30 December 2022
We did not change ratings at trust level at this inspection.
CQC temporarily suspended all routine inspections on 16 March 2020 to support and reduce the pressure on health and social care services during the COVID-19 pandemic. CQC, as well as providers, want to be able to prioritise keeping people safe during this time. This inspection was already underway at the time of the suspension and therefore couldn’t be completed in the usual way.
This report includes the findings from the completed service level inspection of the trust’s community health services for children and young people, but the well-led inspection was not completed. CQC is only able to update findings on well-led at the overall trust level or update the other trust-level ratings when we have inspected the well-led component. As a result, the ratings for the overall trust and five key questions included in this report are from a previous inspection.
We completed an inspection of the trust’s community health services for children and young people, which we rated as good overall. For more information on our findings from this inspection, please see the community health services for children and young people section.
30 December 2022
Central London Community Healthcare (CLCH) NHS Trust provides community health services across London and Hertfordshire.
This inspection focused on community health services for adults provided by the trust in the London borough of Harrow. This was a focused inspection reviewing one key question: is the service safe?
We completed this inspection to review how the trust had implemented improvements following an incident in 2021 in which a member of staff did not follow the correct procedures. Following the incident, the trust implemented a Quality Action Team to drive improvement in the Harrow community nursing team. There was a primary focus on the community nursing teams during this inspection however we did also visit tissue viability, podiatry and rapid response services.
Community services for adults covers services provided to adults in their homes or in community based settings. This includes planned care, ongoing and intensive management of long-term conditions, coordination and management of care for people with multiple or complex needs, acute care delivered in people’s homes, and health promotion.
We last inspected the trust’s community health services for adults in September 2017. At this inspection, we rated the core service as good overall, with safe, effective, caring and responsive rated as good and well-led rated as outstanding.
Our inspection was conducted by short announcement (with 48 working hours’ notice) to enable us to observe routine activity and to ensure that everyone we needed to talk to was available. Before the inspection visit, we reviewed information that we held about these services and information requested from the trust.
As part of the inspection we visited:
- Honeypot Lane Health Centre
- Alexandra Avenue Health and Social Care Centre
Our rating for the community health services for adults did not change and remained as good overall.
Our rating of Safe went down. We rated it as requires improvement because:
- The community nursing service did not have enough nursing staff. All the locality teams had high vacancies. The trust was trying to recruit new staff and had ensured few visits were deferred, but staff and managers told us that vacancies placed them under pressure and were impacting their ability to complete all tasks.
- Staff did not always complete records with enough detail and some handover meetings were brief and lacking in detail. This meant staff did not always have access to all the key information to keep patients safe.
- There was a lack of leadership oversight for the localities. Audits and supervised visits were not occurring regularly, which meant leaders did not have sufficient oversight of the skills and issues within the teams. The trust had identified the need to increase oversight and was recruiting six new band seven team lead roles. Three of whom were already in post.
- Staff were not consistently documenting capacity decisions.
- We identified one incident where a referral was not made to the local authority when other people using the service could have been at risk of neglect.
- The service provided mandatory training in key skills to all staff and made sure everyone completed it.
- Staff understood how to protect patients from abuse. Staff had training on how to recognise and report abuse.
- The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. Staff kept equipment and their work area visibly clean.
- The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well. When providing care in patients’ homes staff took precautions and actions to protect themselves and patients.
- The service used systems and processes to safely prescribe, administer, record and store medicines.
- The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. 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. Managers ensured that actions from patient safety alerts were implemented and monitored.
15 June 2020
Our rating of this service stayed the same. We rated the service as GOOD because:
- Since our last inspection in 2017, compliance with mandatory training and staff appraisal had improved. All team managers routinely monitored training and appraisal compliance.
- The service ensured staff understood how to protect children, young people and their families from abuse.
- Risks to children and young people using the service were assessed and their safety was managed so they were protected from avoidable harm.
- The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve the service.
- Managers monitored the effectiveness of the service. The service planned care to meet the needs of the local population and when there was a gap in service provision managers escalated this appropriately.
- When families were waiting for treatment, most services ensured they kept in contact and invited children, young people and their families to group sessions.
- Staff provided a good standard of care and treatment. Staff were hardworking and ensured they consistently gave compassionate care to children, young people and their families. They took account of a child or young person’s individual needs and helped them understand their condition.
- Leaders ran services well using reliable information systems and supported staff to develop their skills.
- Staff understood the service’s vision and values and were focused on the needs of children and young people receiving care.
- Staff were committed to improving services and worked on new initiatives to improve their service.
- The Brent health visiting team did not have enough staff to deliver care safely. High vacancy rates and large caseload sizes meant they were not completing important baby and child reviews mandated in the Healthy Child Programme (HCP). At the time of the inspection, the team had 69 families awaiting allocation to a health visitor. The team was not monitoring these families. The lack of monitoring and oversight of children, young people and their families put them at risk.
- Staff did not always complete or review treatment records in a timely manner with important information. Information such as allergy status was not always recorded clearly, and some children and young people did not have an up to date care plan in place. This put children and young people at risk of not receiving the right treatment at the right time. Whilst the trust was providing new technology to enable staff to complete records during visits, this was not yet delivering consistent improvements.
- Lone working processes were not robust and did not ensure that staff whereabouts were monitored whilst out in the community. Staff told us that they did not always wear their personal safety alarms. This put staff at risk of being unable to escalate a concern when working alone.
20 August 2015
Overall rating for this core service
We rated community dental services at this trust as good. Processes and procedures were in place to monitor safe systems within the clinics and in areas such as radiography, cleanliness, decontamination, medicines and safeguarding . Incidents were appropriately reported, staff were aware of how to report incidents and there was learning from incidents. Medications were appropriately stored. The environment and equipment were clean and well maintained. Infection control procedures were in place. Staff had been appropriately trained and there were sufficient staff to meet the needs of the service.
The service used National Institute of Health and Care Excellence (NICE) and best practice guidelines to support the care and treatment provided for patients. Treatment plans were produced for each patient taking into account their personal needs and consent gained for all aspects of the treatment provided from the patient and/or their parent/ appropriate person. Clinical audits were undertaken regularly to monitor and improve performance. Staff were appropriately trained for their jobs and professional development was actively supported and encouraged. Multi-disciplinary working was evident in the co-ordination of patient care.
Patients told us they were treated with dignity and respect when accessing and receiving treatment. Patients and their representatives spoke highly of the care provided and that care was delivered by staff who were compassionate and understanding of their needs. There was good collaborative working between the service and other healthcare services to ensure good patient outcomes.
The service was able to meet the needs of specific groups of the community who cannot access the dental care they need elsewhere and staff were very aware of this. Access to treatment was generally satisfactory. Patient feedback surveys and complaints processes were in place to gather information to maintain and improve the service. There was good collaborative working between the service and other healthcare services to improve the quality of care for patients.
Initiatives had been established to improve the service and use the resources effectively. Staff we spoke with felt supported in their roles and that their managers were approachable and accessible
5 February 2018
Our rating of this service stayed the same. We rated it as good because:
- Our concerns regarding staffing and high turnover were addressed and managers explained the situation well. The trust was actively recruiting for staff and had managed to fill most vacancies.
- All patients we spoke with spoke positively in regards to cleanliness and hygiene. The trust scored a high PLACE score in this category also.
- The service had close multidisciplinary team working. There were daily MDT handovers and formal weekly MDT meetings. The service used a MDT progress sheets to record actions and tasks for all relevant professions.
- Patients were involved in their own rehabilitation, goal setting and discharge planning from their admission to the wards. Discharge dates were set and agreed as a goal and individual needs and rates of recovery were considered at multidisciplinary meetings.
- On all the units we visited, we saw staff were caring and compassionate towards patients. Staff treated patients with kindness, dignity and respect. We found that staff were sensitive to the needs of the patients and their families.
- The service took account of patients’ individual needs, such as those living with dementia, patients that had non-English language requirements, cultural and religious beliefs.
- The shared governance system used an innovative approach to allow junior staff members and patients to actively engage with the trust’s governance procedures.
- The service used safety monitoring results well. Staff collected safety information and shared it with staff, patients and visitors. The service used information to improve the service.
- The service was very proactive in the use of risk assessments, all patients were routinely assessed by nurses and therapy staff. The use of assessments was actively monitored.
- The service prescribed, gave, recorded and stored medicines well. Patients received the right medication at the right dose at the right time.
- Staff we spoke with were aware of how to report incidents and the trust had a robust system of incident investigation and learning.
- We found that individual patients’ pain was assessed and managed appropriately, however we found that pain scores were not always regularly completed.
- The service used the malnutrition universal screening tool. Patients were screened on admission for malnourishment and the dietician assessed all patients whose nutritional needs were highlighted.
- Inappropriate referrals form the acute setting were minimised by the employment of tracker nurses who screened and triaged all referrals.
- We observed that staff provided emotional support to patients when they displayed anxiety during rehabilitation activities.
- The majority of patients we spoke with confirmed that their care plans had been explained to them and they understood and agreed with the content.
- Patients had access to support from a psychiatrist if needed.
- The service planned and provided services in a way that met the needs of local people.
- During the 12 months prior to the inspection the trust had no bed moves for non-clinical reasons and also did not have any bed moves at night for the core service.
- Learning from complaints was discussed in morning MDT handovers and monthly staff meetings
- The trust had managers at all levels with the right skills and abilities to run the service.
- The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff and patients.
- Nursing and allied health staff we spoke with across both divisions told us that the working culture has improved since that last inspection.
- The service engaged well with patients, staff and the public to plan and manage appropriate services, and collaborated with partner organisations effectively.
- The Inner London division wards did not have a fully functioning call bell system, the service had put in mitigating actions, however all patients we spoke on those wards raised concerns regarding the situation.
- Nearly all patients we spoke with across all sites complained that the quality of food provided by the trust was not suitable.
- Although there was generally a good quality of documentation, some records we looked at were not completed as they should have been.
- The trust set a target of 95% for completion of mandatory training and the inpatient overall training compliance was 91% against this target.
- Between July 2016 and June 2017, 86% of permanent non-medical staff and 77% of permanent medical staff within the core service had received an appraisal compared to the trust target of 90%.
5 February 2018
Our rating of this service improved. We rated it it as good because:
- There had been a focus on continuous improvement across the service since our last inspection. There was now improved governance in end of life care, with a clear structure of accountability and audits and outcome measures in place.
- Appropriate measures were in place to keep patients safe from avoidable harm. Incidents and safety monitoring results were collated and shared to improve the service.
- Policies, procedures and ways of working had been brought into line with local and national guidance. Risk assessments and care planning for patients at the end of life had improved since the last inspection.
- There was good team working and morale across the service. Local managers supported their staff in their roles, with chances for professional development offered. Staff received the right additional training and support to care for patients at the end of life.
- Patients were provided with compassionate and person centred care, which took account of their individual differences and needs. Relatives and friends were involved in care planning wherever appropriate and recognised as part of the caring team. Volunteering roles and initiatives focused on adding extra value to the patient experience across the service.
- Staff across the trust worked hard to build effective partnerships with external agencies in order to coordinate care for each patient and improve patient pathways. Referrals into the service were managed appropriately and patients were seen in a timely manner.
- Not all staff in the service had received their mandatory training or an annual appraisal.
- Although documentation had improved since our last inspection, there were still some problems with the consistency of patient records across the trust. In addition, there was currently no formalised consent process in place for the administration of bisphosphonate infusions at the Pembridge Unit.
- We found some minor issues with infection prevention control at the Pembridge Unit and staff did always not follow the procedure for monitoring the fridge temperature in the body store correctly.
- Some junior staff reported that the senior management team were not always visible.
20 August 2015
Overall rating for this core service Good
Central London Community Healthcare (CLCH) NHS Trust provided urgent care services for patients living in, or visiting, the boroughs of Barnet, Hammersmith and Fulham, Kensington and Chelsea and Westminster. There were, on average, a total of 18,200 attendances each month.
We saw that urgent care services were safe, effective, caring, responsive and well-led. All care provided revolved around patient injuries, illnesses and ailments. Feedback from patients and relatives was very positive and we observed staff to be caring and compassionate in their approach. Environments were clean in all areas with well-maintained equipment and all staff followed infection control principles. Patient records were electronic and were completed regularly and consistently. Medicines management was generally good. National guidelines were followed for common conditions and clinical audits were carried out with good levels of compliance. Staff felt involved, were competent, received training updates and continuous professional development. All staff had received appraisals.
A relatively new management structure including centre managers had begun to enable the sharing of good practice across centres. Reporting and learning from incidents was well managed. There had been no reported serious incidents in the past 12 months. Staff were aware of safeguarding principles and followed procedures and almost all staff had received the full range of mandatory training. Most staff felt supported senior managers and directors and described working as part of happy, cohesive teams and they felt empowered and supported to make good clinical and management decisions.
All urgent care centres across the trust met the 4 hour wait targets although there had been a marked increase in demand through referrals to centres by GPs. Staffing levels were planned and flexed to meet demand for the service around busy periods. X-ray services were available on-site at 3 urgent care centres. There had been considerable staff shortages with a high number of vacancies although recruitment processes were well underway. Medical cover was provided by local GP services. Staff worked in partnership with local services and were able to make direct referrals to both primary and secondary care. Ambulance response times had increased for patient transfers to local Accident and Emergency Departments and the trust were in discussion with the ambulance service.
We spoke to 67 patients and 14 visitors who all told us patients felt safe and cared for during their treatment and staff were respectful of their needs and preferences, sensitive to personal and cultural issues and genuinely cared about patients’ wellbeing and to explain the care being offered along with any advice for the future. We observed staff speaking to patients in a sensitive and compassionate manner. Very few formal or verbal complaints were received. Most patient concerns raised were about waiting times. Complaints, when they did occur, and feedback about them were discussed by staff at regular team meetings. Incidents were investigated to identify patterns and trends and lessons were learned in individual centres and across the trust
There were good examples of staff and public engagement and staff told us they regularly spent time with patients to look holistically at their health and give explanations and advice. Staff looked for opportunities to improve the service offered to patients and had made innovative changes to meet need and circumstances in individual centres.