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Inspection Summary


Overall summary & rating

Updated 31 May 2018

Quadrant provides health visiting and school nursing services for children, young people, and families who live in North Tyneside.

We regulate independent healthcare services but we do not currently have a legal duty to rate them.

We found the following areas of good practice:

  • Staff protected children and young people from avoidable harm and abuse, and they followed appropriate processes and procedures to keep them safe. The lead safeguarding nurse advisor had good oversight of the concerns raised by staff and actively shared information and learning across the service.
  • The vision, strategy, leadership, governance, and culture promoted the delivery of high quality person-centred care. A dynamic team of directors, supported by a proactive senior manager professional lead, area leads and lead safeguarding nurse advisor had good oversight of risks, which they monitored and reviewed regularly.
  • Managers and staff managed caseloads well, and there were effective handovers between health visitors and school nurses to keep children safe at all times. On a day-to-day basis, staff assessed, monitored, and managed risks to children and young people. This included risks to children who were subject to a child protection plan or who had complex health needs.
  • Children, young people, and families felt staff communicated with them effectively, kept them involved and informed about care and treatment, promoted the values of dignity and respect, and were kind and compassionate.
  • Services were organised to meet the needs of children and young people. Managers and practitioners worked collaboratively with partner organisations and other agencies to ensure services provided choice, flexibility, and continuity of care.
Inspection areas

Safe

Updated 31 May 2018

  • Staff protected children and young people from avoidable harm and abuse.

  • Staff understood their responsibilities in relation to incident reporting, learning, and improvement. All practitioners knew how to report incidents and North Tyneside Council had developed a bespoke electronic reporting system to meet the needs and requirements of the service. We saw evidence of lessons learned and this was shared at team and management meetings.

  • Safeguarding children and young people had a high priority and staff knew what to do if they had a concern. The lead safeguarding nurse advisor had good oversight of the cases within the service and actively shared information and learning with staff. All practitioners had completed Signs of Safety training and we found robust evidence of engagement with the multi-agency safeguarding hub (MASH), which involved other agencies such as the police, housing, and social services.

  • The quality of care records was good and practitioners completed electronic records in line with national guidance.

  • Staff managed caseloads well, and there were effective handovers between health visitors and school nurses to keep children safe at all times. On a day-to-day basis, staff assessed, monitored, and managed risks to children and young people. This included risks to children who were subject to a child protection plan or who had complex health needs.

  • Although the service had experienced an increase in staff turnover immediately following the transition from the NHS to local authority, managers had recruited new staff to fill the vacancies. There was good skill mix within each team. Compliance with mandatory training was good and the service had implemented a system to ensure there was sufficient oversight of training requirements.

Effective

Updated 31 May 2018

  • Policies and guidelines were evidence-based, and there were good examples of multidisciplinary and multi-agency working and collaboration.

  • Staff completed comprehensive assessments, which took into consideration the physical and mental health needs of children, young people, and families.

  • The care and treatment of children and young people achieved good outcomes and promoted a good quality of life.

  • Health visitors and school nurses delivered the Healthy Child Programme and managers routinely collected and monitored the data using a performance dashboard. Performance was good and practitioners delivered all mandated contacts in the pre-school years.

  • The service had achieved full accreditation with the UNICEF Baby Friendly Initiative and breastfeeding rates showed continuous improvement.

  • Managers encouraged staff to develop their professional skills and practitioners took ownership of their own performance. All staff had received an annual appraisal and there was a good preceptorship programme for new staff joining the service. The management team had also prioritised the recruitment and retention of staff through the introduction of developmental staff nurse posts.

  • Practitioners exercised good practice in relation to consent and confidentiality, and appropriately applied Fraser guidelines and Gillick competency when offering treatment to children less than 16 years old.

Caring

Updated 31 May 2018

  • Staff created a strong, visible, person-centred culture. Practitioners were highly motivated and inspired to offer the best possible care to children, young people, and families, including meeting their emotional needs.

  • All staff we spoke with were passionate about their roles and were dedicated to making sure children, young people and families received the best patient-centred care possible.

  • Throughout our inspection, we observed staff delivering compassionate and sensitive care that met the needs of children, young people, and families.

  • Staff treated children, young people, and families with dignity and respect and involved them in their care.

  • We observed members of staff who had a positive and friendly approach towards children and parents. Staff explained what they were doing and took the time to speak with them at an appropriate level of understanding.

  • Families spoke positively about the health visiting and school nursing service. Feedback from surveys indicated 99% of respondents would recommend the service to family and friends and 100% said they felt practitioners listened to them.

Responsive

Updated 31 May 2018

  • Managers and staff planned and delivered services to meet the needs of children and young people and worked in partnership with families, partner organisations, and other agencies.

  • The service prioritised the needs of the most vulnerable children and families. Practitioners worked collaboratively with other agencies to deliver joined up care for young parents and for vulnerable families who had experienced domestic abuse.

  • Families had access to the right care at the right time, taking into account children and young people who were vulnerable or those with urgent or complex needs. School-aged children could access timely advice and information from a school nurse via the Chat Health text messaging service.

  • Staff actively promoted involvement from children, young people and families, and the individual needs and preferences of children and young people were central to the planning and delivery of services.

  • Staff proactively looked at different ways to address and manage public health needs, such as managing obesity. The service provided a dedicated Healthy 4 Life nurse to deliver an evidence-based intervention programme designed to encourage and support behaviour changes and help facilitate long term health benefits.

  • There was an open and transparent approach to handling complaints. Information about how to make a complaint was available and we found evidence of lessons learned.

Well-led

Updated 31 May 2018

  • The leadership, governance, and culture promoted the delivery of high-quality, person-centred care.

  • There was a good strategy, designed to meet the needs of children, young people, and families and deliver a high quality service. Managers had proactively engaged with staff and other stakeholders.

  • Managers created a culture of openness and transparency with a clear focus on putting children and young people at the centre of their care. Staff displayed integrity in their work and communication was very good.

  • There was strong collaboration and a culture of collective responsibility amongst practitioners and managers, with a common focus on improving quality of care and the patient experience.

  • Managers had an inspired shared purpose and strived to deliver, and leadership was good across the service. There was a clear management structure, and line managers were visible and involved in the day-to-day running of services.

  • There was a good governance structure. Monthly operational and governance meetings provided opportunities to discuss regular agenda items such as risk, incidents, and safeguarding.

  • Risks were reviewed at local and senior management meetings, and appropriate timescales and mitigation was in place.

  • Staff were very positive about working for North Tyneside Council. They felt respected and valued by managers at all levels and described them as approachable and supportive.

  • Managers and staff gathered feedback from children, young people, and families. They listened to suggestions and incorporated the feedback into their list of priorities. There was a collective focus on continuous improvement. Staff felt empowered to raise concerns and offer innovative suggestions to improve service delivery, quality, and care.

Checks on specific services

Community health services for children, young people and families

Updated 31 May 2018