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Provider: Cambridgeshire Community Services NHS Trust Outstanding

Reports


Inspection carried out on 30 Apr to 5 Jun 2019

During a routine inspection

Our rating of the trust improved. We rated it as outstanding because:

  • We rated safe, effective, responsive and well led as good. We rated caring and well-led at trust wide level as outstanding.
  • We rated safe in community services for children and young people as requires improvement.
  • We rated two of the core services we inspected as good overall and one as outstanding.
  • During this inspection, we did not inspect community dental services or community adult services. The ratings published following our previous inspection form part of the overall rating awarded to this trust following this inspection.
  • The aggregated rating for well-led at core service level was good. However, we rated well led at trust wide level, which is a separate rating as outstanding.


CQC inspections of services

Service reports published 30 August 2019
Inspection carried out on 30 Apr to 5 Jun 2019 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30 Apr to 5 Jun 2019 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30 Apr to 5 Jun 2019 During an inspection of Community health sexual health services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 30 August 2019
Service reports published 20 June 2018
Inspection carried out on 27 March 2018 During an inspection of Community dental services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 27 March 2018 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 7 July 2015
Inspection carried out on 18 June 2015 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Service reports published 14 April 2015
Inspection carried out on 24 February 2014 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 27 March 2018

During a routine inspection

  • We rated safe, effective, caring, responsive and well led at core service level as good. In rating the trust, we also considered the current ratings of the other services we did not inspect. Our decision on overall ratings consider, for example, the relative size of services and we use our professional judgement to reach a fair and balanced rating. We rated well led for the trust overall as good.
  • Community health services for adults remained good overall. Safe improved from requires improvement to good. Effective, caring, responsive and well led remained good. We found areas of improvement in relation to staff attendance at mandatory training. Staffing levels had improved and despite some vacancies remaining, managers proactively ensured there were sufficient staff on duty. The disposal of clinical waste in patients own homes however was not in line with the trust’s policy.
  • Community dental services remained good overall. Safe, effective, responsive and well led remained good. Caring improved from good to outstanding. The service had taken steps to mitigate any further risks associated with the reported never events. We saw numerous examples where dental staff demonstrated compassion and delivered patient centred care. The service considered the needs of patients and delivered a service that met the needs of the community. Complaints were fully investigated, and responded to in a timely manner.

Inspection carried out on 27 May - 7 June 2014

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.

We found that the provider was performing at a level which led to a judgement of Good.

We were pleased to find many areas of very good practice across all core service areas. Staff took an active role in delivering and promoting safety, learning and improvement. There was a clear picture of safety across most services. However in isolated areas there were inadequate infection prevention and control procedures and medicines management. Staffing establishments were actively reviewed but were not sufficient in all areas. Some staff teams were stretched and unable to meet people’s needs in a timely way. The provider had in place strategies to manage risks and improve recruitment.

Care and treatment were effectively meeting the needs of patients, families and carers through evidence based practice, guidance and care pathways. There was very good multi-disciplinary working and initiatives to support people at home and avoid admission to hospital. Staff demonstrated a good understanding of the social and economic factors and cultural diversity of their local communities so that sensitive and respectful care could be provided. Staff monitored outcomes using a range of audits, assessments and feedback mechanisms.

Overall, staff were appropriately qualified and competent to carry out their roles safely and effectively in line with best practice. However, in some areas of rehabilitation staff did not have appropriate training and levels of staff attendance at mandatory training and appraisals were below the Trust’s targets.

People using the services were treated with compassion, dignity and respect. People were consistently positive about their experiences of receiving care. We noted that there were mutually respectful working relationships between different professional groups.  Patients were involved in planning their care and were supported to manage their own health and care when they could and to maintain their independence. There were systems in place within all teams for learning from experiences, concerns and complaints.

People were able to access care and treatment close to home in local community hospitals, clinics and treatment centres. District and community nursing services were flexible and worked across professional and organisational boundaries. The Trust ran a number of successful projects, including with other providers, which helped prevent hospital admissions. Trust staff generally had good working relationships with partner organisations, such as social services and the voluntary sector.

The Trust had a clear statement of vision and values. Staff were not consistently aware of these although the organisational values were widely demonstrated by staff across the Trust. The Trust had a two year operational plan for 2014-16 that set out intentions for quality, recruitment, finance and sustainability. Overall we found staff groups were aware of the current transformation programmes. Staff reported an open culture at the trust which gave them confidence to report concerns. Most but not all staff we spoke with felt they were consulted about changes to services and were able to contribute to service developments.

There was an effective governance system and the Trust used a range of tools to monitor quality and risk. In most clinical teams, senior staff showed a good awareness and understanding of governance arrangements, and they maintained local performance data, risk registers and audits. Most but not all teams were benchmarking themselves against other service areas in the Trust. In North Cambridgeshire Hospital, there was a lack of oversight of the mortuary and the Trust could not provide evidence that risks had been managed, or the quality of the service monitored. We raised these concerns at the time of the inspection and the Trust took immediate action to close the mortuary and put in place alternative arrangements for the care of deceased patients.

There was good clinical leadership throughout all units, and a visible, strong leadership at Board level. Work was ongoing to clarify and strengthen the Trust’s strategic direction and governance structures to ensure the safe transfer in and out of services as a result of procurements which will take effect later in 2014 and early 2015.

We reviewed the Trust’s outstanding non-compliance with the essential standards of quality and safety. We found the Trust was now compliant with Regulation 22, Staffing, at Hinchingbrooke Hospital and with Regulation 10, Assessing and monitoring the quality of service provision at Head Quarters. We also found the Trust was making progress with addressing shortfalls of staffing in the community nursing services.

As a result of the concerns identified during this inspection, we judged the provider was not meeting Regulation 10, Assessing and monitoring the quality of service provision in End of Life Care, and Regulation 13, Medicines management on Inpatient wards. These findings are detailed in the core service reports. We have asked the provider to send us a report that tells us what actions they are taking to meet these essential standards.

Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance