Sirona Care & Health C.I.C.

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from avoidable harm. At our last inspection we rated this key question as requires improvement. At this inspection, the rating has stayed the same. People remained at risk of avoidable harm because staffing levels were not always sufficient to meet demand. Some staff did not have the competencies required to deliver safe care. However, improvements had been made to the assessment of patients whose wounds or overall condition were deteriorating. Which helped strengthen the service’s approach to identifying and responding to risk.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

At our last assessment, we found the service did not have enough qualified, skilled and experienced staff. Staff did not consistently demonstrate the competencies required for their day‑to‑day roles, including recognising deteriorating wounds and pressure ulcers. As a result, the service was issued with a warning notice for a breach of Regulation 18 (staffing).

During this assessment, we focused on community nursing and podiatry teams. We observed home visits and clinic appointments. Staff reported they had completed required competencies in areas such as wound care, dressings, verification of death and syringe drivers. Training was delivered through a mix of online and face‑to‑face sessions, with competencies signed off following assessment. The provider supplied a training list for podiatry, community nursing out‑of‑hours community nursing teams, which showed improving compliance with required courses.

We identified at our last assessment that not all staff were able to identify deteriorating wounds or pressures sores. We had reviewed notification forms of patients who had suffered harm as a result prior to our last assessment. We were sent details of the training programme for community nurses and podiatrists. This demonstrated that staff had undertaken training and competency assessment in managing a deteriorating patient and wound care. Since our last assessment a point of escalation telephone line (POE line) had been introduced for community staff. We observed staff contacting this telephone support line to report any concerns following a visit with a patient. Staff were able to speak with senior staff for advice and support regarding a change in the patient’s condition. Additional visits were able to be booked in as required. Staff told us this was helpful in supporting them to manage patients with a deteriorating wound and/or condition. Staff also used the National Early Warning Score 2 (NEWS2) template as part of their assessment when they felt a patient’s condition was deteriorating. NEWS2 is a standardised, NHS-endorsed clinical tool used to detect acute illness, deterioration, or sepsis in adults.

Staff had access to a wound‑monitoring app, which we observed being used consistently. Although completion of the required information depended on a reliable mobile signal and remained time‑consuming. Staff reported the wound app was a useful tool for monitoring the conditions of wounds. Following the inspection,the provider told us they had implemented a revised template, reducing completion time while retaining the required clinical information.

The wound care app enabled the wound care team to have access to deteriorating wounds for monitoring and to support staff in reviewing and amending any treatment plan.

One patient reported their treatment was delayed because the nurse allocated to undertake compression bandaging did not have the required competency. As a result, the patient experienced avoidable pain. They also told us that 1 of their scheduled visits had been missed. This was reported to the provider at our feedback meeting.The provider advised following the site visits they cannot offer set times appointment and inform patients on the day when they were scheduled for a home visit. This was to support the allocation of urgent visits responding to clinical emergencies and deterioration, the rescheduling of visits was undertaken through the use of a clinical triage tool.
 

We observed a podiatry clinic where 1 session was being run by a foot care assistant and another by a podiatrist. The foot care assistant told us they were able to get advice and support from the podiatrist in the other clinic if they had any concerns about any patients. We saw the podiatrist attend the foot care assistant clinic to give advice and carry out some treatment. This resulted in the patient not having to attend another separate appointment.

Staff had access to risk‑assessment tools to help them identify risks to patients. At the last inspection, we found delays in completing these assessments, and staff did not always have the knowledge required to complete them. At this inspection, staff told us a new risk‑assessment template had been introduced and formed part of the patient record. We observed community staff completing risk assessments following each visit. Senior staff reported using weekly or monthly themes to reinforce key areas of risk. For example, a Malnutrition Universal Screening Tool (MUST) week was used to support staff in identifying adults who may be malnourished or at risk of malnutrition.

Staff raised ongoing concerns about staffing levels across community nursing and podiatry services. Community nurses told us that although staffing numbers were mostly at establishment, increasing patient acuity and the volume of insulin visits resulted in a sustained high workload. Some community staff stayed past their finishing time to complete their visits and records. Both community nursing and podiatry teams had access to bank and agency staff to help support service delivery. Staff reported some areas had better staffing levels than others and it was noted that the geography and clinical needs of the populations vary across the providers community teams. During our visit, 1 permanent community nurse was working an additional bank shift, and podiatry staff reported that they were able to work overtime to meet demand.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.