East Cheshire NHS Trust

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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 abuse and avoidable harm. At our last assessment we rated this key question as requires improvement. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

Staffing was not a concern within the community services for children, young people and families, and staffing was sufficient to ensure care and treatment was delivered in times of reduced or increased patient capacity.

Staff were suitably trained and competent to administer medicines, with standard operating procedures (SOP) and auditing of medicine processes in place. Staff had access to support from the pharmacy department if needed.

Records were generally comprehensive, and staff collaborated with other teams in services for children, young people and families, and external services where additional support for patients had been identified. Staff had training to recognise abuse, and were confident in reporting safeguarding concerns, they worked well with the Trust’s internal safeguarding team, local authorities, and outside agencies.

Premises where patients received care were accessible and suitable to the needs of the patients.

Mandatory training compliance rates were above 90% for the core training modules and infection prevention control across all bands of staff, meaning staff had the required training for their roles.

Staff did not always complete and review risk assessments, so identified risks were not always managed or mitigated appropriately. When risk assessments and risk management plans were completed, there was an audit process in place to check documentation, but the audit process did not identify care plans and risk assessments were not fully completed or reviewed and updated, as necessary.

At Congleton War Memorial Hospital there was an ongoing programme of internal environmental improvement, with public and clinical areas being improved to provide a modern environment in which patients received safe care and treatment.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify good practice.

Staff we spoke with knew the process for reporting incidents and there was a drive within the service for staff to report all incidents.

Managers had a good oversight of incidents through the safety quality and standards meeting and lessons learned were shared with the teams and the wider service. This learning was shared with teams through regular team meetings, hand over meetings and newsletters.

Following serious incidents staff were supported, received debriefs and had access to a staff support scheme, should they require ongoing support.

We observed how staff discussed patients in handovers and multi-disciplinary team meetings (MDT), discussions were open, friendly, and supportive, and advice and learning was shared as group.

In the 12 months prior to our inspection (1 August 2024 until 31 July 2025), the service reported 5 adverse incidents, and these were managed through the Trust Patient Safety Incident Response Framework (PSIRF). Where appropriate incidents were escalated to Patient Safety Incident Investigations (PSII) and learning was identified. Otherwise, incidents covered a range of categories, none of which were serious.

Staff understood the duty of candour. They were open and transparent and gave patients, parents, and carers an explanation if and when things went wrong. These was evidence of lessons learnt following the outcome of investigations.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

We reviewed 9 care records. We found that records were not always comprehensive, with evidence of risk assessments not being completed through a holistic approach to assessments.

The records showed that staff identified where patients required additional support from other community and social care services. We observed a patient who had care and treatment from the complex care team, district nursing team and community occupational therapist. In addition, the patient could access the children and young people’s inpatient unit. A matron managed both the children and young people’s inpatient service and district nursing team, and had direct links to the paediatric community team, so close working relationships were established, and referrals could be made quickly and support received by families. In the complex care team, the auditing of patient’s care records could be improved by more regular reviews of the content of care plans to reflect patients’ form or style of communication when patients did not use words and used other methods of communication.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding adults’ levels 1 and 2 and safeguarding children level 3. Training compliance was above 90% across teams.

Staff were confident in recognising safeguarding concerns and knew how to make a safeguarding alert through the Trust’s internal process and the local authority’s process. Staff had close links with the Trust’s safeguarding team, who also provided support and training to teams. During handovers safeguarding was considered and discussed openly with the team. This ensured all staff were aware but also enabled staff to access support from the team.

Staff could give examples of when they had raised safeguarding concerns and were confident with identifying abuse. The specialist community children’s team staff have quarterly safeguarding supervision from the specialist nurse for safeguarding children to build confidence in making referrals.

Safeguarding level 3 training contained the Mental Capacity Act 2005 (MCA) and was not documented separately. Staff understood the MCA and completion of consent training which included the Deprivation of Liberty Safeguards (DoLS) was at 90% and above. The MCA training included Gillick competency, and the safeguarding specialist lead nurse offered advice and support on safeguarding referrals for children under 18 as in line with The Children Act. We saw that staff completed capacity assessments when appropriate and detailed these in patient care and treatment records. Training included working with autistic people and people with a learning disability.

We scored the service as 2. The service did not always work with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was potentially unsafe and not supported through up to date and detailed assessments.

When staff completed comprehensive risk assessments for patients these detailed how to reduce and mitigate risks to patients. However, risk assessments were not regularly reviewed, so identified risks were not always managed or mitigated appropriately. For example, in the complex care team we found sections on an emergency medicines plan for a patient were left blank, so could not determine if this information was relevant or not. Another plan for maintaining a safe environment had not been updated since October 2024, a plan for managing epilepsy had not been updated since 2022, and one patient had two care plans for enteral feeding, with different information in them. We saw copies of accessible care records in a pictorial format, but these were not routinely used.

Risk assessments included a pressure ulcer risk assessment, skin inspection and body map when these assessments were required.

Staff used recognised tools to assess the risk to people, such as the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) and the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) which were used to monitor patients for deterioration. Staff used the Hammersmith Infant Neurological Examination (HINE), which isa neurological assessment consisting of 34 items encompassed within 6 focus areas: posture and tone; tone patterns; reflexes; spontaneous movements; abnormal signs; and orientation and behaviour.

Where appropriate, staff assessed patients at risk of physical deterioration using the Paediatric Early Warning Score tool (PEWS), which enabled them to monitor and then escalate patients when required.

Records showed that staff obtained consent as part of the initial assessments for all patients.

Children and young people and their parents were able to give feedback on their care through surveys, and parents were confident to raise concerns directly with staff.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

All premises where patients received care were safe and suitable to meet the needs of patients and their families. The clinic rooms were accessible and there were appropriate adjustments in place such as lifts and double wide doors where required.

