Quality Report September 2014

Governing Body Quality Report

Governing Body Report September 2014 1

GB 14/156

Quality Report September 2014

Contents

Page

2 Key Messages

4 Sign Up to Safety Campaign 9 NICE safe Staffing Guidance

Patient Safety 11 Quality Visits to Providers 12 Safeguarding & Deprivation of Liberty - Cheshire West ruling

15 Care Homes

Patient Experience 28 Complaints

32 Patient Experience

36 PALS



Key Messages

Page

1. Sign up to Safety – the 5 pledges 5

2. Other national safety initiatives 8

3. NICE safe staffing guidance for adult inpatient wards in acute hospitals 9

4. Mental Capacity Act/Deprivation of Liberties 12

5. Savile Report 13

6. Responses to letters from MPs 30



Quality Strategy

The Quality Strategy sets the context for this Quality Report. Commissioning is a tool for ensuring high quality, cost–effective care which relies on adequate and meaningful data. Quality is a key thread that underpins the work undertaken by commissioning groups. The mission is to improve the health and wellbeing of people in Nottinghamshire with a specific aim to improve quality by delivering improved safety, effectiveness of services and improved patient experience. The key principle is doing the right thing first time and every time in both commissioning and provider endeavours. We are maximising our use of regional and national enablers, such as quality indicators, NHS Evidence and NHS Choices in our quest for quality. The three quality domains are:

Patient Safety (the safety of treatment and care provided to patients)

Patient experience (the experience patients have of the treatment and the care they receive)

Clinical Effectiveness (measured by both clinical outcomes and patient-related outcomes monitored through the Performance Reports to the

Governing Body)

Quality is only achieved when all three domains are met; delivering on one or two is not enough. To achieve a good quality service the values and behaviours of

those working in the NHS need to remain focussed on patients first.

Our ambition is to commission excellent, safe and cost effective healthcare for Nottinghamshire. The Quality Strategy (2012-2017) sets out how we will ensure quality is at the heart of commissioning. The Quality Framework sets out our Governance

processes for achieving this.



PATIENT SAFETY Aim: To commission safe services for our local community

Patient safety will be our highest priority (Quality Strategy 2014-2019).

Sign Up to Safety Campaign

Sign up to Safety: Listen, Learn, Act: Listening to patients, carers and staff, learning from what they say when things go wrong and take action to improve patients’ safety

http://www.england.nhs.uk/signuptosafety/ Background

Sign up to Safety is a new national patient safety campaign that was announced in March by the Secretary of State for Health. It launched on 24

June 2014 with the mission to strengthen patient safety in the NHS and make it the safest healthcare system in the world.

http://www.england.nhs.uk/signuptosafety/

https://www.gov.uk/government/speeches/sign-up-to-safety-the-path-to-saving-6000-lives



The Secretary of State for Health set out the ambition of halving avoidable harm in the NHS over the next three years, and saving 6,000 lives as a result. This is supported by a campaign that aims to listen to patients, carers and staff, learn from what they say when things go wrong and take action to improve patient’s safety helping to ensure patients get harm free care every time, everywhere.

Organisations who Sign up to Safety commit to strengthen patient safety by:

Setting out the actions they will undertake in response to the five Sign up to Safety pledges and agree to publish this on their website for staff,

patients and the public to see.

Committing to turn their actions into a safety improvement plan (including a driver diagram) which will show how organisations intend to save lives

and reduce harm for patients over the next 3 years.

The five Sign up to Safety pledges:

1. Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.

2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly

measuring and monitoring how safe their services are.

3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients

and their families if something goes wrong.

4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local

services that patients use.

5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and

celebrate the progress.

A National Co-ordinating and Support Group has been established, chaired by Sir David Dalton who is supported by Dr Suzette Woodward as Campaign Director.

The following national organisations have committed to system wide support of Sign up to Safety:

NHS England will provide expert clinical patient safety input to the development of improvement plans and framework for plan

assessment. They will also play a key leadership role in the campaign and will ensure all their programmes of work described above are

actively working to support the campaign.

http://www.england.nhs.uk/signuptosafety/about/#signs

http://www.england.nhs.uk/patientsafety/



Monitor and the NHS Trust Development Authority will offer leadership and advice to trusts and foundation trusts who participate in Sign

up to Safety and who will develop and own locally their improvement plans. They will also sign post to partner organisations for specific

expertise where required.

NHS Litigation Authority which indemnifies NHS organisations against the cost of claims, will review trusts’ plans and if the plans are

robust and will reduce claims, they will receive a financial incentive to support implementation of the plan. Any savings made in this

way will be redirected into frontline care. This is just one way that we can tackle some of the financial costs of poor care. Any savings

made in this way will be redirected into frontline care.

The Care Quality Commission will support trusts signed up by reviewing their improvement plans for safety as part of its inspection

programme. CQC will not offer a judgment on the plans themselves but consider them as a key source of evidence for Trusts to

demonstrate how they are meeting the expectations of the five domains of safety and quality.

The Department of Health will provide Government-level support to the campaign and work with the Sign up to Safety partners to

ensure that the policy framework does all it can to support the campaign and the development of a culture of safer care.

Providers who have signed up to the campaign include:

The following 12 trusts have joined Sign up to Safety for the initial phase and are developing their patient safety improvement plans based the actions they committed for each of the five Sign up to Safety pledges

Central London Community Healthcare NHS Trust

Frimley Park Hospital NHS Foundation Trust

Nottingham University Hospitals NHS Trust

North Bristol NHS Trust

Oxleas NHS Foundation Trust

The Royal Berkshire NHS Foundation Trust

Royal United Hospital Bath NHS Trust

Salford Royal NHS Foundation Trust

Sheffield Teaching Hospitals NHS Foundation Trust

Staffordshire and Stoke-On-Trent Partnership NHS Trust

Taunton and Somerset NHS Foundation Trust

2gether NHS Foundation Trust

https://www.gov.uk/government/organisations/monitor

http://www.ntda.nhs.uk/

http://www.nhsla.com/

http://www.cqc.org.uk/

https://www.gov.uk/government/organisations/department-of-health

http://www.england.nhs.uk/signuptosafety/whos-signed-up/clch/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/frim-park/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/nott-uni/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/nrth-brist/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/oxleas/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/royal-berk/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/royal-unit/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/salford/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/sheff-teach/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/taun-som/

http://www.england.nhs.uk/signuptosafety/whos-signed-up/2gether/



Nottingham West, Nottingham North and East and Rushcliffe CCGs have all signed up. Our pledges are as follows:

Put safety first.

We will:

Support our providers to reduce harm through:

The development of CQUIN schemes (deterioration, sepsis, falls, etc)

Work across boundaries, organisations and agencies to reduce harm

Develop our quality strategy to focus on harm reduction.

Continually learn.

We will:

Continually monitor the quality of our providers

Receive patient stories at our Governing Bodies

Undertake regular quality visits to providers to ensure services are safe and listen to patient feedback

Honesty.

We will:

Develop our ‘Being Open’ policy and monitor providers ‘duty to candour’

Support providers through the Patient Association to improve the management of complaints, we pledge to follow the same process for our

complaints.

Collaborate.

We will:

Work with other agencies and organisations to share learning and improvements, supported by local fore/groups

Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and

celebrate the progress.

Support.

We will:

Improve capacity and capability in improvement science through NHS IQ programmes

We will undertake quality visits to provider services and give feedback

We will use our contractual levers to support providers



The National patient safety priorities have been determined and are listed below:

In association with the Sign up to Patient Safety campaign there are a number of other initiatives: Patient Safety collaboratives – These are regionally based safety improvement networks led by Academic Health Science Networks that will work

across whole local systems and all health care sectors, to deliver locally designed safety improvement programmes drawing on recognised evidence based methods. They will begin their work later in the year. Organisations that sign up to safety can commit to join their local collaborative as part of their plan (although they are open to all organisations). Patient Safety Fellows – Work is underway to create a group of 5,000 respected, enthusiastic and effective safety improvers who will become the backbone of patient safety improvement over the coming decade, making an active contribution to improving safety. The group will launch later this year and organisations who participate in Sign up to Safety are involved in the collaboratives will benefit from the expertise of the fellows and can also support their own staff to become fellows. New National Reporting and Learning System (NRLS) – Work is underway to review and re-commission the NRLS. We already have the world’s most comprehensive incident reporting system and this will be developed further to make incident reporting as easy, effective and rewarding as possible, so that learning and improvement continue to grow across the system. SAFE team – A new Safety Action for England team will be developed to provide short-term support to individual trusts in the area of patient safety. SAFE will provide trusts with a clinical and managerial resource to help to develop organisational and staff capabilities to help improve the delivery of safe treatment and care. SAFE will be piloted later this year and could help support signed up organisations, and others, who require additional help.



Safety website – A new set of hospital patient safety data is now available on NHS Choices enabling trusts to be compared against each indicator. Putting key safety information into the public domain supporting transparency and helping patients to make informed choices about their care and exercise their right to challenge their local healthcare providers on safety issues. Organisations that have signed up to safety can use this public data to inform their plans and conversations with their local communities. All staff working across the health and care system can also participate in Sign up to Safety by going to the Sign up to Safety website (www.signuptosafety.nhs.uk) and making their own commitment to improve safety. National organisations including regulators, inspectors and the Department of Health will all make a public commitment as part of Sign up to Safety representing the system wide commitment to this work. They will also support local organisations as required to develop their plans.

Clinical Commissioning Groups are supporting this campaign through:

Development of the Quality Strategy which outlines a 5 year plan to improve safety and the experience of our populations.

Supporting our providers of care through CQUIN to reduce harm and encouraging them to sign up to the campaign

Improving the capacity and capability of Primary Care through the LISQ programme

------------------------------------------------------------------------------------------------------------------------------------------------------------------ NICE safe staffing for nursing in adult inpatient wards in acute hospitals - Issued: July 2014 http://www.nice.org.uk/guidance/sg1/resources/guidance-safe-staffing-for-nursing-in-adult-inpatient-wards-in-acute-hospitals-pdf

Following a number of landmark reports (Francis, Berwick and Cavendish reports), the NICE guidance follows on from the National Quality Board paper: How to ensure the right people, with the right skills, are in the right place at the right time. A guide to nursing midwifery and care staffing capacity and capability (National Quality Board 2013) and Hard truths, The journey to putting patients first (Department of Health 2013). There is no single nursing staff-to-patient ratio that can be applied across the whole range of wards to safely meet patients' nursing needs. Each ward has to determine its nursing staff requirements to ensure safe patient care. This guideline therefore makes recommendations about the factors that should be systematically assessed at ward level to determine the nursing staff establishment. It then recommends on-the-day assessments of nursing staff requirements to ensure that the nursing needs of individual patients are met throughout a 24-hour period. The guideline also makes recommendations for monitoring and taking action according to whether nursing staff requirements are being met and, most importantly, to ensure patients are receiving the nursing care and contact time they need on the day. The emphasis should be on safe patient care not the number of available staff. This includes recommendations to review the nursing staff establishment for the ward and adjust it if required.

http://www.nice.org.uk/guidance/sg1/resources/guidance-safe-staffing-for-nursing-in-adult-inpatient-wards-in-acute-hospitals-pdf



There is no single nursing staff-to-patient ratio that can be applied across all acute adult inpatient wards. However, take into account that there is evidence of increased risk of harm associated with a registered nurse caring for more than 8 patients during the day shifts. Therefore if the available registered nurses for a particular ward (excluding the nurse in charge) are caring for more than 8 patients during the day shifts, the senior management and nursing managers or matrons should: closely monitor nursing red flag events, perform early analysis of safe nursing indicator results, take action to ensure staffing is adequate to meet the patients' nursing needs if indicated by the analysis of nursing red flag events and safe nursing indicators. In many cases, patients' nursing needs, as determined by implementing the Safe staffing for nursing in adult inpatient wards in acute hospitals recommendations in this guideline, will require registered nurses to care for fewer than 8 patients. Hospitals need to have a system in place for nursing red flag events to be reported by any member of the nursing team, patients, relatives or carers to the registered nurse in charge of the ward or shift.

Nursing red flags

Unplanned omission in providing patient medications.

Delay of more than 30 minutes in providing pain relief.

Patient vital signs not assessed or recorded as outlined in the care plan.

Regular checks on patients to ensure that their fundamental care needs are met as outlined in the care plan. This is often referred to as 'intentional rounding' and involves checks on aspects of care such as the following: Pain, Personal needs,

Positioning:

Less than 2 registered nurses present on a ward during any shift.

Implementation of this guideline is the responsibility of local commissioners and/or providers. CCGs are monitoring safe staffing levels in a number of ways (through quality forum, quality visits, provider reports etc) Review staffing as a factor in quality issues such as pressure ulcers, HCAI and poor patient experience. CCGs are working with providers to support safer staffing through system level working (Nottinghamshire Nursing Cabinet has been set up to address workforce issues etc).



Quality Visits to Providers The Quality Team co-ordinate quality visits to the provider organisations which they are responsible for providing assurance of safety and quality to the Governing Bodies, in line with contractual agreements. The provider organisations which receive scheduled, responsive and unannounced visits are NUH, CHP and Circle, Nottingham. The aims of the visits are to:

gain a contextual understanding of the services which are commissioned

develop effective working relationships between staff in provider and commissioner organisations

facilitate triangulation and exploration of indicators of service delivery and enhance intelligent interpretation and analysis

identify awareness and action of provider in relation to key areas of concern and enable staff and service users to share their perspective on these Lay members from the CCGs have agreed to be available to take part in the quality visits to providers and are this is expected to commence as soon as their code of conducts are signed and the ‘Disclosure and Barring’ process is complete. CCG Governing Body members and CCG officers are encouraged to take part in these visits and can contact Liz Owen ([email protected]) to arrange attendance. Planned visits for 2014/15

Provider Date Area Reason for Visit Circle Nottingham 29/5/2014 Gateway A (Dermatology/skin surgery) To learn about the service and progress against CQC action plan

Circle Nottingham 22/7/2014 Short Stay Unit Newly opened – visiting for assurance

Circle Nottingham 23/9/2014 tba




Provider Date Area Reason for Visit Community Health Partnerships 1/5/2014 PRISM (Newark & Sherwood

Integrated Team) To learn about progress with Newark and Sherwood Integration model.

Community Health Partnerships 7/7/2014 NNE Integrated CHP Team To learn about progress with NNE Integration model and to monitor progress with reducing pressure ulcer damage.

Community Health Partnerships 4/9/2014 Lings Bar Hospital Follow up visit and also as part of review of Lings Bar.

Community Health Partnerships 3/11/2014 tba



mailto:[email protected]



Provider Date Area Reason for Visit NUH 17/4/2015 Paediatric and Maternity Follow up from CQC inspection in November which highlighted area as requiring

improvement

NUH 24/6/2014 Radiology Dept. Never Event involving wrong site intervention. Assurance required against action plan

NUH 4/7/2014 Return Visit to clinic 1 Follow up visit to monitor improvements made as a result of commissioner report.

NUH 4/8/2014 Outpatients Dept. Follow up visit from CQC Inspection in November.

NUH October - tba tba

NUH December - tba tba

NUH February 2015 - tba tba

Safeguarding NHS England have set up a number of sub groups to lead on national safeguarding priorities; The Child Sexual Exploitation sub-group held its initial meeting on 03 June 2014. The group is tasked with reviewing and implementing the relevant recommendations contained with the DH Child Sexual Exploitation report (https://www.gov.uk/government/publications/health-working-group-report-on-child-sexual-exploitation ) and will provide regular updates to the National Safeguarding Group on progress. First update awaited Mental Capacity Act, Deprivation of Liberties (MCA/DoLS) The government has responded to the House of Lords report; this can be found at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/318730/cm8884-valuing-every-voice.pdf Key outcomes are;

The government will consider the case for establishing a new independently chaired Mental Capacity Advisory Board.

The Government will hold implementing partners to account, ensuring they deliver against their commitments and responsibilities.

Everyone has responsibility for raising awareness and every professional who works with individuals who may lack capacity should regard the responsibility to familiarise themselves with the provisions of the MCA as a basic professional duty.

The Department of Health will commission a review of current guidance and tools to determine what represents the “gold standard” that can then be widely disseminated. In 2015, the Government will host a national event to both raise awareness of the Act and to hear the views of professionals and the public as to how we can further develop our programme of work.

Professional training is a priority and the Government, together with Health Education England and the Royal College of General Practitioners, have identified immediate actions. NHS England and the Association of Adult Directors of Social Care (ADASS) have committed to lead on work examining the important role that commissioning has to play in encouraging a culture in keeping with the principles of the MCA.

The Care Quality Commission (CQC) has prioritised the MCA in the fundamental revision of its regulation and inspection model.

The Government will ask the Law Commission to consult on and potentially draft a new legislative framework that would allow for the authorisation of a best interests deprivation of liberty in supported living arrangements. In light of this, the Law Commission will consider any improvements that might be

https://www.gov.uk/government/publications/health-working-group-report-on-child-sexual-exploitation

https://www.gov.uk/government/publications/health-working-group-report-on-child-sexual-exploitation

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/318730/cm8884-valuing-every-voice.pdf



made to the Deprivation of Liberty Safeguards (DoLS). In the short term, ADASS will lead a task group to consider the implications of the recent Supreme Court judgment on deprivation of liberty and the Government will commission a revision of the current standard forms that support the DoLS process.

The Office of the Public Guardian (OPG) is undertaking significant work to increase the level of awareness and understanding of Lasting Powers of Attorneys (LPAs) HM Courts and Tribunal Service has committed to increasing the staff complement of the Court of Protection and the Government has committed to the revision of the Court of Protection Rules – with a view to having new rules in place by April 2015.

In March 2014, the Supreme Court delivered a judgement in relation to conjoined appeals of “Cheshire West” and “P & Q”. The precedent created has significantly widened the definition of deprivation of liberty. In short, it is now clear that if a person lacking capacity to consent to the arrangements, is subject both to continuous supervision and control and is not free to leave, they are deprived of their liberty. This has significantly widened the definition of deprivation of liberty and it is clear that people living in domestic and supported living arrangements are now also potentially subject to DoLS. Within Nottinghamshire, the local authority are reporting a 10 fold increase in referrals for Deprivation of Liberty authorisations, a picture which is duplicated across the country. The local authority are recruiting/seconding more social workers in to post in an attempt to meet this demand. Human Trafficking Human trafficking is the illegal trade of human beings for the purposes of commercial sexual exploitation or reproductive slavery, forced labour, or a modern-day form of slavery. The health consequences of human trafficking can be very significant, which means that the NHS may be the one public agency to which a victim can turn for assistance. The provision of healthcare services to victims may present the opportunity not only to address their health needs, but also to facilitate access to wider support services that can afford them care and protection. The resources are being posted on the Nursing Directorate website, to view these, follow the link below to the resource: https://www.gov.uk/government/publications/identifying-and-supporting-victims-of-human-trafficking-guidance-for-health-staff PREVENT The PREVENT coordinators are being aligned to the Home Office (HO) priority areas. Revised job descriptions are being developed and vacancies recruited to. The priority areas identified by the HO are; • West Midlands; Birmingham • East Midlands; Leicester, Derby, Stoke-on-Trent • North West; Manchester, Blackburn with Darwen, Liverpool • Yorkshire & Humber; Bradford, Leeds • London; Brent, Camden, Ealing, Enfield, Greenwich, Hackney, Hammersmith and Fulham, Haringey, Islington, Kensington and Chelsea, Lambeth, Lewisham, Newham, Redbridge, Tower Hamlets, Waltham Forest, Wandsworth, Westminster, South Central, High Wycombe, • East of England; Luton Savile The reports have now been published and can be accessed from the following link; https://www.gov.uk/government/collections/nhs-and-department-of-health-investigations-into-jimmy-savile It is noted that there is an investigation report produced by Nottinghamshire Healthcare Trust regarding an incident at Saxondale Hopsital in 1971/72, this involved a young member of the public (not a patient) who attended a fund raising disco at the hospital which was hosted by Jimmy Savile - The investigation has concluded:

https://www.gov.uk/government/publications/identifying-and-supporting-victims-of-human-trafficking-guidance-for-health-staff

https://www.gov.uk/government/collections/nhs-and-department-of-health-investigations-into-jimmy-savile

https://www.gov.uk/government/collections/nhs-and-department-of-health-investigations-into-jimmy-savile



• It is always good practice to continuously reinforce to staff, through the Trust`s Safeguarding Training, the importance and awareness of reporting incidents of inappropriate behaviours via safeguarding processes and procedures. • Post Francis it is even more important that the NHS is open and transparent and listens to complaints • No further action is required with regard to this matter The Trust is currently conducting an investigation into Jimmy Savile’s association with Rampton Hospital. Prosecution of domestic violence cases The Director of Public Prosecution (DPP) has developed new draft guidance for crown prosecutors on the “Prosecution of Domestic Violence cases”. The new draft guidance, which has not yet come into force, explains the potential impact of domestic abuse on different groups to help prosecutors adopt a tailored approach taking into account their particular support needs. The Domestic violence guidance covers sexual abuse in intimate partner relationships, as well as cases for under 18 year olds. The role of SARCs is also covered. Please follow the link below for the DPP’s statement and to access the actual consultation document; http://www.cps.gov.uk/consultations/dv_2014_consultation.html Forced marriage Revised practice guidelines are being developed alongside the revised statutory guidance “The Right to Choose” originally issued under s.63 Q(1) of the Family Law Act 1996. The statutory guidance is different to the multi-agency practice guidelines in that it provides advice and support to all frontline professionals who have responsibilities to safeguard children with or without learning disabilities, and protect all adults, with or without learning disabilities from the abuses associated with forced marriage. It also outlines the responsibilities of Chief Executives, Directors and Senior Managers within those agencies involved with handling cases of forced marriage. It also covers issues such as staff training, developing inter-agency policies and procedures, raising awareness and developing prevention programmes through outreach work. Ill treatment or wilful neglect Ill treatment and wilful neglect (complete). This is the government response to the consultation of making it an offence to wilfully neglect a patient with capacity (it is already in place for those who lack capacity). It will apply to all formal health and social care provision (excluding children’s services, as this is already covered by legislation). The paper outlines the commitment by Government and DH to make this a statutory offence. Please click the link below for further details; https://www.gov.uk/government/consultations/ill-treatment-or-wilful-neglect-in-health-and-social-care

http://www.cps.gov.uk/consultations/dv_2014_consultation.html

https://www.gov.uk/government/consultations/ill-treatment-or-wilful-neglect-in-health-and-social-care



Care Homes CQC in their recent document ‘A fresh start for the regulation and inspection of adult social care’ (2013) outlined their inspection and regulation processes for the next 3 years. (http://www.cqc.org.uk/sites/default/files/documents/20131013_cqc_afreshstart_2013_final.pdf ). This will include the five key questions that they will ask of services:

Are they safe?

Are they effective?

Are they caring?

Are they responsive?

Are they well-led? It will also include an understanding of the experiences of people who use adult social care services as key to the process. The future ‘operating model’ includes:

Registering those that apply to CQC to provide care services.

Intelligent use of data, evidence and information to monitor services.

Expert inspections.

Information for the public on our judgements about care quality, including a rating to help people choose services.

The action we take to require improvements and, where necessary, the action we take to make sure those responsible for poor care are held accountable for it.

Essential outcomes that care homes are currently regulated against are listed below, but this framework may change with the introduction of the new operating model. Outcome Outcome Name Number 01 Respecting and involving people who use services 02 Consent to care and treatment 04 Care and welfare of people who use services 05 Meeting nutritional needs 06 Cooperating with other providers 07 Safeguarding people who use services from abuse 08 Cleanliness and infection control 09 Management of medicines 10 Safety and suitability of premises 11 Safety, availability and suitability of equipment 12 Requirements relating to workers 13 Staffing

http://www.cqc.org.uk/sites/default/files/documents/20131013_cqc_afreshstart_2013_final.pdf



14 Supporting workers 15 Statement of purpose 16 Assessing and monitoring the quality of service provision 17 Complaints 20 Notification of other incidents 21 Records HOMES OF NOTE Elder Homes Group: Eton Park, (Burkitt) (Millington Springs - North Notts); Monthly meetings are held with LA, CCG and owner to monitor progress in addressing issues in relation to poor quality care and non-compliance with CQC standards. As a result both LA and CCG have suspended contracts. Burkitt care home has now closed (1.5.2014)

HC-One:

Group is up for sale but unsure whether all homes will remain under same ownership or sold individually. HC-One homes in south CCGs are Beauvale (Bingham), The Beeches (Arnold), Springwater Lodge (Calverton) and Silverwood (Beeston) Since Pharmacy Plus has gone in to liquidation, all HC-One homes have moved back over to Boots for their pharmacy supplies.

Legend:

History of concerns that are resolving but require some monitoring to ensure progress maintained

On-going concerns around quality of care delivery / lack of compliance with CQC standards - care home requires regular monitoring of standards of

care and action plans by CQC/LA/CCG

Serious concerns raised / contract suspensions in place / non-compliance with CQC standards – care home requires frequent monitoring of

standards of care and action plans by CQC/LA/CCG.

