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Archived: Mallard House Call Centre Good Also known as NHS 111 Service

This service is now registered at a different address - see new profile

Inspection Summary


Overall summary & rating

Good

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Derbyshire Health United (DHU) evening and overnight district nursing service on 9 & 10 May 2016. As part of this inspection we visited Mallard House Call Centre where the south district nursing team were based. Overall the service is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Staff knew how to and understood the need to raise concerns and report incidents and near misses.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff had received extended training relevant to their role. For example, staff had undertaken training in varying aspects of end of life care, dementia awareness and domestic abuse awareness.
  • A care concern referral process had recently been introduced. This system enabled referrals to be made where the concerns for the patient did not relate to suspected abuse but related to care needs or welfare of the patient.
  • Through the comment cards patient completed for us, they said they were treated with compassion, dignity and respect. The also told us they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Patient information was available in different languages. Complaints were fully investigated and patients responded to with an apology and full explanation.
  • Vehicles used to visit patients in their own homes were clean and well equipped.
  • There was a clear leadership structure and staff felt supported by their team leaders and the senior management team.
  • The provider proactively sought feedback from staff and patients, which it acted on.
  • There were innovative approaches to providing integrated person-centred care. Rightcare plans were developed by the patient’s GP and shared with the evening and overnight district nursing service for clinically high demand patients including nearing end of life and those with complex health needs. Special notes were used to record relevant information about patients.
  • There were effective safeguarding systems in place for both adults and children at risk of harm or abuse. There was an effective system in place for adults to support people about whom there were care or welfare concerns.
  • There were clinical supervision and appraisal processes in place for all clinical roles and support was provided for those members of the nursing team who were required to revalidate.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice including:

  • A daily comfort call system was in place for patients referred into this service with palliative care needs and those patients who were at the end of their life.These patients received a telephone call on a daily basis to assess their care needs and received priority visits when required.

  • DHU worked towards achievement of a quality target to achieve a minimum of 95% of all requests for urgent visits to be achieved within a four hour time frame.During the period 1 April 2015 – 31 March 2016, a total of 18,361 patient contacts were recorded. The overall achievement of this target was 99.75% of urgent visits attended within a four hour timeframe. Data was monitored on a monthly basis and any reported breaches of this target were investigated on an individual basis to ascertain whether an actual breach had occurred.

  • DHU carried out an end of life care admission audit which involved a review of all hospital referral rates and emergency 999 calls for terminally ill/palliative care patients. This audit monitored reasons for admission to hospital and any further communication with or actions taken by DHU and identified whether a Rightcare plan was in place for these patients. This enabled DHU to continually monitor the appropriateness of unplanned admissions to hospital and use of emergency services. The results of this audit showed that 75% of either hospital admission or emergency 999 calls were appropriate or unavoidable. Results highlighted that 50% of cases did not have a Rightcare plan in place. Reasons for either admission or an emergency 999 call were recorded for those cases deemed inappropriate to enable DHU to monitor trends and action plans were implemented as a result of this audit.

  • An out of hours coordinator was in place on a daily basis who was also supported by a clinical lead who provided clinical oversight and support in the community to the nursing teams. The out of hours coordinator continually monitored the location of all members of the nursing teams when working in the community via the ‘Adastra’ electronic system and ensured regular communication with staff throughout their shift. The coordinator continually monitored and re-allocated workloads across all nursing teams to ensure work was re-allocated to other teams should a nursing team require to spend more time with a patient dependent upon their care needs, whilst ensuring other patients received a home visit as soon as possible by the most appropriate team. This system also ensured achievement of the quality target to achieve a minimum of 95% of all requests for urgent visits within a four hour time frame.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 October 2016

The provider is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording incidents and significant events.

  • Lessons were shared to make sure action was taken to improve safety.

  • The service had clearly defined systems, processes and practices in place to keep patients safe from harm and abuse. Staff understood their responsibilities and had received training relevant to their role.

  • The provider had systems in place to ensure that people were appropriately recruited and vetted to ensure their eligibility and suitability for their role.

  • Risks to patients were assessed and well managed.

  • Vehicles used to take members of the district nursing team to patients’ homes for home visits were well maintained, cleaned and contained appropriate emergency medical equipment.

  • Monthly checks were carried out to ensure all nurses were registered with the Nursing and Midwifery Council (NMC).
  • All employees who had direct contact with patients, were offered annual influenza vaccines.

Effective

Good

Updated 4 October 2016

The provider is rated as good for providing effective services.

  • Our findings showed that systems were in place to ensure that all members of the district nursing team were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Health care assistants (HCAs) received training in the role of the HCA in end of life care. We saw evidence of these training records during our inspection.
  • There was evidence of appraisals and personal development plans for all staff.
  • There was evidence of clinical audit, clinical supervision and reflective feedback processes for all staff to ensure the delivery of high quality patient care.

  • Staff received training relevant to their roles and were up to date with all mandatory training.

  • The service worked closely with the GP out-of-hours service and with patients’ own GPs. Information was shared with the evening and overnight district nursing service through Rightcare plans and special notes, ensuring that the patient’s needs and wishes were known.

  • Staff had access to counsellors and de-brief sessions should they have required support following a particularly traumatic, emotional or upsetting home visit.

Caring

Good

Updated 4 October 2016

The provider is rated as good for providing caring services.

  • In the comment cards patients completed for us they said they were treated with dignity and respect by helpful, polite and caring staff.

  • Patients were satisfied that they were involved in decisions about their care and treatment.

  • We saw evidence of a ‘Derby City ‘Dignity Campaign’ certificate of achievement’ in recognition of their work to promote dignity and respect.

  • Some members of staff were Dementia Friends and Dignity Champions.

  • Staff treated patients with kindness and respect, and maintained patient and information confidentiality at all times.

  • Two members of the district nursing team had recently been nominated and received an internal recognition award for the outstanding level of care shown to two individual patients who were at the end of their life.

  • A daily comfort call system was in place for patients referred into this service with palliative care needs and those at the end of their life. These patients received priority visits when required.

Responsive

Good

Updated 4 October 2016

The provider is rated as good for providing responsive services.

  • The provider undertook continuous engagement with patients to gather feedback and held regular patient and public involvement sub-committee meetings to review suggestions for improvements. Changes were made to the way it delivered services as a consequence of this feedback. Patient satisfaction, patient safety, friends and family test results and healthwatch information were also discussed.
  • The service understood the needs of the population it served and engaged with the local Clinical Commissioning Group to provide services that were responsive to the needs of the population.
  • Rightcare plans were developed by the patient’s GP and shared with evening and overnight district nursing service for patients with higher levels of need such as patients with long term conditions, complex health needs and those at the end of their life. The district nursing service worked jointly with the GP out-of-hours service which ensured staff had access to Rightcare plans and special notes which were used to record relevant information about patients.
  • Information about how to complain was available and easy to understand. Evidence showed that the service responded quickly and sensitively to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 October 2016

The provider is rated as good for being well-led.

  • It had a clear vision with quality and safety as its top priority. The service was responsive to feedback and used performance information proactively to drive service improvements.

  • The views of patients were taken into account and acted upon through active public engagement.

  • The organisation had a number of policies and procedures to govern activity and held regular governance meetings.

  • There was an overarching governance and performance management framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The senior management team encouraged a culture of openness and honesty.

    The service had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • There was a strong focus on continuous learning and improvement at all levels, staff were encouraged to continually learn and develop their skills.