, reviewed and appropriate changes made to improve treatment care and the experience of patients and their supporters.

Well-led

Good

Updated 29 June 2017

We rated well-led to be good.

  • All the staff we spoke with knew the MCH values. Staff felt people lived by them.

  • There were clear lines of governance and all the staff we spoke with told us they felt valued and supported by their local managers, the managing director was visible and attended meetings on an ad hoc basis.

  • All the staff we spoke with told us the service had an open and honest culture and staff were passionate about providing the best service possible for the people they supported.

  • The service proactively engaged and involved all staff as shareholders and ensured that the voices of all staff were heard and acted on. The leadership actively promoted staff empowerment through shareholder involvement.

  • There was a process in place to identify, understand, monitor and address current and future risks and the executive leaders were knowledgeable about risks faced by the service.

  • Children’s therapy and health visiting staff reported to Heads of service and the Heads of service reported to the associate director of therapies and children. The associate director of therapies and children reported to the managing director.

  • The health visiting teams were divided into ‘hubs’ based at different locations and there was a lead at each hub.

  • Staff were clear about the lines of accountability and staff we spoke with expressed confidence in the leadership of the organisation.

  • The senior leadership team ‘signed up’ to a set of leadership behaviours and were confident they would be held to account, as would others, if they did not reflect those behaviours.

  • Feedback from staff about local leadership was positive and complimentary.

  • MCH had developed its own leadership development programme ‘LEAD’ which was designed to support staff to develop the skills, knowledge and behaviours to be successful leaders.

  • We saw good local leadership with an open and transparent culture. There was a clear vision and focus on the delivery of good quality care.

  • Staff were positive about their experience of working in the organisation and showed commitment to achieving the provider’s strategic aims and demonstrating their stated values.

  • Staff spoke highly about their departmental managers and the support they provided to them and patients. All staff said managers supported them to report concerns and their managers would act on them. They told us their managers regularly updated them on issues that affected the separate departments and the whole organisation.

  • Governance processes were evident at departmental, organisation and corporate level. This allowed for monitoring of the service and learning from incidents, complaints and results of audits.

  • Staff asked patients to complete satisfaction surveys on the quality of care and service provided. Departments used the results of the survey to improve services.

  • The organisation was proactive in celebrating staff achievements with several teams receiving awards recently.

Checks on specific services

Community health services for adults

Good

Updated 29 June 2017

•The organisation had systems and processes in place to keep patients free from harm. Patients were protected from the risk of abuse and avoidable harm. A range of risk assessments were utilised by the various clinical teams to assess and manage risk and staff would escalate risks which could affect patient safety. We saw systems in place for reporting, investigating and learning from incidents.

•Infection prevention and control practices were in line with national guidelines. Clinics we visited were visibly clean, tidy and fit for purpose. Staff providing patient care in clinics and patients’ home environment wore personal protective equipment and were bare below the elbow. Staff demonstrated an appropriate hand washing technique.

•Staff kept medical records accurately and securely in line with the Data Protection Act 1998.

•Medicines were stored appropriately and administration was in line with relevant legislation.

•Staff had the appropriate skills and knowledge for their roles and received regular mandatory training and supervision. The organisation actively supported staff to develop and extend their knowledge and competencies, and supported staff with external training and secondments.

•Staff had a good awareness of policies and procedures based on national guidelines and standards. We saw evidence of local and national audits undertaken to monitor the quality, safety and effectiveness of care.

•There was good demonstration of multidisciplinary working within the organisation and with external agencies such as local acute care providers and adult social care.

•Staff treated patients with kindness, compassion and respected patients dignity at all times. We saw staff involving patients and their families in decision making about their care and providing emotional support with great depth of understanding.

•People’s concerns and complaints were listened and responded to and feedback was used to improve the quality of care. There was a system in place for capturing learning from complaints and incidents and there was good local ownership of any problems with teams working closely together to resolve any issues that arose.

•We saw good local leadership with an open and transparent culture. There was clear vision and focus on the delivery of excellent quality of care. Staff were positive about their experience of working in the organisation and showed commitment to achieving the providers strategic aims and demonstrating their stated values.

•The governance framework ensured employee responsibilities were clear and quality performance and risks were all understood. The senior management were visible and regularly engaged with staff and patients.

•The organisation was proactive in celebrating staff achievements with several teams receiving awards recently.

Community health services for children, young people and families

Good

Updated 29 June 2017

• Services delivered by the location were safe. There were procedures in place to protect vulnerable service users. Record keeping was safe and secure. There were good infection control procedures in place and the service had the right number of appropriately trained staff to provide the service.

• Services were effective, evidence based and focussed on the needs of children and young people. We saw examples of good multidisciplinary work. Care and treatment was evidence based, and there were policies and procedures in place to support staff and ensure that services were delivered effectively and efficiently. Parents told us that staff displayed compassion, kindness and respect.

• Children, young people and families who used the service were overwhelmingly positive about the way staff treated them. Service users were treated with dignity, respect and kindness during all interactions with staff and relationships with staff were positive. Service users and staff worked together to plan care and there was shared decision-making about care and treatment.

• We found the service was responsive to needs of children and families. Multidisciplinary team working, including external partners, ensured children and young people were provided with care that met their needs.

• The services for children, young people and their families were well led. The board and senior managers had oversight of the reported risks and had measures in place to manage these risks. Staff felt well supported by their local managers and felt they were valuable members of the organisation.