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Archived: i-HEART 365 Service - Extended Hours Good

The provider of this service changed - see new profile


Inspection carried out on 14, 16 and 17 November 2018

During a routine inspection

This service is rated as Good overall. (Previous inspection February 2018 - Inadequate)

The key questions now are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at i-Heart 365 Service - Extended Hours service on 14, 16 and 17 November 2018 to follow up on breaches of regulations and inspect a service in special measures. 

We previously carried out an announced comprehensive inspection of the service on 13 and 14 February 2018. Our overall rating for the service was inadequate and inadequate for providing safe, effective, responsive and well-led services, it was rated as good for caring. We served warning notices for breaches in relation to Regulation 16: Receiving and acting on complaints and Regulation 18: Staffing. 

At this inspection we found:

  • The service had reviewed the systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
  • The service had introduced systems to review the effectiveness and appropriateness of the care it provided. It had ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients were able to access care and treatment from the service within an appropriate timescale for their needs.

We observed one area of outstanding practice:

  • The provider had reviewed the identification and management of sepsis across all its services and routinely recorded patient observations in the face to face settings to calculate early warning scores. They had been proactive by sharing and promoting this work with other organisations across healthcare pathways and had contributed to the review of external incidents relating to sepsis led by other organisations.

The areas where the provider should make improvements are: 

  • Review checking of emergency medicines and equipment in line with the Resuscitation Council UK guidelines.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 13 & 14 February 2018

During a routine inspection

This service is rated as inadequate overall. (Not previously inspected)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Inadequate

Are services well-led? – Inadequate

Overall the service is rated as inadequate.

We carried out an announced comprehensive inspection at Barnsley Healthcare Federation CIC on 13 and 14 February 2018 as part of our inspection programme. We inspected three registered locations where regulated activities are carried out.

Our key findings were as follows:

  • There was no open and transparent approach to safety and no effective system in place for recording, reporting and learning from significant events.
  • Risks to patients were not adequately assessed or acted upon.
  • Patients were at risk of harm because systems and processes were not always in place to keep them safe. For example, the telephone triage process in the extended hours service and the out of hours service was judged unsafe. This was because clinicians were undertaking tasks without the support of triage protocols and guidance or evidence of appropriate training
  • Patients care needs were not always assessed and delivered in a timely way according to need. The service had not met all the National and Local Quality Requirements used to monitor safe, clinically effective and responsive care.
  • There was a system in place that enabled staff access to patient records, and information was shared with the patients GP following contact with patients using the service.
  • The service could not demonstrate that it ensured care and treatment was delivered according to evidence-based guidelines. For example, we saw in one patients record incorrect prescribing of some medicine.
  • Staff involved patients in their care and treated people with compassion, kindness, dignity and respect. Patients told us through CQC questionnaires, that they felt listened to and supported by staff and had sufficient time during consultations to make an informed decision about the choice of treatment available to them.
  • There was a lack of overarching clinical governance arrangements in place that meant patients were not kept safe from avoidable harm.
  • There was limited audited clinical oversight; the recording in patient records was poor and baseline observations were not recorded consistently in the patient records we viewed.
  • There was a leadership structure but communication between some staff and management was limited and some staff felt unsupported by managers. Following the recruitment of a new manager in December 17 some staff told us that they felt more confident in approaching leaders and felt more supported to do their jobs.
  • Significant issues that threatened the delivery of safe and effective care were not adequately identified or managed by leaders within the organisation.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure the competence and skill of clinical staff is assessed.
  • Implement an effective processes for assessing patients who attend the GP streaming and out of hours service.
  • Ensure a system is in place and staff have been trained, understand and follow the system at all times with regard to sepsis management.
  • Implement effective and sustainable clinical governance systems and processes and ensure managerial oversight at all times.
  • Ensure that staff who are employed at the service receive the appropriate support, training and professional development necessary to enable them to carry out their duties.
  • Ensure that there is an accessible system for identifying, handling, investigating and responding to complaints made about the service.

As a result of these failures we have concluded patients are at serious risk of receiving unsafe care or treatment. Due to the serious concerns we found regarding the safety of patients we immediately wrote to the provider following the inspection under Section 31 of the Health and Social Care Act 2008. We asked them to provide us with assurance that they would take action immediately to mitigate identified risks to patient safety in terms of patient care, treatment and welfare. We also informed the provider that we would be issuing a notice to impose some restrictions on the providers registration in order to keep patients who used the service safe.

Special measures statement

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any, key question, we will take further action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice