Chime Social Enterprise

Updated 21 September 2017

Chime is a staff owned social enterprise registered to provide regulated activities of diagnostic and screening procedures plus treatment of disease disorder or injury. At the time of our inspection, Chime was commissioned by Northern, Eastern and Western Devon Clinical Commissioning Group to provide audiology services to adults and children living in Mid Devon, East Devon and Exeter areas. This service includes paediatric hearing testing, fitting, paediatric hearing aid habilitation and rehabilitation and diagnostic follow-up of all babies identified through the New-born Hearing Screening Programme

The audiology service for children and young people is provideded at several different locations including both sites of the local acute hospital, community hospitals, special schools and a parent and toddler group for hearing impaired children. Services are provided on an outpatient basis with some domiciliary visits.

• Chime has been registered with the CQC since 21 March 2011. This service was previously inspected in January 2013 and again in January 2014 and was judged to be compliant in all core standards.

• The registered manager at the time of our inspection, Jonathon Parsons, had been in post since March 2011.

Updated 21 September 2017

Chime Social Enterprise provides audiology assessment and treatment for adults, and children and young people. Only audiology services for children were included as part of this inspection as audiology services for adults are not currently required to be registered with the Care Quality Commission. This report includes the community children and young people core service.

The regulated activities are diagnostic and screening procedures and treatment of disease, disorder or injury.

Chime is a community interest company. This means that any surplus of funds is reinvested into the organisation to improve NHS services. Chime has a contract to offer NHS children’s audiology services, free at the point of delivery on behalf of NHS Northern, Eastern and Western Devon Clinical Commissioning Group. At the time of our inspection a re-tendering process was underway.

Chime accepts referrals from health, social care or education professionals for children living in Exeter, Mid- and East Devon. It provides detailed hearing assessments, advice and appropriate management of permanent hearing loss. This includes fitting hearing aids and other appropriate listening devices together with specialist advice and information. Chime carries out a variety of different tests, depending on the age and ability of the patient and whether they have any complex hearing problems, including hearing loss and tinnitus. Some children under three years of age are seen as part of the new-born hearing screening programme. Once tests are completed the team make recommendations and provide appropriate treatment. Patients attend the audiology service as outpatients or are seen in their own homes. Staff also visit schools and a community group setting.

During April 2016 to March 2017, Chime carried out a total of 51,689 episodes of care. Of these, 7,216 (14%) were with children and young people.

We regulate this service but we do not currently have a legal duty to rate it. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary. We found the following areas of good practice:

• Staff were confident to identify and report safeguarding concerns.
• Staff knew how to report incidents. There had been prompt investigation and learning from a serious incident that was shared within the team and with other audiology services.
• Facilities were clean and equipment was in calibration and well maintained.
• There was sufficient staffing and fluctuations in demand were anticipated effectively.
• There was good compliance with mandatory training for safeguarding level two and three and for moving and handling, conflict resolution and prevention of radicalisation training.
• The service had recently been awarded Improving Quality in Physiological Services (IQIPS) accreditation. IQIPS is a professionally led programme with the aim of improving services, care and safety for patients undergoing physiological tests, examinations and procedures.
• All staff were qualified to carry out their role and were given opportunities to develop and share their skills.
• Current evidence based practice was used to develop and deliver treatment. The service used up to date technology to obtain good outcomes for patients.
• Teams worked effectively with other services for the benefit of patient care.
• Patients who moved from children’s to adults services were prepared for this transition in a coordinated way. Staff respected the confidentiality of patients and their families.
• Staff involved parents of patients throughout the consultations and provided comprehensive explanations of symptoms and treatment options.
• Information leaflets for patients and their families had been upgraded to explain what to expect from the hearing assessment and how parents could help children to benefit from their audiology treatment.
• Patients were offered appointments at a range of locations including home visits for very young babies.
• When paediatric patients required audiology assessment or intervention, they were assessed within six weeks and treated within 18 weeks. This met the standards set by the clinical commissioning group.
• Staff viewed the leaders of the service as knowledgeable, approachable and supportive.
• Leaders were focussed on the forward vision for the service.
• Staff demonstrated the values of the organisation and were engaged with the service strategy.
• Staff enjoyed their work and were committed to providing effective and patient centred care. Teamwork was valued and nurtured both within the service and with external agencies.