Nottingham North & East CCG Area:

Care Home Type of service

Number of health funded

residents

Timeline of Visits to care home

Visiting Agency Outcome Actions

Albemarle Court

Nursing & Residential

CHC- 01 FNC -05

18.07.13 CQC inspection Non-compliant in five outcomes.

25.07.13 LA Contract suspension put in place.

02.08.13 LA QDO & CCG QMF visit There have been three recent deaths at the home, Safeguarding investigation underway.

Low

Mode

rate

High



20.08.13 CCG Health contract suspended.

13.09.13

CCG audit

CCG QMF audit highlighted a number of areas for improvement, action plan in place and being monitored – seven of ten outcomes not met.

11.10.13

LA QDO & CCG QMF visit

New manager commenced 17.09.13, who previously worked at St. Andrew’s Lodge. Another safeguarding concern has led to suspension of two nurses pending investigation. Documentation in need of review. Staffing levels, especially at night, require review.

22.10.13 IPC outbreak notification IPC notified re scabies outbreak at Albemarle Hall and 1 case at Albemarle Court staff work across all

3 care homes including Parker House. All 3 homes residents and staff treated as precaution

3.1.14 IPC audit LA Unannounced visit, manager off sick. Action plan required to address ipc training ,policies, waste,

cleanliness

07.01.14

CCG QMF visit

Follow up re absence of action plan and discussion re management strategy in absence of manager. The manager has been off sick and when she returns is unlikely to continue in management role.

08.01.14 LA audit Awaiting outcome.

22.01.14 CCG Action plan and management strategy received by CCG.

6.2.14 IPC LA IPC action plan received some work completed

06.03.14 CCG QMF visit An unannounced CCG QMF visit to follow up on action plan and management strategy received from Albermarle Court.

16.04.14 CCG and LA visit

Joint CCG QMF and LA QDO visit to meet new manager and discuss plans for home improvement according to action plans.

29.04.14 CQC visit CQC are carrying out a routine inspection of the home using national standards.

22.05.14 CCG and LA visit New manager in place who appears to be having a positive impact on the service and staff team. Care environment seems calm, creative and person centred. Care documentation continues to require completion of updating. Out of 25 care files, 7 remain to complete. Deputy manager is aiming to complete two care files per week. MCA being reviewed by manager alongside care documentation review. Due to non-completion of care documentation and MCA information, the suspension appears to remain relevant. One new admission of a privately funded resident.

11.06.14 LA Provider meeting scheduled. This was cancelled due to the provider not being able to attend. The meeting is to be rescheduled.

25.06.14 LA Provider meeting scheduled.

01.08.14 Joint CCG QMF and LA QDO visit

Quality monitoring visit arranged in response to social work communication regarding intake of fluids for residents and query of medication dispensing techniques. Review of contract suspension also. Improvements noted.

Most recent CQC Inspection: 29.04.14

Compliant with Outcomes: 01, 02, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 17, 21

Summary:

On-going quality review visits with LA to continue in order to seek assurance that the home is meeting requirements to lift suspension in place. CQC report published on 10.06.14. Joint LA and CCG audit is scheduled.

Non-Compliant with Outcomes: 16

Charnwood Court

Nursing and Residential

CHC – 01 FNC - 15

12.09.13 CCG QMF CCG audit completed and action plan in place.

14 & 15.10.13 CQC inspection Non-compliant in six outcomes, issued warning notice for outcome four.



November 13

Joint CCG QMF and LA QDO visit

Made aware of national concerns regarding financial viability of Four Seasons group Notified that registered manager is leaving. Peripatetic manager in place at Charnwood Care home.

22nd/29th November 2013

IPC audit LA IPC audit completed with actions required re cleanliness, training, policies,

27.01.14 IPC audit LA IPC Action plan received from relief manager some actions complete others ongoing

28.01.14

CQC review CQC highlighted IPC, use of thickening agents, PEG site management, staffing levels and activity of residents and pressure ulcer prevention as issues to be addressed within the care home.

14.02.14 CCG quality visit Charnwood is being managed by a peripatetic manager. A permanent manager is being sought. Home felt calm, no unpleasant odours. Improvements were noted to action planned issues.


Unsafe transfer of care noted and escalated. Infection prevention and control issues noted. Internal communication issues noted. Struggle to appoint permanent registered manager for the care home.


The care home continues to progress according to CQC action plan. Recommended action includes developments with staffing levels, meaningful activity and data protection.

12.08.14 IPC Notice of a D and V outbreak. Four residents affected. Home is closed to admissions

18.08.14 IPC update The outbreak appeared to have settled over the weekend but 1 resident started with symptoms today. All are isolated and full ipc precautions are in place. The home is closed. Specimen sent last week to be tested today for norovirus

20.08.14 IPC update Confirmed NOROVIRUS from 1 sample sent. There have been no new cases or residents with symptoms since 18th August the home is hoping to re-open 21.08.14 after terminal cleaning


Compliant with Outcomes: 01, 02, 04, 06, 07, 09,10, 11, 12, 14, 16, 17, 21 Summary:

Peripatetic manager has been replaced by new permanent manager. The home appeared to improve under the stewardship of the peripatetic manager. Continue to monitor home, continue to work to action plans and assess for improvements.

Non-Compliant with Outcomes: 05, 08,13,

Loreto Cottage

Learning disability

CHC – 0 FNC - 0

28.01.14 CQC inspection Unannounced routine inspection.

June 2014 LA and CCG Information received from LA QDO regarding concerns about care provision at Loreto cottage raised during annual Quality Banding Audit.

08.07.14 CCG visit CCG quality monitoring visit. Noted possible issue with logistics of lift.

30.07.14 Loreto Cottage Loreto Cottage provided a protocol regarding use of the lift and ensuring the security of the medicines room.


Compliant with Outcomes: 01, 02, 04, 05, 06, 07, 08, 10, 11, 12, 14, 16, 17, 21 Summary:

CCG QMF and ASL to undertake a quality monitoring visit unannounced.

Non-Compliant with Outcomes: 09, 13,

Willow Brook Nursing and Residential Care Home


CHC –04 FNC – 12

29.08.13 CCG Quality Monitoring Audit

Scheduled and announced Quality Monitoring Audit.

30.09.13 Joint LA and CCG Quality Monitoring Visit

Responsive visit to monitor outcomes according to the action plan submitted by the care home and

concerns regarding nursing care delivered to a resident. Concerns were raised via a Notts CC social

work safeguarding referral.

October 2013 Manager and Regional Manager both moved on from Willow Brook Nursing and Residential Care

Home. The Deputy Manager was given the title, Interim Manager. An Area Manager was brought in

from an alternative locality to support the management of Willow Brook.



02.01.14 CQC Inspection Improvements required against two outcomes; Outcome 11 – management of equipment and Outcome

17 - management of complaints.

09.01.14 IPC Audit Infection Prevention and Control Audit completed.

28.01.14 CCG Quality Monitoring Visit Monitoring of changes made according to Quality monitoring Audit Action plan submitted by the care

home.

12.06.14 CQC Inspection Concerns shared with CCG include;

Staffing levels on nights

Staff competency

Quality of care plans

Lack of dementia training

Falsification of records

Nursing competency issues

Two (2) safeguarding referrals, made by CQC inspectors

No registered manager since previous manager left in October 2013, a new manager has

been in post for six (6) weeks

Night staff allocation of care needs

28.07.14 Willow Brook The care home announced that they have relocated people living at Willow Brook whom require nursing care. Willow Brook is deregistering from providing nursing care with CQC.


Compliant with Outcomes: 05, 06, 07, 09, 10, 12, 14, 17 Summary:

Scheduled CCG quality monitoring visit.

Scheduled Joint LA and CCG Quality Banding Audit.

BUPA are de-registering Willow Brook as a nursing home due to availability of suitably skilled nursing

staff. This is due to be completed in August 2014.

Non-Compliant with Outcomes: 01, 02, 04, 08,11, 13, 16, 21

Woodthorpe Manor


CHC – 01 FNC - 06

16 & 18.12.13 CQC inspection CQC issuing warning notices for outcomes 1, 4, 8, 9, 13 and 16. CQC to issue compliance actions for outcomes 2, 5, 10, 11, 14 and 21.

16.01.14 Joint CCG/LA audit LA QDO and CCG QMF audit highlighted a number of areas of concern, action plan is expected. Contract suspended by CCG in light of concerns.

