The Care Quality Commission (CQC) has published a report on a London NHS trust’s community healthcare service, following an inspection undertaken in October.
Inspectors visited Central London Community Healthcare NHS Trust’s community health services for adults in Harrow, focusing on its community nursing teams but also specifically looking at its tissue viability, podiatry and rapid response provision.
The inspection was undertaken to assess whether the trust had made improvements following a patient safety incident last year.
CQC only assessed how safe the service was, which was rated as requires improvement.
The service and trust overall weren’t inspected, so both remain rated good overall.
Jane Ray, CQC deputy director for London, said: "While we saw examples of safe care and treatment in the service, there were areas where improvement must be made.
"These include ensuring people’s records were adequately detailed, so their needs and preferences can be reflected in their care.
"Like many other NHS trusts and organisations across the wider care sector, the service had a high number of nursing vacancies. This increased the pressure it faced and impacted the care people received.
"While the trust understood this issue and it was taking steps to address it, it must go further to do all it can to prevent people’s care and safety being compromised.
"However, the trust was successful in delivering staff training, including to prevent abuse. It was also managing infection risk and people’s medicines well.
"We have reported our findings to the trust so it knows what it must improve in the service.
"We continue to monitor the trust, including through future inspections, to support it to deliver the best possible care."
The inspection found:
- The service lacked enough nursing staff, causing high vacancy rates. While the trust was trying to recruit new staff and had ensured few visits were deferred, staff and managers told inspectors that vacancies placed them under pressure and impacted their ability to complete all tasks.
- Staff did not always complete records comprehensively, and some handover meetings were brief and lacking detail. This meant staff did not always have access to all key information to keep people safe.
- There was insufficient oversight from leaders, to help them understand the skills and issues within teams, as audits and supervised visits did not occur regularly. The trust had identified the need to increase oversight and was recruiting six new team leaders, three of whom were already in post.
- Capacity decisions were not consistently documented.
- Inspectors 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.
However:
- The service provided mandatory training in key skills to all staff, and it ensured everyone completed it.
- Staff understood how to protect people from abuse.
- Infection risk was well controlled.
- The design, maintenance and use of facilities, premises and equipment supported people’s safety. Staff managed clinical waste well. When providing care in people’s homes, staff took precautions to protect themselves and the people using the service.
- 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, and managers investigated incidents and shared lessons with the whole team and the wider service. When things went wrong, staff apologised and gave people honest information and suitable support.
The inspection report will be published on CQC’s website on Friday 30 December.
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