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Archived: MSH Health & Wellbeing Community Interest Company

We are carrying out checks at MSH Health & Wellbeing Community Interest Company. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Updated 27 June 2017

Services we do not rate

We regulate sexual health services, but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

  • Staff understood how to fulfil their responsibilities to raise concerns and report incidents.

  • Medicines management processes were fit for purpose and ensured people were kept safe from avoidable harm. This included the storage of refrigerated medicines in the main office and medicines used in the Queens Park sexual health service.

  • Deteriorating service users had their care reassessed and their care plan amended accordingly.

  • Staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

  • Staff adhered to the principles of infection prevention and control and demonstrated appropriate practice in hand hygiene and the use of personal protective equipment.

  • All clinical staff had appropriate safeguarding training and demonstrated how they used this to protect people from harm.

  • People supported by the domiciliary care service consistently told us staff who visited them were competent, well trained and professional in their approach to their work. Staff and their mix of skills were used innovatively to give them the time to develop positive and meaningful relationships with people to best meet their needs.

  • Sexual health services were provided in line with national guidance from the British Association of Sexual Health and HIV. These services were monitored using four key performance indicator targets. The service performed better than the target for two indicators and variably in the two other indicators. Where performance was variable, staff identified contributing factors and ensured the service was maintained.

  • Staff demonstrated a consistent focus on improving patient outcomes through opportunistic health promotion in sexual health services. This included providing free condoms, sexual health advice and signposting and smoking cessation support.

  • Staff used information and records systems that ensured they always had patient history information for appointments. There was evidence of communication with GPs and other healthcare services when needed to provide coordinated care.

  • People we spoke with consistently referred to staff as kind and caring people. All 123 Care Quality Commission comment cards received from sexual health services were positive and over 90% of people noted the friendliness and kindness of staff as key factors in their response.

  • The provider ensured individuals were at the heart of their care, underpinned by a staff team who placed a high value on partnership working. The service encouraged those who received domiciliary support to maintain and maximise their independence.

  • During all of our observations of care in sexual health services, staff demonstrated kindness, warmth and compassion. They involved people in discussions and decisions about their health and took the time to answer their questions.

  • Staff were trained to provide emotional support to people attending sexual health services.

  • The service provided domiciliary care and support that was focused on individual needs, preferences and routines. People's care and support was planned proactively and in partnership with them.

  • Care plans were in place which outlined people's care and support needs. Staff were extremely knowledgeable about people's support needs, their interests and preferences in order to provide a personalised domiciliary care service.

  • The provider placed a high level of importance on equality and diversity in respecting the needs and wishes of people who used the service and those who worked within it.

  • Staff provided a responsive and individualised sexual health advice, screening and support service that met the needs of the local population. This included providing advice and guidance based on sexual risk as well as recognition of the different needs of people based on sexual identity. Sexual health services included a mix of walk-in and pre-bookable appointments, and on-demand private appointments were available seven days a week.

  • Leadership within the organisation was visible. Communication was effective and the service actively sought and listened to the views of staff.

  • All staff were demonstrably passionate and enthusiastic about the service. Clinical staff involved in sexual health services had clear future plans to develop the service that aligned with the changing needs of the local population, particularly those living with HIV into old age.

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

  • The fire safety policy and the fire risk assessment were out of date.

  • There was no process in place to formally audit success outcomes.

  • Supervision of staff was not regularly recorded.

  • Consent to provide support was not recorded consistently.

  • There was no risk register in operation to demonstrate how risk was managed.

  • There was no clearly defined deputy role to support the nurse manager in the event of any unplanned absence.

  • There was no formal system in place to seek feedback from those who used the domiciliary support service.

Inspection areas

Safe

Updated 27 June 2017


  • Staff understood how to fulfil their responsibilities to raise concerns and report incidents.

  • Medicines management processes were fit for purpose and ensured people were kept safe from avoidable harm. This included the storage of refrigerated medicines in the main office and medicines used in the MSH@Queens Park sexual health service.

  • Those who used the domiciliary care service received support to manage their medication safely.

  • Those who received domiciliary support in their own homes had their care reassessed and their care plan amended accordingly.

  • There were safe recruitment procedures in place.

  • Staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

  • Staff adhered to the principles of infection prevention and control and demonstrated appropriate practice in hand hygiene and the use of personal protective equipment.

  • All staff who provided domiciliary support had appropriate safeguarding training and demonstrated how they used this to protect people from harm.

  • This included sexual health services, where staff were able to provide services to young people.

  • Staff maintained appropriate care records at sexual health service locations that included patient history and documentation of any safety concerns.

However,

  • The fire safety policy and the fire risk assessment were out of date.

  • Staff used Patient Group Directions (PGDs) to administer medicines in the sexual health service. Although most of these were maintained, we found two had expired.

Effective

Updated 27 June 2017


  • People supported by the domiciliary support service consistently told us staff who visited them were competent, well trained and professional in their approach to their work.
  • Staff and their mix of skills were used innovatively to give them the time to develop positive and meaningful relationships with people to best meet their needs.

