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Independent Clinical Services Limited Good Also known as Thornbury Community Services


Inspection carried out on 22 March 2016

During a routine inspection

Independent Clinical Services trade as Thornbury Community Services, a nationwide agency providing commissioned care services with an office in the Long Ashton area of Bristol. This report focuses on the community care that TCS provides to people in their own homes. Thornbury Community Services (TCS) supply registered nurses and carers to Clinical Commissioning Groups (CCGs), case managers and private individuals providing care for clinically complex patients in their own homes. People have conditions such as acquired brain injuries, spinal injuries, paediatric and neurological conditions and require complex and high-intensity care. TCS provide community care for over 100 people around the U.K. and employ over 600 staff.

This provider was given two days’ notice of this inspection. This was because they provide care in the community and we wanted to be able to speak with some people using the service. The inspection took place on 23 and 24 March and 6 April when we looked at records in the office and spoke with the registered manager. We made telephone calls to staff and people using the service around the country on 15, 19 and 20 April. We made further phone calls on 17 and 18 May.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a strong emphasis on respecting people’s choices, and supporting them to achieve their wishes and ambitions. The provider ensured there were no barriers in place which would prevent people from achieving their ambitions. Relatives said the family was considered in all aspects of care planning, and they were involved in regular review meetings.

The risks of abuse to people were reduced because there was an effective recruitment and selection process in place. Staff were able to demonstrate a good understanding of how to recognise and report abuse. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

People received a service that was based on their needs and wishes. A bespoke care team supported each person, which meant staff knew people very well. Care plans were personalised and contained detailed information about the support people needed. Staff were specifically trained according to the needs of the person. Staff competencies were assessed annually, or when there were any changes.

Review meetings were held regularly and people were phoned as well, to ensure the support was meeting their needs. The service was flexible and responded to people’s requests where possible. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.

Relatives spoke highly of the quality of care given by carers. They said they trusted the carers to have the skills to keep them safe. People had positive relationships with their carers. Nobody expressed any concerns about any of the care provided. People received their medicines on time and in a safe way.

The provider learnt from accidents, incidents and complaints. They investigated these thoroughly and made changes where necessary. The provider gave us information about one instance when they did not have a complete oversight of a situation, and introduced additional training for staff and other changes to reduce the likelihood of a similar situation occurring.

Environmental risk assessments were completed for every new person using the service. This included checks to ensure the property was safe with adequate access, heating and lighting.

Inspection carried out on 10 July 2013

During a routine inspection

The people that we contacted as part of our inspection gave positive feedback about the agency. Examples of comments included, "they are 100% we could not do without them, we didn�t expect to find such good care�, �they have all been wonderful they have all been really easy going they are friendly and there have been no hiccups�.

We saw that care plans were detailed and contained sufficient information to allow staff to support and care for the individual concerned.

Staff told us that they received training to support them in their work and that they were well matched to the people they were asked to work on.

There were systems in place to monitor the quality of the service and this included gaining feedback from people receiving care from the agency.

Peoples personal records were accurate and stored securely.

Inspection carried out on 17 January 2013

During a routine inspection

The staff and relatives that we contacted as part of our inspection all gave positive feedback about the agency. Comments included they are "wonderful" and we are "100% satisfied". Another person told us that they had experience of a number of agencies and Thornbury were "the most professional". We heard that staff at the agency were approachable if any issues or concerns arose and these were acted upon.

Staff told us that they received training to support them in their work and that they were well matched to the care packages they were asked to work on. We saw that care plans were detailed and contained sufficient information to allow staff to support and care for the individual concerned. Procedures for recruiting staff were robust and so people were cared for by staff who were suitable and had relevant skills.

There were processes in place to ensure that medication was administered and recorded safely. These processes were supported by a comprehensive policy. Staff received training where people had particularly complex needs around medication. Any risk associated with medication were well considered and plans were put in place to ensure an individuals safety.

There were systems in place to monitor the quality of the service and this included gaining feedback from people receiving care from the agency

Inspection carried out on 29, 30 June 2011

During an inspection in response to concerns

The students who spoke to us were positive about how they are supported by the nurses from the Independent Clinical Services nursing agency. Examples of comments students made included, �they help you when you are upset�, �they are all kind to me �, �I�ve got to know them now very well�, and �they sort your problems out�.

Students told us about agency nurses who have become their �favourite� nurse. They also told us how the nurses have a �good sense of humour� and are �really funny�.

We saw students being effectively supported by the nurses with their needs. We saw that care plans partly support and guide staff, to ensure students receive the care they need. However, we saw that some care plans do not have enough information and detail in them about how to meet the student�s full range of needs.

We saw good evidence that the senior agency nurse is working closely with the senior staff of the college. The senior nurse is working to improve communication with the nurses from the agency and the staff from the college. This is to ensure that students care is planned and delivered in a co-ordinated way.

We found that the agency is putting in place robust systems to give students their medicines in a safe way. This system has initially impacted on students with increased time taken to be given their medicines. We also found that medicine administration records were not always being completed to show if students have had medicines or not. The layout of the current drug charts that the College use does not include a coding system to guide staff as to what to write when a student has not taken their medicines.

We found that the agency is reviewing all accidents and incident that have happened to students since they took over running the service at the treatment centre.

The agency staff have detailed and up to date policies and procedures to guide them in their work and in their nursing practice. However, the agency nurses do not currently have easy access to the college�s policies and procedures. This information is needed for nurses, to enhance the consistency of the service for students from all the staff who support them.

We found that the agency nurses have already built up trusting relationships with the students who they see. The agency�s complaints procedure is not yet available to students or people who may want to complain on their behalf. This means students may not know how to complain about the service.

We found that the agency have worked hard to ensure that students records are properly maintained and stored securely, but student�s medicine records are not yet all up to date and some care plans need more information in them to make them up to date.