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Provider: Livewell Southwest CIC Good

Reports


Inspection carried out on 3 Sept to 2 Oct 2019

During a routine inspection

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

  • We rated all five of the key questions ‘are services safe, effective, caring, responsive and well-led’ as good. Our rating for the organisation took into account the previous ratings of services not inspection this time.
  • Staff in the organisation had worked hard to address concerns we had raised in the last inspection. Two services that were previously rated as requires improvement at the last inspection were now rated as good. Community end of life care and child and adolescent mental health wards had both improved.
  • Livewell Southwest had strong leadership who had the appropriate range of skills, knowledge and experience to deliver community health and mental health services. Staff felt they were visible and approachable. There was a rolling programme of visits scheduled to services by the executives. Executives used these visits to engage with staff and also listen to their views on the services.
  • There was a positive, open and honest culture throughout the organisation. Staff at all levels of the organisation were proud to work at the organisation and morale among staff was very good. both leaders and staff across the organisation put patients at the centre of everything they did.
  • The organisation had recently refreshed and published its new strategy which had been coproduced with staff and stakeholders. The organisation had worked hard to ensure it forged strong strategic alliances with partner organisation. Its contribution to the wider health economy was highly valued by partner organisation and it was now seen as equal partner.
  • Livewell Southwest had effective systems and processes in place to support delivery of the services it delivered. There was an appropriate sub board committee structure and escalation to board through the structure. Non-executive directors (NEDs) chaired committees and were confident to raise any concerns or challenge to the executive team. The organisation was financially stable and there was relevant financial expertise among the executives and NEDs.
  • There was a strong emphasis, from both leaders and staff across the organisation for putting patients at the centre of everything they did.
  • There was also a strong emphasis on listening to staff and providing opportunities for staff at all levels to develop and a strong emphasis on Quality Improvement. The organisation had appointed two Freedom to Speak Up Guardians (although there is no requirement for a CIC to do so). The organisation were using innovative ways to develop its existing staff and to attract new staff.
  • Staff treated all patients with compassion, respect and kindness. The privacy and dignity of patients was maintained at all times. Patients were supported by staff to understand and manage their care and treatment. Staff actively involved families and carers of patients in their care appropriately.
  • Across the organisation clinical areas and premises where patients received care were clean, well equipped and maintained.
  • Services had enough medical and nursing staff. Teams in the organisation had access to a full range of specialists required to meet the needs of patients in their care. Care was planned and provided in a way that met the needs of local people and the communities it served. Staff met the needs of patients with a protected characteristic. Staff supported patients with communication, advocacy and cultural and spiritual support.
  • Generally, staff across the organisation knew their roles and responsibilities under the Mental Health Act 1983, Mental Health Act Code of Practice and the Mental Capacity Act 2005. Staff assessed and recorded capacity clearly for those who might have impaired mental capacity.
  • The organisation managed incidents well and staff understood how to report them appropriately. Incidents were investigated, and lessons learned were shared with staff.
  • The organisation treated concerns and complaints seriously. The organisation investigated concerns and complaints and shared lessons learned with staff. Patients were included in the investigation of their complaint.

However:

  • Patients on Cotehele ward, part of the wards for older people with mental health problems service, did not have access to their bedrooms during the day without a staff member escorting them. This limited their ability to be as independent as possible, which is important for older people in hospital. There were also blanket restrictions in relation to the time patients went to bed in the evening which meant that patients had to go to bed at set times.

  • Staff did not undertake a risk assessment of patients at the time of referral to the community mental health teams and did not monitor patients on the waiting lists prior to their initial assessment. This meant that they did not know whether a patient’s mental health deteriorated whilst waiting for an assessment. Staff assumed the GPs would monitor them but there was no agreement in place as to who should monitor patients on the waiting list.

  • In the community health services for inpatients staff on South Hams ward were not assessing pressure ulcers and wounds adequately and in line with the organisation’s policy. Some staff were also unaware of the organisation’s policy on safeguarding in relation to the development of pressure ulcers and when notifications should be made to the Care Quality Commission.

  • There was further work needed by the organisation on equality and diversity.