  • Staff were aware of people's individual preferences and had the skills, knowledge and ability to meet their needs.

  • Training was appropriate and available to all staff.

  • Links with health and social care professionals were good.

  • Sexual health services were provided in line with national guidance from the British Association of Sexual Health and HIV. These services were monitored using four key performance indicator targets. The service performed better than the target for two indicators and variably in the two other indicators. Where performance was variable, staff identified contributing factors and ensured the service was maintained.

  • Staff demonstrated a consistent focus on improving patient outcomes through opportunistic health promotion in sexual health services. This included providing free condoms, sexual health advice and signposting and smoking cessation support.

  • A practice development nurse was in post and provided clinical training and competency checks to nurses and healthcare support workers. Healthcare support workers were working towards the national care certificate.

  • Staff used a system to contact people who did not act on sexual infection test results that required them to seek treatment. This ensured people were supported to access timely treatment and care, including when they were difficult to reach.

  • Clinical staff used information and records systems that ensured they always had patient history information for appointments. In addition, consent was always documented and there was consistent evidence of communication with GPs and other healthcare services when needed to provide coordinated care.

However,

  • There was no process in place to formally audit success outcomes.

  • Supervision was not regularly recorded.

  • Consent to support was not consistently recorded on domiciliary support records.

Caring

Updated 27 June 2017


  • People who used the domiciliary support service consistently referred to the registered provider and their staff as kind and caring people.

  • People supported by the domiciliary care service told us they felt safe with the staff who supported them. Staff frequently went beyond their contracted duties to ensure people were safe and comfortable.

  • The provider ensured individuals were at the heart of their care, underpinned by a staff team who placed a high value on partnership working.

  • The domiciliary support staff understood the importance of encouraging people to maintain and maximise their independence.

  • During all of our observations of care in sexual health services, staff demonstrated kindness, warmth and compassion. They involved people in discussions and decisions about their health and took the time to answer their questions.

  • All 123 Care Quality Commission comment cards received from sexual health services were positive and over 90% of people noted the friendliness and kindness of staff as key factors in their response.

  • Staff were trained to provide emotional support to people attending sexual health services, including for pre and post-HIV test counselling. During our observations we saw staff were skilled in reducing people’s anxieties and recognising when they were worried about test results.

Responsive

Updated 27 June 2017

(Domiciliary care service)

  • The service was responsive to supporting people and provided care and support that was focused on individual needs, preferences and routines.

  • People's care and support was planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered.

  • Care plans were in place which outlined people's care and support needs. Staff were extremely knowledgeable about people's support needs, their interests and preferences in order to provide a personalised service.

  • People told us they were supported by staff who knew them and consistently met their needs.

 (Sexual health service)

  • The provider placed a high level of importance on equality and diversity in respecting the needs and wishes of people who used the service and those who worked within it. An advanced sexual health educator provided sex and relationship education services to local schools and colleges. This included body development classes for children from the age of six and more complex psychosexual support to college-age students.

  • Staff provided a responsive and individualised sexual health advice, screening and support service that met the needs of the local population. This included providing advice and guidance based on sexual risk as well as recognition of the different needs of people based on sexual identity.

  • Sexual health services were provided within an equality and diversity policy and service standards framework that prioritised respect, dignity and privacy for each individual. We saw staff adhered to this during all of our observations.

  • Staff provided sexual health events, outreach services and chlamydia screening to colleges in local boroughs. This included providing targeted health promotion information and individualised guidance for students on reducing the risk of sexually transmitted infections.

  • Staff ensured people who were vulnerable received appropriate care and support. This included people who were at risk of sexual exploitation or harm or young people who were sexually active below the legal age of consent.

  • Sexual health services were offered flexibly. This included through a mix of walk-in and pre-bookable appointments and on-demand private appointments were available seven days a week.

Well-led

Updated 27 June 2017


  • Communication was effective throughout the organisation. The service actively sought and listened to the views of staff.

  • The registered provider had a clear understanding of what was required of a quality service and this was evident from the feedback we received from people supported by the service.

  • All staff were demonstrably passionate and enthusiastic about the service. Clinical staff involved in sexual health services had clear future plans to develop the service that aligned with the changing needs of the local population, particularly those living with HIV into old age.

  • The management advisory group provided structured governance into the operation of sexual health services and included input from service users and clinical specialists.

  • From speaking with members of the management advisory group, it was clear the group’s role included capacity to challenge decision-making and to contribute to service development.

However,

  • In the absence of audits, the provider was unable to be assured of outcomes for those who used the service and of areas of the service which required improvement. However, governance structures and feedback from clients provided reassurance of the high standards of the service.

  • There was no risk register in operation to demonstrate how risk was managed.

  • There was no clearly defined deputy role to support the nurse manager.

  • There was no established auditing programme.

  • There was no formal system in place to seek feedback from those who used the domiciliary service.