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

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.


Inspection carried out on 16-18 November 2016, 27 & 28 November 2016, 30 November 2016 and 1 December 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.

Letter from the Chief Inspector of Hospitals

Bristol Community Health C.I.C. was inspected with planned and announced visits over 16-18 November 2016. We visited many community teams, locations, patients’ homes, schools, and clinics during this time. We went back to a number of locations and teams for unannounced visits on Sunday 27 November (the urgent care centre), 28 and 30 November and 1 December 2016.

This inspection was a comprehensive look at all services provided by Bristol Community Health C.I.C., with the exception of its prison healthcare service, which is inspected by a specialist CQC team alongside Her Majesty’s Inspectorate of Prisons. The core services we inspected were:

  • Community health services for adults
  • Community health services for children, young people and families
  • Community mental health services for people with learning disabilities or autism
  • Urgent care services

Among the sites we visited where services are provided were: New Friends Hall in Stapleton, Bristol and The Withywood Centre in Withywood Bristol. This was to meet people and staff in the community learning disabilities service. We visited the urgent care centre in Whitchurch, Bristol. We visited health centres in Bristol, Eastgate Centre Clinic, Osprey Court, local schools, and children’s centres to inspect services for children, young people and families. To inspect the community adults’ services, we went to a range of health centres, went out with community nursing teams to patients’ homes, visited Knowle Clinic, an intermediate care centre, and Southmead Hhospital. We met with the palliative home care team and went on visits with them to meet their patients and families they were supporting. In addition, we went on visits with the ‘fast track’ team, who arrange care and support for patients being discharged home from hospital at the end of their life.

All staff throughout Bristol Community Health were cooperative, helpful and supportive to us at all stages of the inspection.

Our key findings were as follows:

  • We rated services for their safety as good overall, although some improvements were needed to children and young people’s services, which were working under a temporary contract managed in conjunction with three other health providers. The contract had now been awarded to the three organisations from April 2017 for the next five years, and work to integrate children and young people’s services was commencing. However, this had not affected the quality of care provided by the children and young people’s services. Patients were protected from abuse and harm.
  • We rated services for their effectiveness as good overall, although there were some areas in the children and young people’s services that needed improvement. This included issues arising from problems with the computer systems, the availability of patients’ records, and the lack of an effective audit programme. However, patients were receiving good outcomes from their care and treatment. Quality of life was promoted, and care and treatment based upon the best available evidence.
  • We rated services for caring as good overall, with outstanding care in the urgent care centre. Patients, their carers, parents and anyone who encountered Bristol Community Health staff were treated with compassion, kindness, dignity and respect.
  • We rated all services for their responsiveness as good. Services were planned, organised and delivered to meet people’s needs. The organisation supported people in vulnerable circumstances. It listened to people’s concerns and improved when it recognised something had gone wrong or could be done better. However, there was a variable performance when endeavouring to provide care to people at the right time. Some services were doing well, but others were struggling with the impact of rising demand and shortages of staff.
  • We rated services for the leadership and governance as good overall, although work was needed to integrate and improve the systems and use of information in the children and young people’s services. Bristol Community Health was an organisation with a strong culture. Staff were open, honest, and wanting to deliver high-quality person-centred care. The organisation supported learning, innovation and improvement.

We saw several areas of outstanding practice including:

  • There was an outstanding, dedicated and committed approach to engaging with people who were patients of Bristol Community Health, their families, their carers, volunteers, and the wider community. The Patient and Public Empowerment programme, underpinned by the patient charter, put patients at the centre of decisions, valued their feedback and input, and made changes and improvements from listening to and engaging with people.
  • The chief executive and her leadership team had an outstanding commitment to staff. The organisation had been established as an employee-owned social enterprise. It recognised staff for effort and achievement through a number of different schemes, including award ceremonies and personalised contact.

  • The organisation’s approach to shared decision-making and inclusion of the patient was well embedded within their culture. We observed this in practice and in records.
  • Specialist services were provided by Bristol Community Health to meet the needs of people. These services were flexible and innovative to make improvements. They enabled services to deliver care and treatment, which was accessible to the local population, with no discrimination. For example, through the migrant health services and the Macmillan rehabilitation support service.
  • The Haven service recognised the additional support required for staff who were often dealing with difficult, challenging and upsetting situations. Weekly access to a psychologist was made available for staff.
  • In children's services, staff respected and recognised each child as an individual. We observed outstanding caring from staff who were singing a song to each individual child and addressing them using their name when they entered the room for their therapy session. These children had profound needs, and we recognised how their faces lit up when they came into the session and had their special song.
  • Families and carers of children and young people provided consistent positive feedback about the service. One parent told us “staff are so supportive and helpful,” “staff are always there when you need them,” while another told us “staff are really friendly, helpful and always welcoming.” Another mother told us '”the service is brilliant, couldn't have asked for a better one.”
  • In adult services, we observed outstanding multidisciplinary team working both across the organisation and with other healthcare providers. In particular, staff worked hard to make sure all involved in a patient’s end of life care were up to date with the situation, and their visits were all coordinated.
  • There was an outstanding response to people who were coming to the end of their life. The palliative home care team made sure their service worked to meet the needs of the patient and those they were close to.
  • The visibility of, and support provided by the safeguarding team had increased the quantity and quality of safeguarding referrals across the whole organisation.
  • The multidisciplinary working undertaken by the rapid response team was helping to speed up patient discharges and prevent hospital re-admissions.
  • The organisation had effective processes to review staff teams and identify areas of risk to provide active support. These were known as ‘hot teams’. This allowed issues and risks to be identified early, and plans to be made to help support these teams.
  • In the urgent care service, we heard of numerous examples where staff had gone the extra mile to support patients and those close to them.
  • The urgent care staff had developed a comprehensive support network and a range of referral pathways for adults and children in primary, secondary and community health care settings.
  • The urgent care service had engaged the support of the lead emergency consultant at the local children’s hospital to facilitate joint working, and education.

However, there were also areas of poor practice where the provider needs to make improvements.

Importantly, the provider MUST:

  • Take action to ensure all staff in the children and young people's service receive the appropriate level of safeguarding training for their role.
  • Ensure a complete set of records are transferred with the child from the health visiting team to the school nursing team in line with Royal College of Nursing guidelines.
  • Take action to ensure the health visiting team maintains an individual set of records for each child, which are filed under the individual child’s surname.
  • Ensure staff in the children and young people's service comply with safe systems to ensure that toys are cleaned in line with the Cleaning and Decontamination of Toys’ policy and ensure there is a system to monitor compliance around toy cleaning. We also observed poor compliance with hand washing and cleaning of equipment between use after each child.
  • Ensure compliance with staff mandatory training and appraisal in the children and young people's service.
  • Ensure there are standard operating procedures for the transition of all children into adult services.
  • Take action in the children and young people’s service to ensure there is a systematic process of audit to monitor service quality and performance, for example records audits, and auditing the single point of access system.

Professor Sir Mike Richards

Chief Inspector of Hospitals

CQC inspections of services

Service reports published 16 February 2017
Inspection carried out on 15, 16, 17, 18, 28 November and 1 December 2016 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 15 to 18 and 30 November 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 16/17 and 27 November 2016 During an inspection of Reference: Urgent care services not found Download report PDF (opens in a new tab)
Inspection carried out on 16 and 17 November 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
See more service reports published 16 February 2017