CQC inspections of services

Service reports published 3 January 2020
Inspection carried out on 3 Sept to 2 Oct 2019 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 3 Sept to 2 Oct 2019 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 3 Sept to 2 Oct 2019 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 3 Sept to 2 Oct 2019 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 3 Sept to 2 Oct 2019 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 3 January 2020
Service reports published 7 August 2018
Inspection carried out on 17 April 2018 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 17 April 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 17 April 2018 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 17 April 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 17 April 2018 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 7 August 2018
Service reports published 7 August 2017
Inspection carried out on 03 May 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Service reports published 19 October 2016
Inspection carried out on 21 - 24 & 29 June 2016 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Community urgent care services Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Community health sexual health services Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Substance misuse services Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 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 21 - 24 June 2016 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 & 28 June 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
Inspection carried out on 21 - 24 June 2016 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
See more service reports published 19 October 2016
Inspection carried out on 17 April 2018

During a routine inspection

  • We rated four of the key questions, ‘are services safe, effective, responsive and well-led’ as good and the key question, ‘are services caring’ outstanding. Our rating for the organisation took into account the previous ratings of services not inspected this time.

 

  • Staff took the time to interact with people who used the service and those close to them in a respectful and considerate way. Staff were highly motivated and inspired to offer care that was kind and promoted people’s dignity.

 

  • Staff demonstrated understanding of patient’s care needs and wishes and showed an encouraging, sensitive and supportive attitude to patient’s and their relatives / representatives.

 

  • Patient’s were encouraged to be involved in the development of the service and were involved in their care planning, and carers were also involved where appropriate. We saw excellent examples of patient centred care.

  • Patients and carers gave positive feedback about the care received.

 

  • In the majority of the services we inspected, we found that staff managed access to and discharge from the service well. This was reflected in the time it took for patients to receive an assessment and then their treatment, and in the way the inpatient staff in the majority of the services we inspected worked to help patients to be ready for discharge.

 

  • The organisation’s senior leadership team had the skills, knowledge, and experience necessary to successfully oversee a large organisation. The board were actively working hard to ensure a positive approach to the closer working relationship with Plymouth Hospitals University NHS Trust. A new chief executive had been appointed in March 2018 whose focus was ensuring an appropriate balance between working towards the working relationship and the day to day strategic management of the organisation. The chief executive and vice-chair both had a clear understanding of the challenges and strategic direction of the closer working relationship with University Hospitals Plymouth NHS Trust.

 

  • The provider had worked hard on its recruitment and retention plan with some success. For example, there was now a fully recruited district nursing workforce.

 

  • We saw some examples of excellent leadership at all levels with many dedicated, compassionate staff who were striving to deliver the best care for their patients.

 

However,

  • We rated two services as requires improvement, the child and adolescent mental health inpatient ward and community end of life care.
  • On the child and adolescent mental health inpatient ward, improvements were needed to the governance of the service, care plans and risk assessments.
  • Whilst we noted some improvements within community end of life care. further work was needed to ensure consistency in record keeping and training for staff.

 

Inspection carried out on 21 - 24 June 2016

During a routine inspection

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.

Despite rating Plymouth Community Healthcare CIC as good overall, we had concerns about the safety of patients accessing the Community Mental Health Teams for adults of working age. It is our view that the provider needs to take significant steps to improve the quality of this service and we find that they are currently in breach of regulations. We issued a Section 29 warning notice on 15 July 2016 which told the provider they must make significant improvements. 

Following the June 2016 comprehensive inspection we issued the provider a section 29 warning notice which gives a strict timescale for them to improve. This related to the services provided by Plymouth CIC's community-based mental health services for adults of working age.

In October 2016 we carried out an unannounced focussed inspection of Plymouth CIC's community-based mental health services for adults of working age. This was to see if the provider had met the concerns raised in the warning notice. We found evidence of progress and improvement and at this time we will not be taking any further enforcement action. We will continue to monitor the provider's compliance with the warning notice. Further details can be found in the community-based mental health services for adults of working age core service report.

