Overall rating for this core service Good
Overall we judged community health services for adults were good.
Incidents were reported across teams, learning was identified and shared at regular meetings. The incident reporting and safeguarding policies were understood by staff and regularly used. Sufficient equipment was available and was used safely. The service had infection prevention and control policies and staff were seen to observe good practice. The service had a lone working policy in place and staff were aware of and used procedures to reduce risks when working alone. The service regularly undertook a range of audits to improve performance and support safety.
Community services had carried out a number of recent patient satisfaction surveys, with results showing a positive overall satisfaction rating of 90%. Several examples of new and emerging innovative practice were observed.
Staff and managers understood their roles and responsibilities in the delivery of evidence-based care.
A recognised assessment tool was used to identify deteriorating patients and nutrition and hydration assessments were completed. Staff appeared very competent in their contact with and treatment of patients. Multi-disciplinary working within the trust and joint arrangements with external organisations worked well. Community nursing teams worked closely with GP practices, nursing homes and with social services.
Patients and their relatives were treated with dignity, respect and compassion. Staff respected confidentiality in discussions with patients and their relatives and in their management of written records and other communications. Staff demonstrated good communication skills and were aware of the emotional aspects of care. Advice about self- care was provided when appropriate and we found some outstanding practice in this respect. Patients we spoke with were very positive about the care and treatment they received and about the members of staff with whom they had had contact.
Action to be undertaken following the investigation of a complaint was identified, the action proposed was discussed with the patient and the completion of actions was monitored. Staff could describe how services had changed as a result of action taken.
The service responded to identified risks and maintained a risk register. The service managed foreseeable risks and planned for changes in demand due to seasonal fluctuations and severe weather. The service had contingency plans in place to respond to major incidents.
Staffing levels were sufficient in most areas. In some community locations staffing levels including cover arrangements required review to ensure adequate staffing arrangements for community nursing teams so that patients were not placed at risk.
Patients could access community health services promptly when they needed to and services were provided with ease of access for patients in mind.
Completion of mandatory training stood at over 95% overall for community services for adults staff.
Staff felt there was clear leadership at executive level and the executive team were approachable. Regular open meetings were held for staff to meet with trust executives and these were well attended. Local leadership was effective and staff said their direct line managers were supportive and encouraging. Managers and staff told us they felt there was a clear vision for the community services and a strategy of improvement and development of service delivery.
Before our inspection we held two listening events to allow members of the public to tell us about their experiences of using this service. During our inspection we spoke to 24 patients, eight patients’ relatives, 76 nurses, 12 healthcare assistants, three student nurses, 24 therapists, two doctors, two pharmacists and three ancillary staff. We also looked at 28 sets of patient records.