Safety checks for equipment were conducted centrally to ensure it was properly maintained and calibrated.

Specialist equipment was ordered through an external contractor. Staff told us that there were no issues with accessing the equipment as required. Staff told us that if equipment was ordered before 4pm, they could receive it the same day.

Staff were aware of personal safety protocols when working alone in the community and who to contact in the event of an incident.

We scored the service as 3. They made sure there were enough qualified, skilled, and experienced staff. They made sure staff received effective support, supervision, and development. They worked together well to provide safe care that met people’s individual needs.

Staffing was not raised as an issue during the inspection. Staff told us that caseloads were small in the community nursing team. In the complex care team referrals were received from tertiary centres or commissioners from the integrated care board and staff were recruited to an individual patient’s package of care. Staff supported patients and their parents at the patient’s home address.

Staff told us they had access to flexible working arrangements, and managers could give examples of how agile working and compressed hours were used to good effect without impacting on patient care. This ensured staff had a good work/life balance.

Staff received additional specialist training for their roles. For example, health care assistants in the complex care team received training in enteral feeding, which involved providing liquid nutrients into a tube which had already been inserted (by a clinician) into the gastrointestinal tract. Training included the use of suction equipment, syringe driver training and aseptic non-touch technique.

In the complex care team succession planning was in progress providing additional managerial opportunities and supervision to develop junior staff to lead on management processes.

Staff across the services completed mandatory training with most training above 90%, in the complex care team safeguarding children level 3 was 82% and 64% for completion of the Core Skills Training Framework. Training completion was being monitored by the moder matron who had oversight of the community services, with an action plan in place to address attendance for the Core Skills Training Framework.

We scored the service as 3. The service always assessed and managed the risk of infection. They promptly detected and controlled the risk of it spreading.

We observed staff in clinics and during home visits practice good infection control procedures, and where appropriate used personal protective equipment (PPE) such as gloves and aprons. Staff received infection prevention control (IPC) training level 1 and 2 as part of their mandatory training. Overall completion rates for IPC level 2 training were 90% and above.

The clinical areas were suitable to ensure infection prevention and control was maintained. We observed staff in community nursing, the complex care team and audiology washing their hands and using personal protective equipment when providing care and treatment. After treatment, staff were observed disposing of single use equipment, cleaning working surface areas and in one observation toys used by a child during an assessment.

The complex care team audit staff following infection control procedures while working in patients’ homes to ensure that staff maintained appropriate standards of cleanliness and infection control.

Clinic rooms were kept clean and had suitable furnishings. There were examination couches and appropriate equipment in clinic rooms, which we observed staff clean between appointments. Staff had access to disposable gloves, aprons, masks, and sanitising liquid gel.

We scored the service as 2. The evidence showed improvement was needed. The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines were prescribed through GPs or consultant specialists from tertiary centres, and staff linked in with GPs where necessary. For example, shared care agreements were in place for GPs to prescribe medicines for long term conditions.

Staff in the complex care team received training in medicines management and the Trust provided us with the knowledge pack. We saw 3 training records where staff were signed off as competent to administer medicines. This included the epilepsy nurse specialist providing training on buccal administration, which involved placing a medicine between the gums and cheek, so it was absorbed quickly in the event of a seizure. We saw examples of paper medicine administration records completed for the administration of medicines in patients’ homes and collected for audit purposes. In addition, we looked at the complex care team agreement with parents for the administration of medicines in patients’ homes. The agreement recorded simple analgesia, for example paracetamol and ibuprofen must be documented on a Medication Administration Record (MAR) sheet.It was the parent’s responsibility to provide a MAR sheet and keep it updated, and carers would not administer medications if the MAR sheet was not in date or correct.We were told about an incident that had been noted during a local audit, when a staff at the request of a parent administered prescribed eye drops to a patient, which was not was recorded on the MAR sheet. This was incident reported immediately. The senior nurses clarified this should have been reported by the staff member. Medicines audits were completed locally and did not include patient’s homes.

We observed staff discussing with patients if they had allergies to personal protective equipment (PPE) or other products used for infection control. For example, in clinics we observed staff asking patients if they had a latex allergy at the beginning of appointments.

Staff were confident regarding the oversight of checking and replacing anaphylaxis kits. Staff advised that they were responsible for requesting replacements when the kit reached its expiry date. We saw a tracking report that detailed each pack and the staff member it had been signed out by. All anaphylaxis kits were in date.

We observed staff checking patient referral histories prior to an audiology assessment, and during a community paediatric assessment and community nursing home visit. Staff checked if there had been any changes in prescribed medicines, for example increases in medicines dosages. In the complex care team staff were not allowed to prescribe any new medicines until the clinical lead had confirmed if staff required additional competencies or training to administer it. Parents told us they participated in decisions about children and young people’s care, and treatment and staff discussed options available to them, and their risks and benefits.

In the community diabetes service, we observed patients’ appointments with the consultant doctor, dietician, and diabetes nurse. Patients’ medicines were discussed with them in respect of managing their diabetes, discussing potential side effects, review of the medicine’s effectiveness, infection prevention and control, and diets. Patients and parents were able to ask questions about medicines and the impact on their lifestyle choices and were given advice on health promotion.

Staff told us they had support from the pharmacy department when needed and were competent to administer medicines within the areas they worked. Health care assistants in the complex care team completed training on medicines administration, including the administration of eye drops or topical creams. Training included a competency framework, and observed practice of medicines administration, before staff were signed off as competent. If additional training was required due to the type of medicine being administered, this was sourced from the manufacturing organisation’s specialist nurses. Staff supervision included medicines administration and records were kept at the team office. Staff training on medicines administration was 100% at the time of the inspection.