29.01.14 IPC LA audit visit IPC audit actions required and action plan requested to address environment, waste and IPC training

03.02.14 LA and CCG Action plan received from the care home provider.

04.02.14 LA LA meeting with the provider regarding the action plan and future plans regarding the running of the care home.

26.02.14 LA New manager in post on probation for three months.



27.02.14 IPC LA audit visit Action Plan received with some actions completed

12.03.14 CQC Review inspection to ensure changes had been made.

20.03.14

CCG Suspension lifted.

12.05.14 LA and CCG Progress noted against training, supervision and some documentation issues. No apparent management plans in action due to challenges with recruiting a manager that suits the requirements of the care home. No admin in care home. Quality monitoring audits in place and occurring according to schedule.

10.06.14 Joint LA and CCG quality monitoring visit

Improvements noted. The home owners continue to seek a manager and admin staff for the care home. Improvements on-going.


Compliant with Outcomes: 01, 06, 07, 08, 09, 12, 13, 16, 17, Summary:

A joint LA and CCG review visit is planned.

Non-Compliant with Outcomes: 02, 04, 05, 10, 11, 14, 21

Albemarle Hall


CHC –03 FNC – 06 City CCG - 02

13.5.13 IPC audit LA Multiple issues with cleaning, fridge temperatures, environment, waste, training, policies.

Action plan requested and later received with ongoing works

12.06.13 CQC inspection Non-compliant in 8 outcomes Warning notices issued, Action plan produced.

03.07.13 LA Contract suspension put in place.

16.07.13 LA QDO & CCG QMF visit Some improvements but concerns re staffing levels, residents’ dignity, staff interactions.

08.08.13 LA QDO visit Improvements noted in Care and Welfare outcome.

09.10.13 CQC Medication review – now compliant.

11.10.13

Unannounced LA QDO visit

On-going improvements noted. Home felt calm, no unpleasant odours, residents appeared

happy and well cared for. No concerns identified.

14.11.13 CQC inspection review Concerns rose about bruising to residents.

21.11.13

CCG QMF visit

In response to concerns about falls and bruising. Residents safe and well and action plan

implemented. Weekly unannounced visits undertaken for two weeks until next CQC

inspection.

22.10.13 IPC outbreak notification IPC notified re scabies outbreak at Albemarle Hall and 1 case at Albemarle Court staff work across all 3 care homes including Parker House. All 3 homes residents and staff treated as precaution

09.12.13 CQC inspection review Improvements noted.

13.12.13. CQC visit Significant improvements and compliance in six outcomes, non-compliance with four

outcomes.

17.12.13 Joint LA and CCG audits Significant improvements noted.

2.1.14 IPC audit LA IPC audit review noted improvements seen some actions still required

7.1.14 IPC audit LA IPC action plan received some actions completed others planned

07.01.14 CQC inspection Non-compliant in six outcomes, compliant in five outcomes.



08.01.14 LA Contract suspension lifted, with placement restrictions until 07.02.14.

26.02.14 LA and CCG Care home suspended following an apparent deregistration of the care home with CQC. This

occurred at the same time as a fire officer inspection and issues with perceived safety of four

interior windows.

03.03.14 CCG QMF visit In response to concerns about fire regulations, patient safety and CQC registration.

12.03.14 CQC visit Inspection to ensure improvements had been made.

13.03.14 CCQ Home was re-registered with the CQC under alternate registration details. Albemarle Hall Nursing

Home changed to

20.03.14 CCG and LA Contract suspension lifted as fire safety, CQC registration and patient safety concerns were managed

appropriately and resolved.

16.06.14 CCG and LA Joint quality audit visit undertaken, report will be available in 6 - 8 weeks


Compliant with Outcomes: 01, 02, 04, 05, 06, 07, 08, 09, 10,12, 13, 14, 16, 17, 21

Summary: Continue to work to action plans and progress continues.

Non-Compliant with Outcomes:

Nottingham West CCG Area:

Care Home Type of service

Number of health funded

residents

Timeline of Visits to care home

Visiting Agency Outcome Actions

The Gables Nursing & Residential

CHC - 0 FNC - 16

30.01.14 IPC Infection prevention and control unannounced audit. Concerns and actions identified.

11.02.14 IPC Action plan received work ongoing

15 & 17.04.14 CQC CQC routine inspection of the service.

24.07.14 CCG QMF and LA QDO Joint quality audit undertaken. Outcome awaited.

Most recent CQC Inspection: 15 & 17.04.14

Compliant with Outcomes: 01, 02, 05, 06, 09, 11, 12, 13, 17

Summary:

LA planning a meeting to address infection control and assessing quality issues within the home and sister homes in the Nottinghamshire area. LA and CCG will continue to monitor the care home. An unannounced quality monitoring visit to the care home is scheduled.

Non-Compliant with Outcomes: 04, 07, 08,10,14, 16, 21

The Grange Nursing &

Residential / Intermediate Care beds

CHC - 0 FNC - 13

21.08.13

CCG Audit

CCG QMF audit highlighted a number of areas of concern; action plan was received on 19.09.13.

07.01.14 CCG quality monitoring visit Follow up visit regarding issues highlighted from audit.



10.01.14 LA audit Quality audit confirmed improvements but work needed in some areas e.g. environment and infection control.

22.01.14

Infection control audit

The home overall is in need of updating, fixtures and fittings in resident rooms are damaged and stained, bathrooms and toilets are poor and in need of new equipment and cleaning standards are poor.

03.02.14 Unannounced CQC inspection

04.02.14 Unannounced CQC inspection continued

06.02.14 IPC action plan IPC Action plan received ongoing works

20.02.14 CQC warning notices issued Non- compliant in regulation ten which relates to: Assessing and monitoring the quality of service provision.

08.05.14 IPC IPC audit review significant improvements made with refurbishment –re-visit 6 months

27.06.14 CCG QMF and LA QDO Joint LA and CCG quality monitoring visit. Issues noted with environment. Improvements against action plans evident.

Most recent CQC Inspection: 16 & 18.06.14

Compliant with Outcomes: 01, 05, 06, 07, 10, 11, 12, 13, 14, 17,

Summary:

LA planning a meeting to address infection control and assessing quality issues within the home and sister homes in the Nottinghamshire area. A CQC warning notice has been lifted by the CQC. Joint LA/CCG audit scheduled

Non-Compliant with Regulation: 04, 09, 16, 21

Beeston Lodge


CHC – 0 FNC - 18

03 & 09.09.13

CQC inspection

Warning notice from CQC regarding management of medicines CQC inspection determined non-compliant in outcomes four, thirteen and fourteen. Warning notice served.

20.11.13 Joint visit by LA QDO, CCG QMF and medicines management team

Following joint visit in November CCG issued improvement notice for medications on 02.12.13.

10.12.13 Responsive CQC visit Non-compliant in outcome nine.

17.12.13 CCG Follow up visit regarding improvement notice, noted that the majority of actions completed. Follow up visit planned by medicines management team on 06.01.14

31.01.14 CCG Follow up visit regarding actions highlighted in pharmacy audit, previous CCG visit and non-compliancy with CQC outcomes from CQC report. Concerns regarding dignity and patient well-being.

14.02.14 IPC Infection prevention and control audit occurred. Actions identified

17.03.14 IPC IPC action plan received

09.06.14 Joint visit by LA QDO and CCG QMF

Concerns noted with regard to demonstration of meaningful activity, internal environment, moving and positioning and evidence of care delivery.

07.07.14 CQC Beeston Lodge has been bought by a new provider. The care home has not been inspected by the CQC yet since the transfer. CCG to ensure new provider has access to historic quality monitoring reports.

Most recent CQC Inspection:

Compliant with Outcomes: Summary:

LA and CCG will continue to monitor the care home.

Non-Compliant with Outcomes:



Broadgate care home

Nursing & Residential / Intermediate care beds

CHC – 01 FNC - 20

12.02.14 CQC inspection Concerns focus on consent to care and treatment. Awaiting full report.

19.02.2014 Report of concerns regarding avoidable pressure ulcers occurring within the care home.

Information shared with CCG from CHP rehab nurse working within the home regarding pressure ulcer occurrence within Broadgate Care home. Concerns raised about the quality of care delivered within the home.

20.02.2014 LA quality audit Information to be shared when ready.

21.02.2014 IPC outbreak - Diarrhoea and Vomiting

Five symptomatic staff and four symptomatic residents following the admission of a resident from QMC on preceding Tuesday.

