Updated 30 June 2017
Safety performance was good and staff were aware of their responsibilities to report incidents. Staff told us they received feedback when incidents occurred. CQC received no notifications in relation to safety incidents for 360 Care Ltd in the last 12 months between January 2016 and January 2017. CQC did not receive any safeguarding alerts or concerns in relation to 360 Care Ltd in the last 12 months between March 2016 and the time of our inspection. Staff completed safeguarding training as part of their mandatory training. Compliance with this was 91%. The community matrons were non-medical prescribers. This meant that they were able to prescribe medicines in a timely manner for the patients they visited at home. We saw service and maintenance records, which showed that all equipment used by the non-obstetric ultrasound service (NOUS), clinical matrons and health care assistants was safe, as these had been serviced; safety checked and where necessary, calibrated in line with manufacturers recommendations, within the last 12 months. We reviewed the electronic care records for 10 patients under the care of the community matrons and found that these contained a full and holistic assessment of patients’ needs. Infection Control policies were in place. Staff completed infection control training as part of their mandatory training. Compliance with this was 100%. We observed staff washing their hands before and after providing care. However, overall, mandatory training compliance for all staff at 360 Care Ltd was 75%, which was below the organisation’s own compliance target of 80%.
Local policies were in date and written in line with national guidelines and updated when national guidance changed. We saw from patient’s records and during home visits that the community matrons supported patient’s needs, gave advice and prescribed appropriate pain relief, nutrition and hydration for patients in their care. 360 Care Ltd used a generic patient administration system that allowed staff to access and share records with other key care providers. Staff in all services were able to access patient’s records through a nationally recognised electronic records system and we saw that consent for care and treatment was documented in all records we reviewed. 360 Care Ltd had developed a system to identify patients at risk, and was working in an integrated way with general practice, to avoid unplanned admissions. Records showed that all staff had yearly appraisals and effective clinical supervision. Staff we spoke with told us that there was effective MDT working with all primary and secondary care services. Agile working, which enables staff to connect to patient records system whilst in the patient’s homes, was not being used effectively however 360 Care Ltd were updating their technology systems to address this issue.
We observed staff treating patients with kindness and respect. Staff took time to introduce themselves to patients and explain the care, treatment or procedure they were providing. We spoke to patients and they told us that staff were considerate and treated them with respect at all times. We observed professionalism in all staff interactions with patients and colleagues, without exception. Staff understood and respected people’s personal, cultural, social and religious needs, and considered these when providing procedures. We observed staff take time to interact with patients in a respectful and considerate manner.
We saw that services were planned and delivered to meet the needs of local people. Clinics were provided at different locations to meet the journey requirements of patients and referrers. This ensured flexibility, choice and continuity of care. The service produced an ‘Equality and Diversity Annual Report’ (2016) that showed 360 Care Ltd was committed to providing services which embrace diversity and which promote equality of opportunity. The report identified specific duties that supported the ‘Equality Duty’ and outlined progress made to ensure equality and diversity for example, ‘Equality & Diversity’ training for all staff. We saw initiatives in place to support vulnerable people including those with dementia or a learning disability. There had been no complaints about any of the services provided in the twelve months prior to our inspection.
Staff said clinical leads and business managers were available and approachable; leadership of the service was good, there was good staff morale and they felt supported. We saw that 360 Care Ltd had a vision, mission and values statement. 360 Care Ltd was managed at a corporate level by a board of directors appointed by shareholders. A clinical executive board took overall responsibility for running services at an operational level through lead GPs and business managers. The service had processes in place to ensure risks were identified, monitored, managed and controlled through the corporate risk register. Staff morale was high within the services. Staff were enthusiastic about their work, the services they provided and about the organisation they worked for. Staff explained that morale remained high due to leadership support and good team working. One member of staff told us that 360 Care Ltd were ‘the best team ever’ and that the senior team were very supportive. Each practice had a ‘Patient Participation Group’ (PPG) in place. Additionally the service provided information about an area wide community membership body for North East Lincolnshire named ‘Accord’. We saw examples of innovation.