The Care Quality Commission (CQC) has taken further action to protect children and families in the London Borough of Barnet receiving a health visiting service from Solutions 4 Health following an inspection in September where the service was rated inadequate.
Solutions 4 Health - Barnet, run by Solutions 4 Health Limited, is an integrated community health service that supports children and young people aged 0 to 19 and their families.
This unannounced inspection was carried out to follow up on the progress they were told to make after being issued with warning notices at their previous inspection last April, around having the arrangements in place to protect and support vulnerable children and their families.
Following this inspection, the overall ratings have declined from requires improvement to inadequate as have the ratings for responsive and well-led. The rating for caring has declined from good to requires improvement. Safe has been re-rated as inadequate. Effective has been re-rated as requires improvement.
The provider was issued with two warning notices after this inspection, to focus their attention on making significant, rapid improvements to how they were managing the service, as well as protecting people from abuse and improper treatment.
Jane Ray, CQC deputy director of operations in London, said:
“Our experience tells us that when a service isn’t well-led, it’s more likely they’re unable to meet people’s needs in other areas we inspect, which is what we found at Solutions 4 Health – Barnet. Leaders at the service hadn't ensured their systems were robust enough to monitor, identify and address risks that could harm people's safety.
“For example, we noticed ongoing problems with how the service looks after and checks on children and families coming into the service. There were a few cases where children and families with safeguarding concerns were not handled appropriately in line with their own policy. This could put them at risk of avoidable harm.
“We also saw issues with how easy it was to access the service. We spoke with people using the service at the inspection and found that many of them had difficulties getting the support they needed. People felt unsupported about their health concerns because they had to wait a long time to be seen by the service.
“The service faced challenges in providing the quality of care people deserved because there weren't enough staff. They couldn't deliver all aspects of the national Healthy Child programme due to staff shortages and a high demand for the service. This meant that babies and children were not getting mandated checks and there was a risk that health or support needs might not be identified. Despite this, the service planned to cut back the programme even more. Staff and service commissioners have already expressed concerns about how these cuts could affect vulnerable families in the area.
“We’ve shared our findings with the service so it knows where improvements must be made, and where there’s good practice to build on. We will continue to monitor the service and will return to check improvements have been made and embedded.”
Inspectors also found:
- The service had a Freedom to Speak Up Guardian but four staff members said that they didn’t feel confident to raise concerns about the service directly
- Staff reported low morale and concerns about their job security
- The impact of staffing reductions on all stakeholders had yet to be discussed outside of the service
- Some information was missing from client records.
However:
- The provider used technology to help people at the service. They made a mobile application that gave free advice and support. Two different universities evaluated it and found it useful and informative
- Staff received mandatory training in key skills and understood how to protect children and young people from abuse
- The service promoted equality and diversity in its daily work. Staff had been sensitive to a family’s cultural and religious needs.