25.02.2014 Report of concerns regarding quantity of falls within the home

Information shared with CCG from CHP rehab nurse working within the home regarding x3 falls within two days at Broadgate Care home. Concerns raised about the quality of care delivered within the home.

19.03.14 Joint CCG QMO and LA QDO visit

Recommendations made by QMO. Recommendations confirmed by Care home Manager.

03.04.14 Complaint raised via CHP Complaint regarded the care and welfare of a resident.

22.04.14 IPC audit IPC audit completed some issues identified and action plan requested

23.04.14 Concerns escalated via CCG

Complaint regarded the care and welfare of intermediate care residents.

23.04.14 CCG Confirmation via CCG that the care home will no longer be accepting intermediate care beds.

25.04.14 LA, CCG, CQC and Provider Strategy meeting at Nottinghamshire county hall to address escalating concerns regarding care delivery within the care home.

28.04.14 CCG Further three complaints received via CHP.

01.05.14 IPC IPC action plan received

20.05.14 Joint CCG QMO and LA

QDO visit

Quality monitoring visit to follow up on 25.04.14 strategy meeting.

28/29.05.14 CQC inspection Five compliance actions and one warning notice.

31.07.14 LA Contract suspension on the following grounds; Infection control, Staffing levels and deployment to

meet people’s assessed needs, Staff communication, Pressure care management, Staff support

through supervision, Care plan documentation, Consultation and involvement of people

accommodated and relatives, Hydration and nutrition.

05.08.14 CCG Quality monitoring visit. Improvements against CQC and IPC action plans noted. Concerns over

staffing levels. Care home to be closely quality monitored to ensure patient safety and quality of care.

15.08.14 CCG Agreement with Minster Care Group about a voluntary contract suspension and quality monitoring

schedule.

Most recent CQC Inspection: 28/29.05.14

Compliant with Outcomes: 02, 05, 07, 08, 09, 10, 11,12,14,17 Non-Compliant with Outcomes: 01, 04, 13, 16, 21

Summary: Continue to quality monitor home alongside LA. CQC undertook inspection 28/05 and 29/05. The care home received five compliance actions and a warning notice from CQC relating to infection prevention and control. LA has suspended their contract with the care home as of 31.07.14. CCG have agreed a voluntary contract suspension with the care home, we will continue to quality monitor the service.

Warning notice against outcome: 08



Silverwood Nursing &

Residential CHC – 03 FNC - 26

29 & 30.08.13

CQC inspection

CQC inspection identified poor Infection control practice, poor documentation and concerns regarding care and welfare, safeguarding and quality assurance

24.09.13 IPC LA audit residential area

IPC Audit residential following CQC request, issues identified and action plan requested. Action plan received

14.10.13

Joint LA/CCG visit

Unannounced review visit by LA QDO & CCG QMF – care documentation still in need of review. Some improvements noted.

01.04.14 Joint CCG QMO and LA QDO visit

Recommendations identified.

21.01.14 IPC LA review (residential) Infection prevention and control audit review of the residential care home to monitor against existing action plan. A number of actions were identified. Action plan received 5.11.13

27.02.14 IPC audit (nursing) An Infection prevention and control audit of the nursing care home occurred. A number of actions were identified. Action plan received 21/3/14

22.04.14 CCG Concerns relating to pressure ulcer prevention rose via CCG from CHP.

14.05.14 CQC CQC unannounced routine inspection highlighted full compliance in the areas inspected.

20.05.14

CCG Notified of concerns regarding withdrawal of services by Pharmacy Plus – discussion with area quality manager who confirms that all HC One homes are moving back over to Boots and that all homes are in the process of making this change


Compliant with Outcomes: 01, 02, 04, 05, 06, 07, 08, 09, 10, 11, 12, 13, 14, 16,17, 21

Summary: Await outcome of LA audit and continue to monitor home to assess for improvements. The home is now hosting intermediate care beds, which are being managed by County health Partnerships. Non-Compliant with Outcomes:



Rushcliffe CCG area:

Care Home Type of

service

Number of

health

funded

residents

Timeline of Visits

to care home Visiting Agency Outcome Actions

Eton Park Challenging behaviour unit, Residential and Nursing older people

CHC- 04 FNC- 15 S117 -02

05.06.13 IPC

IPC audit completed following concerns large number of issues identified. Action plan requested and later received work on-going

07.13 CQC inspection

Non-compliant in 5 areas

03.12.13 Contract suspended by LA &

CCGs

New manager in post since November Still environmental issues to be addressed but some improvements made

06.12.13 Joint LA/CCG audit

LA Quality audit – Home scored 28/76. Residential Unit is satisfactory. Main concerns are on mental health units where Care Plans were very poor & on the male unit there were only 9 chairs for 16 residents, many had to spend the day sitting on hard dining chairs. Monthly meetings arranged with provider to monitor progress

06.01.14 LA & CCG meeting with

provider

Provider informed of major concerns regarding all 3 services in Nottinghamshire and requirements for improvements. Monthly meetings arranged with provider to monitor progress these meetings repeated on; 06.01.14, 05.02.14, 07.03.14 and 04.04.14. These meetings are planned to occur on a monthly frequency.

14.01.14 CCG visit

Mental Health Unit extended, taking over 9 beds from nursing unit, work has commenced on outside space

04.02.14 CCG visit

No further work done on outside space for Mental Health Unit - need risk assessments in place when work recommences. Staffing levels and skills of staff remain a concern.

05.02.14 IPC

IPC review against action plan some improvements made however still a number of actions outstanding

05.02.14 LA & CCG meeting with

provider

Meeting with provider to review progress on improvements to all 3 Elder Homes services


Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate.


Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate. Concerns about gas leak, medications and staffing provision.


Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate. Engagement with Dementia outreach about improvements that could be made to the MHU environment.


Safeguarding training delivered by CCG and LA. Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate. It was confirmed by email that the current manager is on gardening leave.


Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate. Concerns about staffing and nutrition of residents. A safeguarding was raised.


Planned quality monitoring visit to ensure staffing provision, training and management cover is adequate.

01.05.14 Relatives Meeting

Relatives meeting scheduled. This is to ensure that relatives and residents are informed of on-going concerns regarding the care home.



13.05.14, Joint CCG QMF and LA QDO visit

Four staff currently suspended. Advertising for care staff pending outcome of Burkitt staff employment meetings. Care documentation continues to be poor. Issues with fridge temperatures and staff culture are being addressed. Pressure mattress settings are being addressed.

23.05.14, Joint CCG QMF and LA QDO visit

Bespoke training for MHU continuing including snapshot training on MH conditions and Challenging behaviour/de-escalation. MHU redecoration in line with Stirling guidance and DOT recommendations. Brighter environment. Observation mirrors being installed this week. IT issues remedied. The home now has a photocopier, printer and fax machine. On-going issues with email access and allocation. Internal quality monitoring calendar in place. New documentation for fluid and food intake, accident/incident reporting and personal hygiene. New protocols for thickening agents.


Quality monitoring of the EPCC against an action plan submitted by EPCC. Outcome highlighted concerns with archiving and the need for timely CQC notifications. The new management team continues to bed in, and improvement have been noted to Oak and Ash care environments.

18.06.14 CQC inspection

Some improvements had been made. CQC lifted the warning notice for both Care and welfare of people who use services and Assessing and monitoring the quality of service provision Some areas of concern remained. CQC have set the provider a compliance action for both areas to make the necessary improvements. CQC we also inspected Cleanliness and infection control and found them to be compliant in this area.

23.06.14 Multi agency meeting to facilitate bespoke management of violence and aggression training (TMVA).

Training offered by Notts HC NHS Trust is ready to be implemented. EPPC have confirmed their engagement with the bespoke training. Training to be delivered on a rolling programme for Oak and Ash units. EPCC TMVA clinical governance to be reviewed within three months from 23.06.14.

06.08.14 Relatives Meeting

LA and EHG hosted a relatives meeting at Nottinghamshire County Hall. This followed on from the previous relatives meeting dated 01.05.14.

27.08.14 Joint CCG and LA QDO visit

Quality review visit


Compliant with Outcomes: 01, 02, 06, 08, 09, 11, 14, 17, 21 Summary: Majority of concerns are centred on poor care planning and record keeping. Management has changed within the care home. LA and CCG suspension continues. A joint LA and CCG visit is scheduled.

