We carried out an announced comprehensive inspection on 22 November 2016 to ask the service the following key questions: Are services safe, effective, caring, responsive and well-led?

Background

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the service was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

LymphCare UK is a community interest company and a social enterprise that provides comprehensive community lymphoedema services in Dudley and Sandwell.

The service runs from West Plaza Clinic at West Bromwich. The service also provides a home visiting service for patients that are housebound. This is one of three clinics which operate under LymphCare UK.

The service accepts referrals from any healthcare professional across Sandwell and Dudley. The service provides care to patients with all types of lymphoedema, primary or secondary, from chronic oedemas to lipoedema. Lymphoedema is a condition of fluid retention and tissue swelling in limbs caused by a compromised lymphatic system.

LymphCare UK is a specialist nurse led lymphoedema service. There are 11 members of staff employed by LymphCare UK, all the staff worked across three locations. The leadership within the organisation runs from the specialist clinical team and interacts with both the operational and executive boards. Both joint managing directors are also clinical nurse specialists within the service.

The West Plaza clinic is based at the Premier Inn hotel in West Bromwich. It consists of three treatment rooms and a very large waiting area with rest room facilities. Lifts facilities were available for wheelchair users. It is a small organisation, open Monday to Friday 8:30am to 5pm.

We gathered information from a number of sources, including data provided by the clinic prior to our inspection. During our inspection, we visited all areas including the clinics and home visits; we spoke with healthcare assistants, nurses, the administration team and two registered managers for LymphCare UK. We also spoke with patients including relatives. In addition, we spoke with the patient booking team who managed the appointments system.

During our inspection we were informed by management that, unfortunately, they had lost their tender to renew their contract with the Clinical Commissioning Group (CCG) this was due to finish March 2017. This meant some staff were offered to work with the new provider or work across the other two clinics. As of April, 2017 patients will be seen by the new provider. We took this on board when speaking with staff.

Our Key Findings:

• Patients received safe care and treatment in a suitable environment.
• Staff treated patients and their families with dignity and respect.
• Staff responded to each patient to meet their individual needs.
• The management team met regularly to review and monitor risks and were dedicated to improving their service.
• Suitably trained staff provided assessments, undertook reviews and offered support to patients and their families.
• Leadership was clear and open and the managers were accessible to staff and patients.
• The senior management team sought feedback from patients and made improvements from this feedback.

We identified regulations that were not being met and the provider must:

• Ensure that staff maintain an accurate, complete contemporaneous record in respect of each patient and that they keep this information up-to-date.
• Ensure written consent is documented correctly and clearly in patient notes.
• Ensure there is a local risk register in place to provide overview of local risks.
• Ensure all staff are up to date with basic life support training.

You can see full details of the regulations not being met at the end of this report.

There were areas where the provider could make improvements and should:

• Review staff personnel folders.
• Review the data capturing for mandatory training to ensure all staff training is recorded and kept up-to-date.
• Review the incident reporting process to ensure all reported incidents are collated.

This specialist nurse led lymphoedema service provided an organised, professional and caring service to the local community. We spoke with six people who used the service. All the people we spoke with were happy with the service they received and were complementary about the staff. We spoke with four members of staff who told us they felt supported and encouraged to undertake training to enhance their skills . This showed that people receiving a service and the staff felt happy about the service.

People's needs were assessed and consent obtained prior to commencing treatment. One person told us , " At my first appointment X went through everything". Another person told us "They gathered information so that they understood the whole person." This showed that people felt involved in their treatment.

People we spoke with told us they knew what treatments they were to receive. They were given appointments in advance. One person told us, "It was easy enough to change an appointment". Another person told us, "They fit me in so that the appointments don't affect my work". Everyone we spoke with told us they did not have to wait longer than five minutes to be seen. We saw that some people were seen at home if they had mobility difficulties. This showed that people were treated as individuals and the service was flexible to their needs.

People told us they felt comfortable in the presence of staff. Staff spoken with were knowledgeable about safeguarding procedures which meant people could be assured of being protected from abuse.

There were effective recruitment procedures in place which assured people they would be cared for by appropriately qualified and skilled staff.

There was a system of quality monitoring to protect people from unsafe practices.