Derbyshire Community Health Services NHS Foundation Trust

On this page

• 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

We looked for evidence that patients were protected from abuse and avoidable harm.
At our last assessment, we rated this key question as good. At this assessment, the rating has remained good.
 

This service scored 75 (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 had a proactive and 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 and embed good practice.
Leaders promoted a strong learning culture where staff felt encouraged and supported to raise concerns. Managers encouraged openness, and staff described a culture where safety was a priority. Staff consistently completed reports for incidents, near misses, or anything they considered a concern. Leaders reviewed them and provided feedback to staff. Learning focused on improvement rather than blame. Multidisciplinary teams discussed incidents and shared learning to improve safety.
Leaders held regular meetings to discuss concerns, share learning, and review feedback, including information received from the acute hospital to identify any common themes. The main themes identified included falls, inappropriate admissions related to mental health needs, and medication errors. For example, learning for medication errors highlighted that medication prescribed for Parkinson’s disease were not given at the correct time. Therefore, one ward used alarms to alert them that the needed to administer the medication. This decreased the risk of errors and enhanced patient care. Where incidents affected staff confidence, supervisors provided targeted support sessions, which improved practice and confidence. The team reviewed incidents, for example falls, in line the trust’s policies and ensured appropriate documentation, and completed follow-up actions.
Patients felt supported to raise concerns and were treated with compassion and understanding. Patients felt the staff took their concerns seriously and made proactive improvements.

Staff worked with patients and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when patients moved between services.
A newly developed care transfer hub strengthened joint working with acute hospitals. The hub operated using a multidisciplinary approach and focused on working collaboratively with social care to ensure patients were transferred to the most appropriate setting to meet their needs. Since its introduction, the quality of referrals had improved.
Discharge coordinators played a key role in supporting safe transitions. They maintained strong relationships with patients, their relatives and the multidisciplinary teams and ensured all options were considered to meet individual needs. They demonstrated good knowledge of available services, including voluntary and non-NHS support.
Staff held daily huddles, handovers between shifts, and weekly multidisciplinary team meetings, which helped ensure continuity of care and timely information sharing. One staff member said, "We work with different teams right at the start of admission through to discharge. This ensures our patients are cared for and supported on the ward and also enables us to have the correct support in place for when patients are discharged."

Staff worked with patients and healthcare partners to understand what being safe meant to them and how this could be achieved. The service focused on improving people’s lives while protecting their right to live safely, free from abuse, discrimination, bullying, harassment, neglect, and avoidable harm. Patients told us they felt safe. One patient said, “I do feel safe here, I would talk to staff if I felt worried.” Staff shared safeguarding concerns promptly and appropriately with relevant partners.
Safeguarding policies were in place and well understood by staff. Staff completed mandatory safeguarding training and demonstrated good knowledge and understanding of safeguarding procedures. Where some staff experienced delays accessing The Oliver McGowan Mandatory Training on Learning Disability and Autism due to training availability, leaders actively addressed this to ensure compliance.
Staff and leaders recorded, investigated, and reported safeguarding concerns in line with local and organisational policies and worked in partnership with other organisations to respond to concerns involving vulnerable people.

Staff worked with patients to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive, and enabled patients to do the things that mattered to them. One staff member told us, “We always assess peoples risks with them, and their families when they are admitted. We formulate care plans to reflect any risks, and complete actions to keep the patient as safe as we can.”
Staff were confident and thorough when admitting new patients. All staff contributed important information for risk assessments, for example weight checks and skin integrity. When patients had cognitive impairments or additional communication needs, staff adapted their communication to ensure understanding and aimed to obtain verbal consent wherever possible.
Risks were assessed, and both patients and staff understood them. The service maintained a balanced and proportionate approach to risk, supporting patients’ choices about their care. Risk assessments were completed and reviewed regularly, although at times records in the electronic system were spread across multiple sections, making them less straightforward to access. Following our feedback, the provider was willing to make the improvements.
Staff managed people’s communication of needs, emotions, or distress in a positive way that protected rights and dignity and maximised learning about the causes of distress.
Emergency equipment was available and maintained. Staff recognised when patients were deteriorating and knew of action to take. Patients were advised on risks related to their condition and actions to take if their condition worsened. The service worked closely with patients to understand and manage risks through a holistic approach. Care was provided in a way that was safe, supportive, and enabled patients to do what mattered most to them.
 