Non-Compliant with Outcomes: 04, 05, 07,10, 12, 13,16

Woodley House

Learning disability

CHC -02 01.01.12 CQC inspection CQC issued warning notice for safeguarding

19.10.12

LA

Home have started work on improvement and refurbishment program LA contract suspension put in place

28.01.13 IPC IPC audit completed following LA concerns, number of actions required and action plan requested. Action plan received and work ongoing to make improvements

18.04.13

CQC inspection

Improvements made, non-compliant in outcome 21

22.07.13 CQC review CQC have visited and home compliant in all areas reviewed accept medication.



03.12.13 LA visit Recommended suspension lifted. Improvements made.

11.06.14 Medicines management team

Made aware of medication incident – missing medication (Movicol) and no investigation initiated.

19.06.14 CCG quality visit Review of concerns regarding medication error, care home manager to complete investigation and forward to CCG ASL


Compliant with Outcomes: 01, 02, 04, 05, 06, 08, 09, 10, 11, 12, 13, 14, 16, 17, Summary:

As of 15.08.14, after receiving information the CQC is reviewing the service at Woodley House.

Non-Compliant with Outcomes: 07, 21



Complaints Incoming complaints Complaints received since April 2013

CCG April May June July Aug Sept Oct Nov Dec Jan Feb March April May June July

Rushcliffe 2 3 1 3 3 0 3 0 0 1 0 2 4 2 0 1

NW 1 0 2 4 1 0 1 0 0 1 1 0 0 0 1 1

NNE 2 0 4 5 5 4* 5 1 0 1 1 1 3 2 1 2

Other 2 0 2* 0 1 0 0 1 2 0 1 0 2

TOTAL 5 3 7 14 11 5 9 2 0 2 3 5 7 5 2 6

*In one complaint the patient is the responsibility of 2 CCGs In total the Complaints team received 8 complaints from June to July these were forwarded to the appropriate provider to investigate as necessary. Complaints received between February 2014 - July 2014 including outcome data from closed cases Month 2014

CCG Location

Complaint Provider

Action taken Outcome

Feb NW Concerns in relation to the level of provision of INR testing at GP Practice

CCG/ GP/ NUH

Closed Staff reminded of the importance of inputting correct accurate information and the necessity of protecting patient data. NWCCG to review GP Led Enhanced Services later in the year and if the member practices express an interest in providing a Level 4 INR monitoring service this will be discussed as part of the review.

Apr Rushcliffe Concerns regarding access to emergency medical care

NEMS Closed Patient experience was poor; patient did encounter delays in treatment due to the lack of bed availability. Staff to be reminded how best to convey information relating to waiting times to

Patient Experience We will commission patient-centred services that meet patient expectations (Quality Strategy 2014-2019)



eliminate confusion. NUH weekend admission process to be reviewed with the management directorate team with the aim to improve the experience of GP/NEMS patients at weekends.

Apr Stagg Concerned about mother being denied podiatry services now she resides in a care home

CHP Closed CHP reviewed the contract and established that podiatry should be offered to patients in care/nursing homes if eligibility criteria for home visits met. CHP have amended the Podiatry Service Operating Procedures and Policy to reflect the above finding

Apr Rushcliffe Concerns regarding the lack of communication/correspondence from the community midwife team during pregnancy

NUH Closed Apologised for the lack of community midwife service. IT systems improved to enable midwifes to be able to book the next appointment whilst patient in attendance. Sure Start centre managers reminded of the importance of patient confidentiality and thought to be give where patients are requested to sit whilst waiting.

May NNE Concerns regarding CHC eligibility criteria CHC Closed - letter submitted by a claims company as a general enquiry.

CHC established no assessments had been undertaken and therefore one was to be arranged to assess patient’s current needs.

May Rushcliffe Concerns regarding difficulties encountered with NHS Continence Prescription Service

CCG Closed Explanation and apology offered for the problems encountered with new service provider. All patients to be informed of the changes to the current service.

May Rushcliffe Concerns regarding lack of communication Woodthorpe

Closed Complaint sent directly to provider for investigation by complainant.

May NNE Solicitors chasing a response to CHC claim CHC Closed Letter acknowledged and forwarded to CHC to respond directly, no record in complaints

May M&A Concerns regarding the care provided to a resident in a nursing home

CCG Closed Complaint passed to North CCGs by CHC

June NW Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CCG Out for investigation

June NNE Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CHC Closed CHC team reviewed the documentation upon receipt of the complaint. Patient was found to be eligible for a referral to the Derby Retrospective Assessment Team for a full assessment



July N&S Concerns regarding Newark Community Rehabilitation Centre

NHCT Closed Complaint sent to NHCT for investigation and response. Complaint acknowledged from CCG and explanation provided that NHCT would be in contact to discuss investigation process and agree a response timescale

July NNE Concerns in relation to the representation on the Hucknall Planning Group

CCG Local Resolution Meeting being held

July NW Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CHC Out for investigation

July NNE Concerns regarding care and treatment received at NUH, delayed discharge due to availability of patient transport

NUH /Arriva

Out for investigation

July Rushcliffe Concerns regarding CCG decision to limit the provision of physiotherapy to two sessions for the same issue within a 12 month period

CCG Closed Advised services needed to be reviewed to ensure CCG remained in budget. Alternative treatment available to patients.

July N&S Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CHC Closed Complaint passed to North CCGs by CHC

A Service Improvement Log is to be established to aid the monitoring of actions identified for implementation. Patient Story learning is also to be incorporated and shared amongst staff and providers via the Quality and Patient Safety Newsletter and websites where possible. Meeting scheduled with NUH to determine how this can be achieved collaboratively. The Patient Experience Team is currently in the process of organising the Patient Association Peer Review for each provider in order for them to achieve the CQUIN. The Peer Review is scheduled to take place on 22/23 October 2014. MP Letters / General Sundry correspondence received between June 2014 - July 2014 including outcome data from closed cases

Month 2014

CCG Location

Concern Provider

Action taken Outcome

June NNE Concerns regarding the number of IVF cycles provided by CCG

CCG Closed Response sent outlining IVF Policy which incorporates the eligibility criteria

June NW Concerns regarding the delay in being picked up post appointment

Arriva Closed Transport initially booked was incorrect which made it difficult on return journey due to Ilkeston Hospital being an isolated site with not many ambulance going in or out which added to the delays. Commissioners working with Arriva Transport on a performance improvement plan



June NNE Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CHC Closed Await contact from Keypoint Law who are to submit a formal complaint

June NW Concerns regarding the delays encountered, patient was picked up late leaving not enough time for the hospital to do the full procedure which has resulted in the patient having to go in again.

Arriva Closed Complaint sent directly to Arriva for investigation by complainant. Complaint acknowledged from CCG and explanation provided that Arriva would be in contact to discuss investigation process and agree a response timescale.

July Rushcliffe Refusal by CHC team to forward application for full CHC Retrospective Reassessment

CHC Out for investigation – ‘out of time concern’

July Rushcliffe Concerns regarding the provision of incontinence pads

CCG Closed Patients can be prescribed a maximum number of continence pads (4). If provision is not sufficient to meet a patient’s needs there is an expectation that the patient will fund the difference themselves.

July NW Concerns regarding the difficulty in obtaining medication for long term condition

Healthcare at Home

Ongoing issues with Healthcare at Home which are being addressed at a local and National level. A number of changes have been put in place including recruitment of additional call handling staff and bringing the warehouse function that had recently been outsourced back in house.

July NW Concerns regarding the delay in being picked up

Arriva Out for investigation



Patient Experience Patient Stories Patient stories continue to be presented to the governing bodies of the south CCGs ensuring the patient remains at the heart of commissioning processes. Origin Story Action GP (patient relayed story to GP) Coordination of care/listening to the patient’s concerns Commissioners liaised with the trust to seek resolution. The patient story has been used to

pilot a new Transfer of Care Communication tool (NHS III) within the trust. To be published nationally.

Complaint (GP practice) Positive outcome

GP practice dispute/communication Shared best practice, importance of good and effective communication and local resolution.

Overview and Scrutiny Committee Transfer of care and transportation Film developed for learning. Key actions from this story for Lings Bar, NUH and Arriva.

Staff feedback Excellent care and treatment by two providers. Shared best practice across the governing bodies. NUH and EMAS to be asked to pay tribute to staff involved in the service provided

Staff feedback Excellent and inclusive care and treatment provided by one provider demonstrated compassionate care.

Shared best practice across the governing bodies. NUH to be asked to pay tribute to staff involved in the service provided

Complaint (via patient’s family) Significant delay in provision of ambulance, placing patient at risk.