At the comprehensive inspection in June 2016 we found the service provided by Plymouth CIC to be good because:

  • Across the inpatient and community services we saw that staff worked with patients and their families to deliver individualised care. Care plans were holistic, they documented detailed assessments of both the emotional and physical needs of patients, were patient centred and most had a strong recovery focus.
  • We observed good assessment and management of risk throughout most services. For example ligature risk assessments were in place and well managed either by rectifying the issues identified or by actively managing the areas where risk was identified to reduce the risk to patients.
  • Generally the wards and community environments were clean, bright and well furnished. The provider was committed to refurbishing environments which required it. For example, it had managed the refurbishment of the Glenbourne well; with particular focus on safety and patient involvement in the re-design.
  • The provider had robust infection control policies and procedures and staff adhered to these across all environments.
  • In the community team for learning disabilities and autism, staff understood the importance for patients of being close to their friends and family. The team had won an award for bringing patients who were staying in hospitals out of the area, back home to Plymouth.
  • We observed that staff delivered care and treatment to patients in a kind, caring manner that respected their dignity. Where concerns had been expressed by patients and carers we saw that this had been addressed appropriately and in line with the expectations of duty of candour.
  • The great majority of the patients that we spoke with on the wards were positive and complimentary about the support they received from staff. Staff interacted with patients positively and respectfully. They demonstrated that they knew the patients well in their interactions with patients and in their responses to them. Where it was appropriate we saw that carers and family members were involved in the care planning process and care plans documented patients’ wishes and feelings about their treatment.
  • Patients told us that food was good and there was a wide choice available to them. The Provider had been awarded five stars for food hygiene by South Hams district council on 29 August 2014, Mount Gould had received a five star rating for food hygiene by Plymouth City Council on 28 January 2014 as part of the scores on the doors rating system.
  • Most staff had received training in and had a good understanding of safeguarding procedures.
  • There was a wide range of activities on the wards throughout the week that patients could benefit from.
  • There were separate health based place of safety (HBPoS) for adults and young people. Staff in the HBPoS manged risk well, including environmental risks and safeguarding concerns. There had been a gradual reduction in the use of police custody for section 136 purposes for adults and since the introduction of the place of safety for young people, there had been no use of police custody for this patient group.
  • Staff were positive about working for the provider as an employer and said they encouraged individual services to improve and had a ‘no-blame’ culture. Staff knew who senior managers and said they were visible. Senior managers and executive board members had visited all locations. Non-executive directors had a good understanding of the provider’s strategy and presented appropriate challenge to the executive team.

However:

  • In some clinical areas, the provider had not ensured that staff had the necessary skills or training. It had not always assessed whether healthcare assistants in the community hospital were competent before they were allowed to carry out initial clinical assessment of patients. Healthcare assistants were re-directing patients to other services before the patients had been assessed by a registered practitioner. Although all staff had received recent training in immediate life support for adults, there was no record of how many had received training in life support for children.
  • The provider had processes in place to identify and report serious incidents. For example, we observed assessment and management of risk with locally held risk registers and use of a risk rating tool that identified problems and escalated these issues for action. However these were not used consistently across all core services, we saw that adaptations required following an incident on the older persons wards had not been made 12 months after the incident.
  • Not all staff were receiving regular supervision in line with the providers’ policy.
  • There were some instances where the provider had not assessed or managed risk well. Staff had not conducted a risk assessment of child and adult resuscitation facilities at South Hams and Tavistock to ensure they were suitable for an isolated unit.
  • Staff in the community mental health teams for adults did not always provide care and treatment in a safe way. Not all patients on waiting lists for treatment had been thoroughly risk assessed.
  • Staff in the community inpatient team did not adhere to the medicines management guidance such as the use of patients own medicines as stock medicine.
  • In the 'end of life care service treatment escalation plans' and 'do not attempt resuscitation decisions' forms were not always appropriately completed and recorded in line with organisation’s policy.
  • MHA training was considered essential for some teams and appeared to be regularly delivered and accessed by staff. However, there was no record of this held locally or at provider level to ensure the right staff had received the correct level of training.
  • At South Hams hospital the provider did not always provide appropriate X-ray facilities when they were required by patients with suspected fractures.
  • The staffing levels and skill mix within the district nursing service was not always safe, and staff were not always appropriately supported.
  • The provider was not always adhering to the safeguarding policy and was not consistently raising safeguarding alerts to the Local Authority safeguarding team and the Care Quality Commission.
  • Cothele ward had a blanket restriction in place which restricted the reasonable movement of patients.
  • The provider did not always act in a timely way to implement learning from incidents.