You are here

Provider: Locala Community Partnerships C.I.C. Good Also known as Kirklees Community Healthcare Services

Reports


Inspection carried out on 05 Nov to 07 Nov 2019

During an inspection looking at part of the service

Our rating of the organisation improved. We rated it as good because:

We rated safe, effective, caring, responsive and well led as good. We rated all four of the core services we inspected as good overall. In rating the organisation, we took into account the previous rating of the core service we did not inspect this time.

  • We rated well- led for the organisation overall as good. The leadership, governance structure and culture within the organisation showed an open, effective and person-centred approach which was driving improvements to deliver good quality, patient centred care.
  • We saw a strong vision and set of values which were shared across the organisation. Staff in core services knew the vision and values and had the opportunity to input into them.
  • Locala had systems in place to identify learning from incidents, complaints and safeguarding alerts. Locala used safety summits to share information between teams and had recently enabled colleagues to access these through skype to improve attendance.
  • There was an open incident reporting culture, staff knew how to report incidents and there was evidence of learning from incidents; there were comprehensive arrangements and procedures for safeguarding and feedback we received from external stakeholders in relation to safeguarding was positive. Staff in core services demonstrated a good understanding of safeguarding and knew how to protect patients from abuse.
  • Robust arrangements were in place for identifying, recording and managing risks, issues and mitigating actions. Recorded risks were aligned with what staff said were on their ‘worry list’. Locala had a risk profile which identified their highest scoring risks, there were key performance indicators in place to monitor risk management and we could see that risk was discussed regularly at both board and committee meetings.
  • On the whole mandatory training compliance figures were good. Staff said they had access to both internal and external learning. Locala’s coaching programme had been shortlisted for the training journal awards in the category of best coaching / mentoring programme.
  • The organisation worked collaboratively with external partners to provide the highest quality of care. Locala was the lead provider for an innovative partnership which brought together five organisations and their 0-19 services to help ensure that all children, young people and families living in Kirklees will be healthy and resilient. Feedback from external stakeholders included recognition of Locala embracing new ways of working.
  • Across the four core services we saw that staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.

However:

  • Although Locala had an LGBT staff network they had not yet developed a Black and ethnic minority or a disability staff network. Locala had recognised that there was a need to develop further staff networks however these were not yet in place.
  • In the community health services for adults, risk assessment reviews were not always documented on the electronic patient record. Staff were completing reviews of risk and these were discussed with the multidisciplinary team however documentation was not always updated in the risk document. In the children, young people and families service we saw some clinical records were not completed within the 24-hour timeframe. Records not completed within the 24-timeframe varied between 1% and 4%.
  • In the community health services for adults not all mandatory training was compliant with the organisational target.
  • In the children, young people and families service the 0-19 service in Kirklees had very high caseloads which were significantly above the organisations recommended colleague caseload.


CQC inspections of services

Service reports published 24 February 2020
Inspection carried out on N/A During an inspection of Reference: Community health inpatient services not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Community health inpatient services not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Community health inpatient services not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Community health inpatient services not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: Community health inpatient services not found Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 07 Nov 2019 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 07 Nov 2019 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 07 Nov 2019 During an inspection of Community dental services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 07 Nov 2019 During an inspection of Community health sexual health services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 24 February 2020
Service reports published 17 May 2017
Inspection carried out on 11-14 October 2016, 27 and 28 October 2016 and 4 November 2016 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 11-14 October 2016, 27 and 28 October 2016 and 4 November 2016 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 11-14 October 2016 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 11-14 October 2016 During an inspection of Community dental services Download report PDF (opens in a new tab)
See more service reports published 17 May 2017
Inspection carried out on 11-14 October 2016, 27 and 28 October 2016 and 4 November 2016

During a routine inspection

We inspected Locala Community Partnerships Community Interest Company (“Locala”) from 11-14 October 2016. We undertook unannounced inspections on 27 and 28 October 2016 and 4 November 2016. We carried out this inspection as part of the Care Quality Commission’s (CQC) comprehensive inspection programme.

We inspected the following core community health services:

  • Community adults services
  • Community inpatient services
  • Community dental services
  • Community services for children, young people and families

In relation to each core service that we inspected we asked if the service was safe, effective, caring, responsive and well-led.

We sampled services provided from a range of locations across the Kirklees and Calderdale areas.

We did not inspect GP services, sexual health services or primary dental services provided by Locala during this inspection.

As a result of this inspection, we have rated the four core services that we inspected. We have not rated Locala as a provider for each of the five key questions or given an overall rating because we did not inspect how well-led the organisation was in relation to all the services that it provides.

