We did not rate this focussed inspection.
We found:
The service did not always control infection risk well. Staff did not consistently use equipment and control measures to protect patients, themselves and others from infection. They did not always keep equipment, vehicles and premises visibly clean.
The service did not have enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Although, managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.
The service did not always manage patient safety incidents well. Staff did not consistently report incidents and near misses. Managers investigated incidents but did not always share lessons learned with the whole team and the wider service. Managers did not always ensure that actions from patient safety alerts were implemented and monitored. However, when things went wrong, staff apologised and gave patients honest information and suitable support.
The design, maintenance and use of facilities, premises, vehicles and equipment did not always keep people safe.
People could not always access the service when they needed it and receive the right care in a timely way.
Leaders did not have all the skills and abilities needed to run the service. They did not understand and manage the priorities and issues the service faced. They were not always visible and approachable in the service for patients and staff. However, they supported staff to develop their skills and take on more senior roles.
The service did not have a service level vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.
Although staff were focused on the needs of patients receiving care, not all staff felt respected, supported and valued. The service did not always promote an open culture where patients, their families and staff could raise concerns without fear.
Leaders did not operate effective governance processes, throughout the service and with partner organisations. Staff at all levels were not always clear about their roles and accountabilities and did not have regular opportunities to meet, discuss and learn from the performance of the service.
Leaders and teams did not consistently use systems to manage performance effectively. They did not consistently identify and escalate relevant risks and issues and identify actions to reduce their impact.
Not all staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements.
Leaders and staff did not actively and openly engage with staff to plan and manage services.
However:
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 and the service worked well with other agencies to do so.
Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.
Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
The service followed best practice when administering and recording medicines. However, they did not always store them safely.
The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.
The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff, including those in partner organisations. However, it was not made clear to patients how to make a complaint or raise concerns.