Archived: The Limes Training Centre Also known as Singleton Associates

The Limes Training Centre is operated by Mr. Nigel Owen Singleton. The service mainly provides care and treatment within the confines of public event site cover which is not a regulated activity. However, the provider does occasionally transport patients off site to other local healthcare providers and as such requires registration with the Care Quality Commission. This regulated activity is reported under emergency and urgent care services.

The service has had a registered manager in post since registration in 2015.

We inspected this service using our comprehensive inspection methodology. We carried out the announced inspection on 4 November 2019. We were unable to observe delivery of the regulated activity during our inspection.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? We were unable to rate caring as we didn’t see any regulated activities being carried out and was not able to see feedback related to regulated activity.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

This is the first time we have rated this service. We rated it as Requires improvement overall.

• The provider did not ensure all staff completed mandatory training. The safeguarding systems and processes within the service did not reflect up to date legislation and guidance. Recruitment practice within the service did not consistently meet the provider’s policy. Equipment checks were not carried out consistently. Staff did not always have effective systems to assess risks to patients fully and act on them. Storage of medicines, including gases, was not always in line with current legislation. Understanding of what constituted an incident was not understood by all staff.

• Audits into clinical care, patient report forms, hand hygiene and medicine management had not been undertaken. Policies did not have clear document control with updated review dates. Many were past their documented review date. The service did not always make sure staff were competent for their roles. Managers appraised some staff’s work performance to provide support and development. The provider did not provide training on the Mental Capacity Act 2005 or the Mental Health Act 1983. However, all staff we spoke with told us how they would support a patient suffering from a metal health crisis.

• The service did not have systems and processes to manage all risks and performance issues. Leaders operated governance processes but there were not always effective. All staff were committed to continually learning and improving services but there was no evidence to support this. The service did not have a vision for what it wanted to achieve.

However, we found the following areas of good practice

• Staff completed risk assessments for each patient swiftly. They removed or minimised risks and updated the assessments.  The service-controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment, vehicles and premises visibly clean. The design, maintenance and use of facilities, premises and vehicles kept people safe most of the time. Staff managed clinical waste well. The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

• The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients regularly to see if they were in pain. All those responsible for delivering care worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.

• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.

• Leaders had the skills and abilities to run the service. They were visible and approachable in the service for staff. They supported staff to develop their skills and take on more senior roles. Leaders actively and openly engaged with patients and staff to plan and manage services. The culture was described as open and honest and the registered manager was approachable, supportive and visible. A whistle-blowing policy was in place to support staff to raise concerns without fear of retribution. The provider had started a social media group which had 28 members at the time of inspection from different services to communicate in the event of a major incident or issue locally.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices that affected urgent and emergency care. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals on behalf of the Chief Inspector of Hospitals