Community Health Care

Updated 22 June 2017

Community Health Care (Nutricia Ltd.) supports adults and children who need specialist enteral nutrition support. They do this through the part of their service called Nutricia Homeward. Additional nutrition is prescribed by doctors in liaison with dieticians and the specially made up formula and medical equipment is delivered. Patients who cannot take nutrition orally may need to take nutrition through tubes which have been surgically placed into their abdomen by specialist doctors. Nutricia Homeward provide ongoing nursing support and training for patients and carers to administer the enteral nutrition. This includes routine visits, urgent visits telephone support and out of hours telephone support. NHS Trusts and independent health providers negotiate contracts for the use of these services which are delivered by Nutricia Homeward under a service level agreement. There is a close working relationship between the NHS Trusts and independent health providers who liaise with Nutricia Homeward staff to ensure each patient receives the recommended care and treatment for their condition.

• Community Health Care has been registered with CQC since 13 April 2011. There have been two inspections carried out at this service. The most recent inspection was carried out on 3 February 2014 and showed compliance with regulations.
• The regulated activities are for treatment of disease, disorder or injury and the registered manager is Cheryl Mallet who has been in post since November 2015.
• We reviewed services provided in England only although the organisation provides services for patients in all parts of the United Kingdom.
• Nursing staff are home based and cover one of the10 regions in England. They visit a variety of locations to support their patients including patients’ own homes, hospitals, schools, clinics and care homes.

Updated 22 June 2017

Nutricia Homeward is part of Community Health Care (Nutricia Limited) which provides services for adults and children who have specialist feeding requirements. The organisation supplies and delivers nutritional feeds and provides nursing support for patients with feeding tubes. Community Health Care (Nutricia Limited) call their enteral feeding and nursing service Nutricia Homeward. Nutricia Homeward services are specific to patient nutrition. This report includes the Community Adults service and also reports on the services delivered to children and young people in the community, where appropriate.

NHS trusts, Clinical Commissioning Groups and independent health providers negotiate services with the organisation to form a contractual agreement. The organisation then deliver services under a service level agreement. The NHS trust or independent health providers who have commissioned these services retain overall responsibility for healthcare delivery to their patients and allocate a managing health care professional for each patient. This managing healthcare professional liaises with the organisation about the level of service and specific needs of each patient. The organisation and the managing health care professional coordinate the delivery of care for the patient regarding enteral feeding.

Nursing staff provide nursing care, support and training about enteral feeding for patients, their families and carers. This is in line with the service level agreement with the NHS Trust or independent health provider. The regulated activities for the organisation are to provide patients with treatment of disease, disorder or injury.

As of March 2017 Nutricia Homeward was supporting 22,797 patients in England. Of these 13,544 (59.4%) were adult patients and 9,253 (40.5%) were children and young people.

We found the following areas of good practice:

• Competency training for nursing and call centre staff equipped them to carry out the functions of their roles. Staff felt supported and valued by their managers.
• Staff followed policies and protocols to prevent and control infection.
• Staff showed respect to patients and their carers giving time and explanations which were suitable for their needs. Children were treated appropriately for their age and responses by the nurses to support them during emotional upset showed a clear understanding of children’s needs.
• There was good multi agency working. Nursing staff were clear on their scope of practice and when they needed to liaise with other health professionals.
• The organisation supported patients to maintain as much independence as they could. A travel and holiday service helped patients plan trips both in the UK and abroad.
• Staff showed a comprehensive understanding of best practice when it came to obtaining patient consent for both adults and children.
• Staff were flexible in the care they provided giving time to patients when they needed it, treating patients with sensitivity and compassion.
• The organisation showed commitment towards continual improvement. They engaged with service users to gather feedback on how to improve services for their patients and acted on information they received; collaborated with other healthcare professionals to research improvements in care; used secure mobile technology to improve the services provided for patients.

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

• Some staff were not aware of the impact that reporting incidents and near misses could have on patient safety. They were not always aware of what type of incident or near miss needed to be reported.
• Some staff seemed unsure of what constituted a safeguarding concern and how to report it without their manager’s support.
• There was no written information about procedures that was suitable for patients living with learning disabilities or dementia. Staff adapted the information used for children.
• There was some governance of procedures to promote patient safety but overview at a senior level was not embedded. However, processes were being developed to improve oversight.
• Fit and proper person processes and procedures were not robust.

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, even though a regulation had not been breached, to help the service improve. We issued the provider with two requirement notices that affected the adults and children’s services. Details are at the end of the report.

Updated 22 June 2017

• Staff followed policies and protocols to protect patients from experiencing avoidable harm.

• Training for staff was effective and thorough to enable them to fulfil their roles.

• There was good multidisciplinary working. Nursing staff were clear on their scope of practice and when they needed to liaise with other healthcare professionals.

• Staff showed a comprehensive understanding of best practice for obtaining patient consent.

• Staff responded appropriately to the needs of patients and their carers.

• Treatment was only delayed or cancelled when absolutely necessary.

• Where targets were not being met, the organisation investigated reasons why.

• Patients were supported to be independent.

• There was focussed commitment towards continual improvement and innovation using patient feedback and conducting research.

• Managers were visible, approachable and supportive.

However;

• Staff were unsure of what should be reported as an incident or near miss.

• Staff were unsure of what a safeguarding concern would be.

• Staff did not have access to written information for patients with learning difficulties or dementia.

• Some governance of the procedures for patient safety were in place but more detailed procedures were in development.

• Fit and proper person processes for director level and were not robust.