Concerns raised with lead commissioner, CCG supporting EMAS to improve their capacity and response times. Independent review of capacity and service model to occur using this to inform the commissioning and development of ambulance services in the future. CQUIN for complaints management developed and implemented.

Patient feedback Care/treatment received from NUH leading to delayed diagnosis of symptoms

Commissioners to seek continuous feedback from patients and their carers about the services we commission and constantly strive for improvement in quality and understand the impact of patient (and their carers) experience.

Erewash CCG

Female patient with a learning disability attended a regular appointment at the gynaecological clinic at Circle Nottingham for an ovarian cyst. The patient felt that reasonable adjustments had not been made under the Mental Capacity Act.

Staff to recognise the importance of capturing patient stories to aid learning in order to improve services for patients. Consideration to be given to using the patient’s story for training purposes both internally within the organisation and more broadly across the healthcare landscape to enable learning and the sharing of best practice. Areas that fell short of the NICE standards to be fed back at senior management level to be addressed.

Patient feedback (Expert Patient Programme) Patient diagnosed with a long term condition participated on Expert Patient Programme and was overwhelmed by the difference to her health and wellbeing.

Commissioners to note the content of the patient story and cascade the information to relevant staff and member practices to assist with the promotion of this programme GPs and Health Professional to promote the course as it is currently underutilised by the CCGs in South Nottinghamshire Commissioners and providers to support the use of the information gathered from the participants to support commissioning intentions GPs to consider the use of member practice venues to enable additional courses to be held



You Said, We Did A ‘You Said, We Did’ Report has been collated (January to June 2014) and will be presented at all CCG patient groups. The report will be published on the website and will be available as requested. Generic PALS enquirers which would benefit the wider population are now incorporated within the report. This report will be produced on a quarterly basis.

You Said We Did

Deaf Awareness You Said…as a deaf parent accessing community services for my child I was asked “if I talk loudly enough do you think you will be able to hear me” What deaf awareness training do NHS staff receive?

We…as Commissioners and Providers take this matter very seriously. Each organisation is to look in to signing up to the British Sign Language Charter. A collaborative event with the Deaf Society was held in May 2014 which identified recommendations for organisations to work towards. A follow up event is scheduled for October 2014.

Flu Jabs You Said…has entitlement changed for free flu vaccinations on the NHS in 2014.

We…advised existing seasonal influenza for at-risk patients vaccination programmes are continuing after August 2014. The seasonal flu programme has been widened so that as from 1 April 2014 it mirrors the at-risk groups set out in the Green Book to include pregnant women, but excluding 204 year olds as they will be covered under the childhood flu programme.

Bus Stops – Nottingham City Hospital You Said…why has the bus stop at Nottingham City Hospital been moved to outside the maternity hospital. This creates a walk to the hospital entrance.

We…liaised with NUH who advised the bus stop was moved due to the car park changes with the theatre project, double deckers could not get past the canopy, and the single deckers were getting stuck behind parked cars collecting babies.

Talking Therapies You Said…you needed more information in relation to what happens to people once they have finished a Let’s Talk Wellbeing course.

We…liaised with the Clinical Lead at Let’s Talk Wellbeing Service who advised that: “Part of a patient's treatment with the Let's Talk Wellbeing Service is to prepare them for and teach them coping strategies for when they finish treatment. A relapse prevention plan is collaboratively formulated for each patient including signposting to further support if required. Part of the relapse prevention plan is an individualised plan as to what the patient will do if their mood deteriorates again in the future.”

Outreach Nurse provision You Said… at our recent Parish Council meeting concern was raised regarding the Outreach nurse provision in Sutton Bonington. Apparently Sutton Bonington is half a mile outside the area covered by the Outreach Service as you can appreciate this leaves residents in Sutton Bonington very disadvantaged. Can you please provide an explanation as to why this service does not cover all residents in Rushcliffe.

We… liaised with Nottinghamshire Healthcare Trust who confirmed that the Outreach Nurse covers the GP practice boundary area and not the geographical border. Therefore Sutton Bonington patients should receive the same level of service provided to other areas in Rushcliffe.



Continuing Healthcare – Transport availability for patient transitioning from child to adult You Said…my child is transitioning from child to adult fully funded care and we have been advised that the only way to access patient transport to community day centres is by having a Personal Health Budget which is something we do not wish to have responsibility for.

We…liaised closely with Continuing Healthcare Team to understand the circumstances of this particular case. A face to face meeting was arranged with all parties whereby it was agreed in the best interest of the patient that a private ambulance company would be employed to provide the transport that would best suit the patients’ needs without the family having to utilise a Personal Health Budget. Continuing Healthcare agreed to put the provision in place.

Patient Transport You Said… I am writing on behalf of Sutton Bonington Parish Council. At our meeting held on Monday 2nd June 2014 a complaint was received over the apparent change in policy with regard to carers being allowed to accompany a patient in the non-emergency patient transport. It appears that unless the patient has Alzheimer's or are mobility impaired they are no longer allowed to accompany the patient. The person concerned was not allowed to accompany her husband even though there was room in the vehicle and the lady offered to pay for the transport. Can you please inform the Parish Council what dictates the rules about patients and careers travelling together in the non-emergency transport.

We… advised the criteria has not changed recently and has been in place with Arriva/Ambuline since commencement of service on 1 July 2012 and complies with the Ambulance and other Non-Emergency Patient Transport Services: Operation, Use and Performance Standards’ *HSG 1991(29)+ published in 1991. This set out guidance for the NHS on the operation, use and performance standards for emergency and urgent Ambulances, superseded by the Eligibility Criteria for Patient Transport Services (PTS) document issued in August 2007.

Criteria documents available on request from PALS by calling 0800 0283693 (Option 2)

Meningitis B vaccination You Said…I understand that babies will soon be offered the meningitis B jab as part of routine vaccinations http://www.nhs.uk/news/2014/03March/Pages/Meningitis-B-vaccine-may-be-available-on-the-NHS.aspx My child is 18 months and I wondered about having him vaccinated – are there any practices offering this please or would I need to find a private clinic? I am due to have another baby later in the year – would they be included? Do you know the timescales please in our area?

We…contacted the Public Health Screening and Immunisation Team who advised that the Joint Committee for immunisation and Vaccination (JCVI) are recommending the introduction of the Men B vaccine into the national Childhood schedule. The Department of Health are working closely with the vaccine manufactures in the coming months with a view to introducing the vaccine as quickly as possible. Therefore it is not currently available at GP practices. Please see recent links with info below: The JCVI statement (and minutes) and DH response are available on GOV.UK at: https://www.gov.uk/government/news/meningococcal-b-vaccination-programme-to-be-introduced https://www.gov.uk/government/publications/meningococcal-b-vaccine-jcvi-position-statement The vaccination can be obtained privately at a cost of approximately £100 per dose. Under 1’s need 3 and under 2’s need 2 doses. Unfortunately, as an NHS organisation, we are unable to recommend private providers for the supply and administration of this vaccine.

http://www.nhs.uk/news/2014/03March/Pages/Meningitis-B-vaccine-may-be-available-on-the-NHS.aspx

http://www.nhs.uk/news/2014/03March/Pages/Meningitis-B-vaccine-may-be-available-on-the-NHS.aspx

https://www.gov.uk/government/news/meningococcal-b-vaccination-programme-to-be-introduced

https://www.gov.uk/government/news/meningococcal-b-vaccination-programme-to-be-introduced

https://www.gov.uk/government/publications/meningococcal-b-vaccine-jcvi-position-statement

https://www.gov.uk/government/publications/meningococcal-b-vaccine-jcvi-position-statement



We are awaiting further confirmation during the course of the year with regard to the actual implementation of this immunisation programme. Once information is available this will be cascaded to all primary care clinicians, e.g. GPs, health visitors, school nurses, practice staff etc. Your GP practice and health visiting team can provide you with more information once the programme is rolled out.



Patient Advice and Liaison Service Contacts with the PALS service CCG April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July

Anonymous / Out

of Area / City

41 34 40 47 14 9 12 20 16 8 13 29 24 9 17 18

NNE 30 24 30 13 23 14 18 17 11 17 22 25 18 20 14 14

NW 18 10 12 12 17 11 25 8 3 4 12 9 8 10 7 4

Rushcliffe 26 25 25 16 25 24 23 23 23 21 18 20 16 14 18 10

Totals: 115 93 107 88 79 58 78 68 53 50 65 83 66 53 56 46

Quality Report September 2014

Documents

Transcript of Quality Report September 2014