Archived: Provide Community Interest Company HQ

Updated 17 April 2014

The provider HQ is based at St Peter’s Hospital in Maldon, Essex. Whilst registered with the Care Quality Commission as a location, the majority of services that were reviewed at this inspection are carried out within community settings, such as community clinics, schools, nursing homes and primary care settings, as well as within people’s own homes. The services provided to people include: diabetes management, continence advice, speech and language therapy, physiotherapy, wound care; respiratory care, child health assessment, immunisation and end of life care.

Updated 17 April 2014

Central Essex Community Services C.I.C. is a provider of integrated health and social care and supplies a broad range of community services across Essex, Cambridgeshire, Peterborough, and the London boroughs of Waltham Forest and Redbridge.

The provider HQ is based at St Peter’s Hospital in Maldon, Essex. Whilst registered with the Care Quality Commission as a location, the majority of services that were reviewed at this inspection are carried out within community settings, such as community clinics, schools, nursing homes and primary care settings, as well as within peoples own homes. The services provided to people include: diabetes management, continence advice, speech and language therapy, physiotherapy, wound care; respiratory care, child health assessment, immunisation and end of life care.

In general, we found that Central Essex Community Services C.I.C. HQ provided safe care. Most areas had processes in place to recognise and investigate patient safety incidents. However, there was an underreporting of incidents and an absence of shared learning following review of reported incidents. There were inconsistencies in staff practice regarding the practical application of these systems and an absence of learning both within and across services and teams.

We found some examples of good leadership and most staff felt they were well supported by their managers. Many said they had good training and development opportunities.

The vast majority of people we spoke to were positive about their care but especially in regards to services provided to children and families. We found some good examples of innovative practice not least the care given to patients by the children's speech and language therapists. The service had won a national innovation award for contribution to their profession. 

In general we found that community services were safe, with pathways of care effectively used to meet the needs of patients, families and carers. The exception to this were end of life care services, where the planning and delivery of service provision  was not coordinated in the same way between inpatient and community teams delivering end of life care.

Updated 17 April 2014

Overall, across all services and teams, patients with long term conditions received safe care. Patients and relatives told us they were treated in a caring and friendly way and were kept well informed. Services are responsive to the needs of patients.

We saw some excellent practice from the district nurse team and in the clinics we visited, where compassionate and individualised care helped to promote independence. However, we were concerned about the procedures and practices around safeguarding, including prioritisation of training and the lack of awareness of appropriate escalation process for those who work alone in the community who may observe safeguarding concerns. 

Whilst we did see appropriate monitoring, reporting and learning from incidents including never events, there were weaknesses in systems to use lessons learned to develop practice and a lack of strategic drive in this area.

Staff demonstrated understanding around the Mental Capacity Act. However, there was not a consistent approach in delivering services for those patients presenting with dementia and this can be directly linked to a lack of formal training and awareness in front line staff.

Information sharing and risk escalation systems were weak and this impacted on the effectiveness of leadership, governance and associated service improvements.

Updated 17 April 2014

Services for children, young people and families were well-led. The combination of visible senior leadership with supportive caring team managers resulted in staff reporting confidence of an open, honest and transparent and positive culture in which to work.

All the children, family members and staff we have spoken with would recommend children and family services to their own family and friends.

Staff were well trained around child protection systems and triggers and were confident of their own roles and responsibilities within these areas, working jointly to safeguard children and young people.

However, service managers and staff were less clear around the reporting and escalation of risk, and this contributed to the over-arching developments required across the organisation.

Front line services responded to the feedback of children and families, and we have seen examples of service developments because of feedback. However, we did hear about some difficulties due to written information for families not being available in alternative languages.

At the point of delivery we have seen caring and compassionate care that is family-centred and personalised to best meet the needs of the child and family. This was not always backed up with detailed up to date care plans signed by children and families. We have heard that for some services this could be as a result of resource and capacity issues.

Updated 17 April 2014

We saw good practice and dedicated services for people nearing and during the end stages of life. We saw and were told about some outstanding practice, in particular from the district nurse team

All of the patients and relatives we spoke with told us that community staff were caring, informative and compassionate. Patients felt they received effective care and treatment both in the community and as in-patients.

The response to patients’ end of life care wishes was very positive. The staff enable patients to die in comfort, in their preferred place and in a dignified manner.

However we saw that governance arrangements and high level systems to ensure learning from risks and the feedback from patients and families were weak.