Staff identified and responded to potential risks in the care environment to ensure that patients were cared for in safe environments designed to meet their needs. They made sure equipment, facilities and technology supported the delivery of safe care. Equipment used to deliver care and treatment was suitable for its intended purpose, stored securely, and used correctly.
Facilities, equipment, and technology were well-maintained and consistently supported staff to deliver safe and effective care. Staff ensured they had effective arrangements to monitor the safety and upkeep of the premises. Health and safety risk assessments and audits were completed regularly, and identified risks were addressed promptly. Contracts were in place to maintain the premises, and a business continuity plan was monitored and reviewed to ensure ongoing preparedness.
Leaders and staff considered both physical and psychological safety, including sexual safety and patients’ sensory needs, ensuring the environment supported overall wellbeing.

Leaders made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development. They employed a range of clinical and non-clinical roles. Staff worked within their agreed areas of competence, and the service followed safe recruitment practices. Patients told us there were sufficient staff numbers. One patient said, “It seems so well staffed and there’s always someone with time for you.” Staff worked together well to provide safe care that met people’s individual needs.
Leaders maintained appropriate staffing levels and skill mix, ensuring patients consistently received safe, high-quality care. The majority of staff and patients confirmed that staffing ratios met the patient’s needs. During the inspection, we saw that staff levels were sufficient to provide care safely. Leaders used tools to monitor staffing, adjust skill mix as required, and promptly address any gaps. One staff member said, "We are very rarely short staffed, and we have a good mix of skills that complement each other's practice. We work very hard to make sure everyone is safe, looked after and well cared for.”
Staff training compliance was good. Leaders managed learning needs and professional development appropriately. Leaders ensured that supervision and appraisals were mostly up to date. Supervision provided staff with regular one-to-one support, guidance, and reflection on their practice, while appraisals reviewed performance, set goals, and identified development opportunities.The trust implemented contingency plans to cover staff shortages, primarily deploying bank staff who were familiar with patients, which maintained continuity and safety of care.

Staff assessed and managed the risk of infection. They identified and controlled the risk of it spreading and shared concerns with appropriate agencies promptly and adhering with national guidance,
Staff completed relevant IPC training. Each ward had a designated infection prevention and control (IPC) lead. Staff had access to up-to-date IPC policies, which they followed consistently. Cleaning schedules were in place and carried out regularly. Leaders completed risk assessments and audits and acted on findings to mitigate any risks. External IPC teams visited regularly to provide additional oversight and support.
Patients were protected as much as possible because premises and equipment were kept clean, hygienic, and well-maintained. Staff, patients, and visitors understood their roles and responsibilities for IPC, and the service shared information appropriately with relevant partners. One staff member said, “All staff and housekeeping continually check the environment, if any issues are identified we report it to the estates department and they come to the ward to address these."
Throughout our inspection, patients and staff described the environment as clean and hygienic, which aligned with our observations. However, on Butterley Ward, inspectors found that a fridge used for staff food was not functioning correctly, with temperatures recorded above the recommended range for several days. This posed a potential risk for the safe storage of food, and staff had not reported or escalated the issue. The matter was promptly addressed following our feedback, and appropriate actions were taken to restore safe storage conditions.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Medicines were prescribed, supplied, and administered in line with legislation, current national guidance, and the Mental Capacity Act 2005. Accurate, up-to-date information about people’s medicines was available, particularly when transferring between services or levels of care.
Patients were actively engaged in decisions about their medicines, and assessments and reviews addressed the level of support required to manage medicines safely. Their preferences were clearly documented in care plans. One relative said, “They printed me off a list of what he’s on now, to explain - so I can check against what he had at home too. That’s exceptional service.”
People’s behaviour was not inappropriately controlled by medicines, and there were appropriate arrangements for the safe management, use, and oversight of controlled drugs.
Staff’s approach to medicines reflected current best practice and professional guidance, and patients were actively involved in all relevant decisions. Staff received regular training in medicines optimisation, were competency-assessed, and felt confident in managing the storage, administration, and recording of medicines. Medicines, including controlled drugs, were stored securely and appropriately. Staff regularly checked stock levels and expiry dates for all medicines, including emergency medicines, and disposed of waste medicines appropriately.
Medical gases, such as oxygen, were stored safely, and required risk assessments were completed. Effective systems were in place to manage and respond to safety alerts and medicine recalls.