We telephoned three people to gather their thoughts of the service being provided. All three were receiving treatment and education from nurses working for Ashfield in2focus. We were also able to talk to two nurses during our visit to the service.

People told us that they were provided with lots of information about the service. One person explained, “they [the service] sent me a big folder and they went through it all.” Another person told us, “they [the nurses] couldn’t have been more helpful; we received a folder and everything was in there.”

We were told that people knew what to do if they had any worries or concerns. One person told us, “they told me about the people I could ring up if I needed anything and they gave me a booklet with all the numbers in.” Another person explained, “I’ve got their numbers and they actually ring me to find out how I am.”

People told us that they were very satisfied with the treatment and education that they had received. One person told us, “the nurse was excellent, first class.” Another person explained “they worked at my pace and I didn’t feel rushed, they explained everything thoroughly and that was important to me.”

Nurses spoken with told us how much they enjoyed working for the service. One nurse explained, “there’s loads of training and we are all well supported.” Another nurse told us, “we are well supported and there is always someone available to talk too if we have any issues, patient care is paramount.”

Services we do not rate

We regulate independent community health services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• Staff were aware of their roles and responsibilities in the reporting and management of incidents.
• The service had not reported any incidents from March 2016 to March 2017.
• Staff were knowledgeable about the duty of candour policy and could describe what actions needed to be taken when applying this legislation.
• The service ensured the health and safety of its employees. The office premises were well maintained and visibly clean. We observed security arrangements that protected the staff and premises.
• We saw there was an effective system in place to protect patient information.
• The provider had an infection control standard operating procedure which staff were knew and followed
• There were effective risk assessment processes in place.
• The service had a ‘travel emergency response’ plan which identified actions to manage any risks in the event of a disaster or a major event where the provider’s ability to provide the infusion service was severely compromised. The managers and staff we spoke with were aware of the Travel Emergency Response plan.
• Patients attending the service were assessed on referral and the times and dates for the infusion regime identified.
• All patient details were stored on an electronic patient record system (EPRS) and were also available off-line.
• Staff had regular clinical supervision with their peer group.
• The service had access to all the information needed to deliver effective treatment. This included risk assessments, care plans, case notes and test results
• The provider had a standard operating procedure (SOP) for obtaining consent. This provided clear guidance on the on the legal and practical implications of consent to examination or treatment by an Ashfield Healthcare employee, and the recording and use of patient confidential information.
• Patients we spoke with said they were treated with compassion and respect and staff were caring in all interactions we observed.
• Staff took time to explain the treatment to patients.
• Staff were responsive to the emotional wellbeing of patients, allowing additional time for support to patients.
• Relationships between people who used the service, those close to them and staff were strong, caring and supportive.
• The service had an equal opportunities policy and a standard operating procedure to define the process for the delivery of healthcare services to patients who did not speak English as a first language.
• Patients we spoke with told us the service was flexible and met their needs. Appointments for treatments were arranged to suit the patients and could be reorganised within reasonable limits and different geographical locations within the United Kingdom.
• Patients were seen within their homes following three completed risk assessments before each infusion.
• There were no complaints for this service for the period January 2016 to January 2017.
• The organisation had a clear strategy for the service.
• The organisation had clear vision and values. Managers developed the vision and values in consultation with staff through a series of workshops and events. All staff we spoke with knew about and demonstrated enthusiasm for the vision and values.
• Staff we spoke with spoke positively about managers.
• There were high levels of staff satisfaction and engagement. Staff were proud to work for the organisation and spoke highly of the culture.

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

• There was no programme of specific infection or prevention control audits. We requested information from the provider about infection and prevention control audits and their outcomes but did not receive these.
• The service issued nursing staff with blood pressure monitoring equipment, thermometers for checking patients’ temperatures and scales for weighing patients. The system for checking this equipment was not effective
• Whilst medicines for infusion were appropriately managed, we were not assured that there was a proper and safe process for the management of epi-pens and anaesthetic spray.
• Whilst staff were knowledgeable about how to protect patients from abuse, we could not be assured staff had received the correct level of training according to the intercollegiate document competency framework, which is a national recommended guidance.
• Ashfield Healthcare were initially not able to provide us with a complete overview of this service and the detailed information we requested before the commencement of the inspection.
• The service did not routinely monitor the outcomes of people’s care.
• Clinical performance audits were not undertaken, which meant Ashfield Healthcare could not benchmark their service against similar providers or identify areas for improvement.
• The service undertook four organisational audits; however, these audits were not relevant to the service we were inspecting.
• Although there was a clinical governance structure in place we were not assured the service leads were managing all of the risks to the service due to there not being any specific infection and prevention control audits or audits of equipment used.
• Prior to and during our inspection, the information provided to us by senior leaders was not always correct and consistent. We were concerned the senior leaders did not appear to understand how their service came under the scope of regulation.
• Following this inspection, we told the provider that it should make improvements to help the service improve. Details are at the end of the report.