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Care Quality Commission report says West London District Nursing requires improvement

Following an inspection between 22 November 2022 and 23 November 2022 of West London District Nursing Service, the Care Quality Commission (CQC) has said that it requires improvement.

West London District Nursing service, based at West London NHS Trust is part of Ealing Community Partners and has said: “We recognise that there are some areas we have fallen short and need to improve, highlighted by this recent report. We welcome this feedback and are working to address it as quickly as possible.”

Care Quality Commission report
Care Quality Commission report

The CQC said this was the first inspection of the service and it was rated Safe as requires improvement in a number of areas which it highlighted:

Not all staff completed monthly pressure ulcer risk assessments for patients with pressure ulcers or a malnutrition universal assessment screening tool (MUST) for patients at risk of malnourishment.
Staff did not use a standardised tool to assess patients who were at risk of physical deterioration, such as the National Early Warning Score tool (NEWS2) tool.
Although staff completed detailed assessments and care plans for patients, records we looked at were not consistently updated after each patient visit.
Although actions from environmental audits were carried out in a timely way, this was not reflected in the recording of updated action plan documents.

The CQC also highlighted in its report areas where the Trust is doing well:

The service had enough staff, who knew the patients and received basic training to keep them safe from avoidable harm. Staff told us that staffing had improved within the last 2 years.
Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff assessed and managed risk and followed good practice with respect to safeguarding.
Staff completed standardised risk assessments for all new patients. Staff considered patients’ needs holistically in daily handover meetings. We saw evidence of good interagency work, for example liaison with GPs, tissue viabilit nurses and the palliative care team.
Managers investigated incidents and shared lessons learned with the whole team. The service used systems and processes to safely administer, record and store medicines.
Managers assessed staff competency to care and treat patients. The service had an experienced nurse practitioner to support staff with induction, sign off on competencies, identify training gaps and liaise within the training department about staff training needs.
Infection prevention and control measures protected people and minimised the risk of infection. Staff could obtain specialist equipment for patients when they needed to.
The service had developed a wound care application in partnership with an external provider. Staff were able to use an application on their mobile phones to scan a wound. The application was able to identify certain information
about the wound, such as the type, width and depth of the wound. Staff were then able to upload the photo onto the patient’s electronic records.

In areas for improvement, the CQC stated:  “The trust must ensure that staff use a standard tool to assess patients who were at risk of physical deterioration.The trust must ensure that staff regularly complete and update documentation as required. Including pressure ulcer
risk assessments, wound care plans and malnutrition universal screening tools. It also said the trust should ensure that actions are updated and on the environmental audit.”

Dr Claire Dillon, director of integrated community health services West London NHS Trust, on behalf of Ealing Community Partners said: “We welcome the recent visit by the CQC inspection team and their feedback on our district nursing services, so that we can continue to improve the care we provide to local residents in Ealing.”

Dr Dillon added: “I am however pleased to see that a lot of positive practice was also observed in this latest inspection, including the outstanding care noted in relation to the innovative use of technology in wound management. We will work quickly as a team to address the areas that have been highlighted as requiring improvement to bring our care up to the required standards”.

Stephanie Bridger, chief nurse, West London NHS Trust commented: “We are incredibly proud of our community nursing staff and the care they provide in what has been a difficult winter for the NHS. However, we recognise that there are some areas we have fallen short and need to improve, highlighted by this recent report. We welcome this feedback and are working to address it as quickly as possible.”

Click here to view the CQC report.

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