Sirona Care & Health C.I.C.

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – We looked for evidence that people were always treated with kindness, empathy and compassion. We checked that people’s privacy and dignity was respected. We also looked for evidence the service was responsive to people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has decreased too good. This meant people felt well-supported, cared for and treated with dignity and respect.

This service scored 85 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service always treated people with kindness, empathy and compassion and respected their privacy and dignity. Staff treated colleagues with kindness and respect.

Staff understood and respected the personal, cultural and social needs of people and understood how these may relate to care needs. This information was recorded and shared with other services or providers where necessary.

Staff treated patients with kindness, dignity, respect and compassion. During home visits with a variety of staff, we saw staff sitting at eye level with patients so they could hold a proper conversation with them. Patients told us that staff always allowed time to talk during visits and were kind.

Staff took time to interact with patients in a respectful and considerate manner. We witnessed staff talking to patients respectfully, and in ways patients were able to engage with.

We spoke with patients who benefitted from the visits of allied health professionals as part of the reablement service. Patients received visits up to four times a day and described the healthcare professionals as ‘incredibly supportive’ and would go the extra mile such as help with household chores following discharge.

Staff showed encouraging, sensitive and supportive attitudes to people who used services, however not all staff recognised when family members or carers were struggling. For example, a patient’s spouse disclosed they were struggling with caring responsibilities, but the staff member did not immediately see this as an issue to be escalated.

The service and staff made sure that people’s privacy and dignity needs were understood and respected, including during physical or intimate care and examinations. We observed staff ensure patient’s privacy and dignity was respected.

For patients whose needs were of a more personal nature, staff were sensitive and delicate in the terminology they used. However, the outpatient podiatry room at Yate Health Centre opened straight into the reception area and there was no barrier or curtain preventing people seeing into the room when the door was open. Patients knocked on the door to alert the podiatrist to their presence as there were no reception staff in this area.

Staff responded in a compassionate, timely and appropriate way when people experienced physical pain, discomfort or emotional distress. Staff continually checked with patients if they had any pain whilst delivering care and treatment and adjusted the pressure they applied accordingly.

There were systems to ensure patients with specific needs were accommodated, such as vulnerable groups including patients with mental health needs or learning disabilities. The provider had a chaperone policy. We saw a copy of a clinic letter sent to patients in advance of their appointment which gave them the option to request a formal chaperone for any intimate examinations or procedures. The policy recognised the increased risk of lone workers such as community nurses, of actions being misconstrued or misrepresented. The policy stated it was applicable to all staff who undertook intimate examinations or procedures and/or provided personal care.

The service obtained patient feedback through the ‘friends and family’ test. From October 2024 to December 2024, 91% of patients who had replied would recommend the service to their family and friends. Seventy-eight percent of those who responded said staff went above and beyond their expectations. Since the inspection the provider had distributed 20 digital tablets across services to support real time data collection of patient experience.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

We did not look at Independence, choice and control during this assessment. The score for this quality statement is based on the previous rating for Caring.

The service listened to and understood people’s needs, views and wishes. Staff mostly responded to people’s needs and acted to minimise any discomfort, concern or distress.

Staff understood the impact that a person’s care, treatment or condition would have on their wellbeing but not always on those close to them. Some staff did not always recognise when family members or carers were in crisis and did not always escalate these concerns.

People were not always told when they needed to seek further help and advised what to do if their condition deteriorated. Most patients we spoke with were aware of emergency contact number which they could access for advice, alongside primary care services. However, one patient with a complex wound had not been advised of how to use the emergency number if their dressing came off or was loose. This could have potentially placed the patient at risk of infection.

All patient visits for the integrated teams which includes community nursing and therapy were risk assessed, and RAG rated based on the clinical needs of patients. Those rated as red needed to be visited on that day as they were high risk. Any outstanding red rated visits were discussed each day at the daily operational flow meetings and were able to be shared with teams that had more capacity. In the last 6 months only 1 red visit was missed, and this was reported on their incident reporting system and the missed visit was due to an error.

Patients were able to call the single point of access on the day if they needed a visit. These were risk assessed and given a priority of within 2 hours if urgent or non-2-hour response, and these would be seen within 48 hours.

Staff told us they informed patients when their visits were deferred due to demands on their service and were given details of the escalation process. However, not all patients were informed when visits were deferred or of the escalation process. Since the inspection the provider has rolled out a patient engagement platform which improved the ability to communicate with patients via text message. This provided an additional tool for teams to use to communicate with patients for example when a visit was being deferred.

We found that patients were given appropriate and timely support and information to cope emotionally with their condition. We observed emotional support being given to patients during home and clinic visits on many occasions. For example, when we accompanied 2 nurses on 4 wound care visits as part of the integrated network team, we saw they were supportive and offered a patient information about a variety of services they may be able to access that would help them engage in their local community and perhaps increase their independence.

We observed a community nurse escalate a patient’s condition to their GP and a senior nurse in the community. We saw they used a risk-based tool, ‘The National Early Warning Score, second version’ (NEWS2) which determines the degree of illness of a patient and prompts early intervention, to assess their condition and then report their concerns. The patient was kept up to date during the escalation process.

We saw evidence of supportive relationships between staff and patients with diagnoses of potentially life limiting illnesses. Patients told us that they felt they could ask staff anything and would get a clear answer.

Senior managers explained there was work underway to explore barriers which prevented patients from attending face to face appointments at clinic locations which would in turn reduce dependency on visits to their homes and free up resources to meet the demand on their services.

Some of the specialist services we saw operated in more than one location. This was in order that ambulant patients attending these services had less travelling to access them and encourage more patients to use these clinics.

The ‘Rapid Emergency Assessment Care Team’ (REACT) were based at 2 local NHS trusts, located in their emergency departments, where they assessed and reviewed older people on admission to see if they met the criteria for an early discharge pathway to help avoid admissions. We were told they had been doing this for 20 years and in the last year, they had assessed 2,236 patients. Some of these patients were not medically fit for discharge but they were able to assist with early discharges and if required, arrange support from other community teams.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.