However, we also found the following issues that the service provider needs to improve:

• Not all staff were up to date with mandatory training; in particular there was low compliance with fire safety, infection prevention and control, basic life support and paediatric life support.
• There was a detailed risk register but this did not contain clear arrangements for reducing the impact of risks and timeframes for when this should be completed and by whom.
• There was no documented method by which key safety and quality information was regularly reported on and challenged by the board as part of the board assurance process
• Staff did not always comply with the organisational policy for infection prevention and control
• Staff had not participated in duty of candour training
• In waiting rooms at locality clinics there no toys or diversional activities for children.
• Children were not always encouraged to voice their opinions during audiology appointments
• The provider did not always signpost children and their families to resources for emotional support where applicable
• Patients and their families were not routinely provided with information about how to complain about services

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, to help the service improve. We also issued the provider with two requirement notices that affected the children’s services. Details are at the end of the report.

Updated 21 September 2017

• Staff were confident to identify and report safeguarding concerns.
• Staff knew how to report incidents. There had been prompt investigation and learning from a serious incident that was shared within the team and with other audiology services.
• Facilities were clean and equipment was in calibration and well maintained.
• There was sufficient staffing and fluctuations in demand were anticipated effectively.
• There was good compliance with mandatory training for safeguarding level two and three and for moving and handling, conflict resolution and prevention of radicalisation training.
• The service had recently been awarded Improving Quality in Physiological Services (IQIPS) accreditation. IQIPS is a professionally led programme with the aim of improving services, care and safety for patients undergoing physiological tests, examinations and procedures.
• All staff were qualified to carry out their role and were given opportunities to develop and share their skills.
• Current evidence based practice was used to develop and deliver treatment. The service used up to date technology to obtain good outcomes for patients.
• Teams worked effectively with other services for the benefit of patient care.
• Patients who moved from children’s to adult services were prepared for this transition in a coordinated way. Staff respected the confidentiality of patients and their families.
• Staff involved parents of patients throughout the consultations and provided comprehensive explanations of symptoms and treatment options.
• Information leaflets for patients and their families had been upgraded to explain what to expect from the hearing assessment and how parents could help children to benefit from their audiology treatment.
• Patients were offered appointments at a range of locations including home visits for very young babies.
• When paediatric patients required uni-disciplinary assessment or intervention, such as an audiology assessment or provision of a hearing aid, they were assessed within six weeks and treated within 18 weeks. This met the standards set by the clinical commissioning group.
• Staff viewed the leaders of the service as knowledgeable, approachable and supportive.
• Leaders were focussed on the forward vision for the service.
• Staff demonstrated the values of the organisation in their work and were engaged with the service strategy.
• Staff enjoyed their work and were committed to providing effective and patient centred care. Teamwork was valued and nurtured both within the service and with external agencies.

However, we also found the following issues that the service provider needs to improve:

• Not all staff were up to date with mandatory training, in particular there was low compliance with fire safety, infection prevention and control, basic life support and
• There was a detailed risk register but this did not contain clear arrangements reducing the impact of risks and timeframes for when this should be completed and by whom.
• There was no documented method by which key safety and quality information was regularly reported on and challenged by the board as part of the board assurance process
• Staff did not always comply with the organisational policy for infection prevention and control
• Staff had not participated in duty of candour training

• In waiting rooms at locality clinics there no toys or diversional activities for children.
• Children were not always encouraged to voice their opinions during audiology appointments
• The provider did not always signpost children and their families to resources for emotional support where applicable
• Patients and their families were not routinely provided with information about how to complain about services