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Archived provider: Peninsula Community Health C.I.C. Good

On 21 April 2015, we published our inspection reports for Peninsula Community Health C.I.C.

Read the full service reports below.

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Inspection Summary


Overall summary & rating

Good

Updated 21 April 2015

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We judged this provider to be providing good safe, effective, caring and responsive services that were well led. The organisation was operating in a unique setting as a community interest company delivering NHS services and operating at the heart of a wider NHS system that is challenged in terms of demand and performance. It was unique in having been set up in a way that left it with historical debt and risks that had not been mitigated. It had been formed in the teeth of opposition from the public and staff. There is also some uncertainty over the future with the current contract due to finish in March 2016. These challenges were being met. The leadership team was highly visible and trusted and were managing the significant risks and uncertainties in a measured way that protected the organisation and enabled staff to concentrate on delivering and developing services.

The organisation had a vibrant positive culture and a palpable “can do” attitude that existed at all levels and was recognised by external partners. Staff talked of a transformed culture and this had been externally recognised with the organisation being recognised by the Health Service Journal (HSJ) Best Places to Work awards. Staff were encouraged to be open and report and learn from incidents and near misses. Services had been developed and shaped by staff and some innovations had been recognised nationally, including the development of nutritional and hydration aids for patients. Patients and their families spoke highly of the services received and the team saw examples of outstanding care where staff had gone the extra mile to ensure patients received the care that they needed.

There were some areas for improvement that have been identified in individual reports. There was one service where requirements in aspect of leadership were needed and one service requiring improvement in safety. There are some areas to improve at corporate level but given the way challenges are being met and managed and the quality and safety of services that are being delivered the organisation has been judged as being good overall.

Inspection areas

Safe

Good

Updated 21 April 2015

We judged good safe care was provided by across community inpatients, community adults, urgent care services and services for children and young people in all the places that we visited. Safety was judged as requires improvement for end of life care.

Incident reporting across all services was timely and part of routine activity with feedback and learning shared within teams. Staff were aware of their responsibilities for safeguarding and were supported by leads for adult and children safeguarding. Although the provider was unable to confirm that where a role required it, that the higher level of safeguarding training had been completed.

Management of medicines was generally good although access to a clinical pharmacist was not consistent in all the community hospitals. All equipment seen had been maintained and annual safety checks had been carried out. Staff had received training for the equipment they used in their roles. All clinical areas we visited were noted to be clean and maintained. Staff were supported to maintain knowledge through mandatory training and link staff for infection control and end of life care. There were vacancies in most of the services with cover arrangements varying: out of hours for community staff had variable cover arrangements and there was a gap in nursing hours on the Isles of Scilly. For staff working in the community it was a priority to ensure the safety of staff undertaking their roles in these settings.

We found concerns with completion of records for some patients receiving end of life care. The provider must ensure that all Allow Natural Death Orders (ANDO) were completed accurately to ensure the patients preferences, choices and best interest are accurately recorded. Regulation 20 of the Health and Social Care Act 2008.

Effective

Good

Updated 21 April 2015

We judged the effectiveness of the services provided as good. People’s needs were met through the use of evidence based guidelines and multidisciplinary working.

Policies and procedures were developed in line with national guidance and were readily available for staff. There were assessments for patients’ pain with appropriate medication being provided. The use of technology to enable patients to monitor their conditions at home via remote tele-health systems had a positive impact on them being able to remain in their own homes. Audit was used in services to monitor patient risks and outcomes to determine the effectiveness of care and treatment. There were good systems in place for multidisciplinary working with other internal services and external agencies in all of the core services. This was particularly good in the children’s bowel and bladder services. However, the limited availability of physiotherapists and occupational therapists (OTs) in some of the smaller hospitals meant that falls management programmes, as part of a patient’s rehabilitation, were not being carried out in line with accepted best practice.

We found concerns in some instances that mental capacity assessments were not always completed or reviewed where patients were identified as not having the capacity to make decisions around end of life care.

Caring

Good

Updated 21 April 2015

We judged the care provided by staff to be good across all the core services and in all the places that we visited. People were supported, treated with dignity and respect and were involved in their care. Patients, their relatives and carers spoke very positively about the compassion and care they received from staff in both in community hospitals and in the community. We saw staff taking time to talk to people in a supportive, kind and appropriate way. Patients and their relatives told us that they felt reassured and were confident to ask questions and make requests.

Responsive

Good

Updated 21 April 2015

We judged the responsiveness of the services provided as good. People’s needs were met through the way that services are organised and delivered. The services were organised in a way that took account of people’s choices, enabled continuity of care and valued the importance of flexibility. People were offered services as close to home as possible. Where that was not possible, for example during temporary closure of inpatient services, options were discussed with people and patients told us they appreciated the efforts that were made to accommodate them. The needs of different groups of people, including vulnerable people, were taken account of. Teams were located throughout the county to be able to respond promptly to patients’ healthcare needs and staff worked as part of multidisciplinary teams to ensure the patients’ needs were met responsively. Changes had been made to venues where clinics were held to meet the needs of people in geographically isolated areas. The care delivered was holistic and individualised. Learning and changes as a result of complaints was achieved through reflection and cascade of information.

Well-led

Good

Updated 21 April 2015

We rated the overall leadership of the provider as good although some improvements were needed for urgent and emergency care services. The overall leadership of the organisation is strong, highly visible and focused on the delivery of safe and high quality care. Although the organisation is challenged by a number of historical and current factors there was an inspiring shared purpose. Staff are proud of the organisation as a place to work and speak highly of the open culture. Staff feel valued and well informed and have confidence in the leadership team to deal with the challenges. The culture is vibrant and very focused on delivering the best care possible in a challenging environment. Staff told us that they could shape services to benefit patients and financial pressures were managed so as not to impact on care. Governance systems were in place to monitor the organisation’s performance against local commissioning and nationally set targets although improvements were needed in aspects of these to ensure that the Board received and dealt with all appropriate information. The changes made over the last 12 months to frameworks and risk systems needed to be formalised and embedded.

Staff were aware the organisation may be going through some changes in the future but felt that the information about this was communicated to them appropriately. Staff told us that members of the executive team had visited their wards and taken time to speak to them and reassure them. All staff we spoke to felt the Interim Director of Operations, the Chair of the board and the Chief Executive Officer (CEO) were approachable and listened to their concerns. Staff were generally very happy with their local leadership arrangements and felt they could talk freely to their managers. The interim director of operations was new in post and had nursing leadership in their portfolio at board level. We saw the organisation encouraged personal development and initiatives and was open to new, innovative ideas and practices. There were several examples of innovations that had developed the service offered to patients.