Our key findings were as follows:

  • Locala’s systems for identifying, investigating and learning from incidents were not robust. There were several examples of this, including an incident that was not identified as a serious incident until several months after it occurred and that was incorrectly deemed to have been unavoidable.
  • The duty of candour requirements were not embedded across the services that we inspected and compliance with the duty of candour requirements had not been monitored by the Board until September 2016.
  • The organisation had safeguarding policies and procedures in place for safeguarding vulnerable adults and children. Safeguarding training rates were variable across the core services we inspected. A serious safeguarding adults incident had occurred in June 2016 which highlighted that some staff in the community adults team had not recognised safeguarding concerns that had been raised by patients and subsequently had not known what action to take. This had resulted in a delay in the organisation taking the appropriate action.
  • We identified significant concerns regarding assessing and responding to risk on Maple Ward. This included falls and venous thromboembolism risk assessments not being completed and national early warning scores not being calculated when it was clinically appropriate to do so.
  • We were not assured that governance and risk management arrangements were robust and we were concerned that there was an insufficient focus on quality within the organisation. Revised governance and risk management arrangements had been introduced shortly before our inspection. However, many of these changes were not fully embedded and it was too early to see whether they would lead to improvements. We saw several examples of serious patient safety issues not being identified or escalated through the governance structures appropriately.
  • We found a mixed picture in relation to the culture of the organisation. This was reflected in the variation in responses in the June 2016 staff survey across the four business units.
  • Mandatory training compliance rates were variable across the four core services that we inspected.Locala had a trajectory that Nurses in the integrated community care teams were not being provided with individual clinical supervision.
  • Appraisal rates were low in the community adults and community inpatient services.
  • Staffing levels were appropriate in the majority of services that we inspected. However, staffing shortfalls were a significant issue in the integrated community care teams, which delivered planned and unplanned care to patients. Staffing issues had been particularly acute in these teams in the period August to October 2016.
  • A number of the infection prevention and control (IPC) policies and procedures were out of date. There were capacity issues in the infection prevention and control team, which meant that the IPC audit schedule hadn’t been followed in all the services that we inspected. We observed staff following IPC practices during the inspection.
  • Care and treatment was evidence based across the services that we inspected. Staff had access to policies and procedures and other evidence-based guidance via the organisation’s intranet. Policies, procedures, assessment tools and pathways followed recognisable and approved guidelines.
  • There was an agreed clinical audit programme in place for 2016/17. Locala had identified that there were gaps in required levels of quality assurance and clinical governance that may lead to poor standards of clinical quality and had commenced a programme of work to address this.
  • The services we inspected participated in a number of audits to measure patient outcomes. We generally saw evidence of good patient outcomes in the services that we inspected, with the exception of Maple Ward where national audit data had not been completed during the reporting period for this inspection. In some instances we did not see evidence of action plans in the community dental service to address the outcomes of audits.
  • Across the services staff used technology to enhance the service they provided to patients, however there were issues with the connectivity of mobile technology which meant that information was not always available to staff when they needed it..
  • Throughout our inspection the majority of patients and relatives informed us they felt involved in care options, decision making and planned treatment. Staff took time to explain the care being administered and to ensure that patients and relatives understood what was happening.
  • Patients were generally able to promptly access care and treatment in the services that we inspected. There were waiting lists for patients to access some services in the integrated community care teams and some visits were being delayed as a result of staffing shortfalls.
  • There was no dementia or learning disability strategy in place. However, Locala had received an award in 2015 from a local voluntary group specialising in dementia care in recognition of the work to become dementia friendly. We saw some good examples of staff and services responding to the needs of people in vulnerable circumstances.

There were areas of poor practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that there are robust procedures in place to ensure that incidents, including serious incidents and never events are correctly identified and reported and are comprehensively investigated and reviewed at an appropriate level within the organisation.
  • Ensure that learning from incidents and complaints is shared and embedded across the organisation.
  • Ensure that the duty of candour process is effective and embedded in practice across the organisation.
  • Ensure that at all times there are sufficient numbers of suitably skilled, qualified and experienced staff, taking into account patients’ dependency levels.
  • Ensure that all staff have completed mandatory training and role specific training.
  • Ensure that infection prevention and control policies and procedures are reviewed and in date.
  • Ensure that the infection prevention and control audit programme is followed and actions are identified and implemented in a timely manner when issues are identified through the audit programme.
  • Ensure that staff are up-to-date with appraisals and staff attend clinical supervision as required.
  • Ensure that there are in operation effective governance, reporting and assurance mechanisms.
  • Ensure that there are in operation effective risk management systems so that risks can be identified, assessed, escalated and managed.
  • The provider must have systems in place, such as regular audits of the services provided, to monitor and improve the quality of the service.
  • Ensure that staff have undertaken safeguarding training at the appropriate levels for their role.
  • Ensure that there are appropriate systems in place in the community adults service to ensure that patients are prioritised and seen promptly in accordance with clinical need. In addition, the provider must ensure that the governance and monitoring of such systems is operated effectively to enable the identification of any potential system failures, and to take action so as to protect patients from the risks of inappropriate or unsafe care and treatment.
  • Ensure that staff competency is robustly assessed in the community adults service.
  • Ensure that timely clinical risk assessments are undertaken and recorded and care plans are developed and recorded that are reflective of the patient’s needs for patients on Maple Ward.
  • Ensure that clinical risks are promptly identified and appropriately monitored on Maple Ward, including the calculation of National Early Warning Scores, as clinically appropriate.
  • Ensure that patients who self-medicate on Maple Ward have been appropriately risk assessed.
  • Ensure that patients having venous thromboembolism prophylaxis on Maple Ward are appropriately assessed as per current best practice guidance.
  • Ensure that a paediatric nurse is available to provide recovery care for children receiving dental treatment under a general anaesthetic, as recommended by the Royal College of Nursing.

Professor Sir Mike Richards

Chief Inspector of Hospitals