During the visit appointments were made for us to speak with seven mothers using the service. We also spoke with three family nurses who supported them as part of the scheme. These comments are from the young mothers:

“I like this programme because I do not feel that I am judged. The FN is always there to support, help and really understands me. I can discuss anything with my FN”.

“I see my FN whenever I need her. She gives me practical help and advice”.

“I needed help with money and support when the father of my baby left. I needed emotional support and my FN was there for me”.

“I feel due to being on the programme I have found my relationships have really improved. This is really noticeable with my mum. She has become my friend”.

“The Family Nurse Partnership programme has taught me things that I did not know before, such as options with housing. It has helped me to know about before the birth and after the birth. It has given me confidence. I can talk with strangers now I could not have done that before. I am able to give my FN feedback on how I am progressing and how I feel every time she visits me”.

The young mothers who spoke with us did not identify any issues or concerns with the staff employed at Ripplez. They were aware of the safety measures in place provided to protect them.

We spoke with six family nurse practitioners and twelve expectant or new mothers. Comments from the mother’s included; “the family nurse helps me to check my appointments and to get suitable accommodation. She has helped me to prioritise how I spend my money. She helped me to manage myself better so that I will consider getting nappies and baby food first. The family nurse is always reliable, always turns up when she says she will. She lets you know if she is running late".

“When the programme ends at two years, all I wish is that every one could have a family nurse. There are no pressures put on you, you are not told what to do just plenty of reassuring guidance. They make you realise you had these qualities all along. They make you realise you all have something in common at all stages, all ages, all back grounds and there are no judgements on you”.

Another mother told us, “I think the nurses provided at Ripplez really care about you. They are well trained and always seem to know what to do. I think the service works well”.

We saw that if concerns were raised there were procedures in place to help deal with them in a timely manner.

Inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We did not rate the services provided by Ripplez Community Interest Company (CIC).

We found

• There were robust incident reporting systems and examples of shared learning.
• Staff at all levels of the organisation understood their responsibilities to protect clients from avoidable harm. Staff had received safeguarding training to an appropriate level.
• Comprehensive client risk assessments were carried out during the course of the family nurse partnership (FNP) programme.
• The provider had a clear policy and systems in place to ensure client records were kept secure.
• Staffing levels and case-loads were in line with FNP national unit licensing requirements.
• The FNP programme was delivered in line with the licensing requirements set out by the FNP national unit. Family nurses were well trained and supported to deliver the FNP programme and received regular clinical and psychological supervision. All staff within the organisation had received a meaningful appraisal within the past 12 months. All staff had completed the required mandatory training.
• There was strong evidence of multidisciplinary working with other health professionals and organisations outside of the service.
• There was a strong client-centred culture. Staff were highly motivated and provided individualised and compassionate care. Clients we spoke with told us staff were kind and caring. Staff communicated with clients in a way they understood. They took time to identify what was important to the client and involved them in the planning of the programme. Client’s emotional and social needs were highly valued by staff and were embedded in their care.
• Ripplez CIC was delivering the FNP programme in partnership with local commissioners. In addition, they were developing innovative, cost effective models of care such as the families first model and community parenting programme.
• Family nurses used interpreters for non-English speaking clients and limited the number of non-English speaking clients for family nurse caseloads.
• There had been no formal complaints about the provider.
• The organisation had a clear vison, values and strategy, which was shared by all staff. There was an effective clinical governance framework in place. Service leads demonstrated they understood organisational risks and were positively managing these through action plans and regular review.
• Staff spoke positively about managers. They told us both the chief executive and clinical director were approachable, visible, and cared about staff members as individuals. We found there were very high levels of staff satisfaction and engagement across all groups of staff.