We spoke with two people who were attending a clinic during our inspection. One said "This is an excellent service". Another told us "The staff are really helpful and caring". People who use the service were given appropriate information and support regarding care and treatment.

Staff were well supported and displayed up-to date knowledge of their specialist field of audiology and hearing loss. They maintained clear and accurate treatment records which protected patient confidentiality. Treatment plans were comprehensive, appropriate and tailored to people's individual needs. Patients' privacy, dignity and independence were respected.

Unexpected events were analysed and used as learning opportunities. The quality of treatment and care was monitored and the results of clinical audits were used to improve practice if necessary.

This was the service’s first inspection since registering with the Care Quality Commission. The provider offered diagnostic and rehabilitative hearing care for adults and children. Referrals were accepted for hearing tests, results were discussed and treatments agreed with the patient or their representative. If hearing aid amplification was recommended it was provided as an NHS service. The provider also accepted referrals for hearing therapy, balance work or tinnitus services. As a social enterprise company profits were reinvested to ensure free services for patients.

At this inspection we looked at a range of assessment and support services available at one hospital location. This was the main base for the provider. We met eleven staff and spoke with three people at the service. We found that people's care was managed well;

People’s views and experiences were taken into account in relation to their care. People experienced treatment and support that met their needs. Staff were trained to ensure that people were safe. Staff knew whom to report concerns about safety to protect individuals from the risk of harm or abuse. Measures were in place to provide a clean and hygienic service.

We found that people received services from suitably skilled staff and that there were enough staff to meet current demand at the service. The records we saw were up to date and well ordered. People’s confidentiality was respected and maintained because records were securely stored.

Chime Social Enterprise provides audiology assessment and treatment for adults, and children and young people. Only audiology services for children were included as part of this inspection as audiology services for adults are not currently required to be registered with the Care Quality Commission. This report includes the community children and young people core service.

The regulated activities are diagnostic and screening procedures and treatment of disease, disorder or injury.

Chime is a community interest company. This means that any surplus of funds is reinvested into the organisation to improve NHS services. Chime has a contract to offer NHS children’s audiology services, free at the point of delivery on behalf of NHS Northern, Eastern and Western Devon Clinical Commissioning Group. At the time of our inspection a re-tendering process was underway.

Chime accepts referrals from health, social care or education professionals for children living in Exeter, Mid- and East Devon. It provides detailed hearing assessments, advice and appropriate management of permanent hearing loss. This includes fitting hearing aids and other appropriate listening devices together with specialist advice and information. Chime carries out a variety of different tests, depending on the age and ability of the patient and whether they have any complex hearing problems, including hearing loss and tinnitus. Some children under three years of age are seen as part of the new-born hearing screening programme. Once tests are completed the team make recommendations and provide appropriate treatment. Patients attend the audiology service as outpatients or are seen in their own homes. Staff also visit schools and a community group setting.

During April 2016 to March 2017, Chime carried out a total of 51,689 episodes of care. Of these, 7,216 (14%) were with children and young people.

We regulate this service but we do not currently have a legal duty to rate it. 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 confident to identify and report safeguarding concerns.
• Staff knew how to report incidents. There had been prompt investigation and learning from a serious incident that was shared within the team and with other audiology services.
• Facilities were clean and equipment was in calibration and well maintained.
• There was sufficient staffing and fluctuations in demand were anticipated effectively.
• There was good compliance with mandatory training for safeguarding level two and three and for moving and handling, conflict resolution and prevention of radicalisation training.
• The service had recently been awarded Improving Quality in Physiological Services (IQIPS) accreditation. IQIPS is a professionally led programme with the aim of improving services, care and safety for patients undergoing physiological tests, examinations and procedures.
• All staff were qualified to carry out their role and were given opportunities to develop and share their skills.
• Current evidence based practice was used to develop and deliver treatment. The service used up to date technology to obtain good outcomes for patients.
• Teams worked effectively with other services for the benefit of patient care.
• Patients who moved from children’s to adults services were prepared for this transition in a coordinated way. Staff respected the confidentiality of patients and their families.
• Staff involved parents of patients throughout the consultations and provided comprehensive explanations of symptoms and treatment options.
• Information leaflets for patients and their families had been upgraded to explain what to expect from the hearing assessment and how parents could help children to benefit from their audiology treatment.
• Patients were offered appointments at a range of locations including home visits for very young babies.
• When paediatric patients required audiology assessment or intervention, they were assessed within six weeks and treated within 18 weeks. This met the standards set by the clinical commissioning group.
• Staff viewed the leaders of the service as knowledgeable, approachable and supportive.
• Leaders were focussed on the forward vision for the service.
• Staff demonstrated the values of the organisation and were engaged with the service strategy.
• Staff enjoyed their work and were committed to providing effective and patient centred care. Teamwork was valued and nurtured both within the service and with external agencies.

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

• Not all staff were up to date with mandatory training; in particular there was low compliance with fire safety, infection prevention and control, basic life support and paediatric life support.
• There was a detailed risk register but this did not contain clear arrangements for reducing the impact of risks and timeframes for when this should be completed and by whom.
• There was no documented method by which key safety and quality information was regularly reported on and challenged by the board as part of the board assurance process
• Staff did not always comply with the organisational policy for infection prevention and control
• Staff had not participated in duty of candour training
• In waiting rooms at locality clinics there no toys or diversional activities for children.
• Children were not always encouraged to voice their opinions during audiology appointments
• The provider did not always signpost children and their families to resources for emotional support where applicable
• Patients and their families were not routinely provided with information about how to complain about services

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, to help the service improve. We also issued the provider with two requirement notices that affected the children’s services. Details are at the end of the report.