inspection report - cqc.org.uk

Inspection Report

We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

HMP/YOI Feltham HMP Young Offenders Institute, Bedfont, Feltham, TW13 4ND

Tel: 02088445454

Date of Inspection: 21 January 2013

We inspected the following standards as part of a routine inspection. This is what we found: Respecting and involving people who use services

Met this standard

Consent to care and treatment Met this standard Care and welfare of people who use services Met this standard Cooperating with other providers Met this standard Cleanliness and infection control Met this standard Safety and suitability of premises Met this standard Supporting workers Met this standard Assessing and monitoring the quality of service provision

Met this standard

| Inspection Report | HMP/YOI Feltham | January 2013 www.cqc.org.uk 1

Details about this location

Registered Provider Central and North West London NHS Foundation Trust

Overview of the service

Her Majesty’s Young Offenders Institute (HMYOI) Feltham accommodates young men aged between 15 and 21. The location is made up of Feltham A for 240 15 to 18 year olds and Feltham B for 494 18 to 21 year olds. Central and North West London NHS Foundation Trust is the lead contractor for the Integrated Health Service. The Trust subcontracts some GP, sexual health and mental health services to other providers. They run a variety of clinics in the outpatient department to review and treat long-term health conditions such as asthma, epilepsy and diabetes. Young people can also see a dentist, optician and speech and language therapist there. There is also a radiography service. The dental provision is contracted and managed separately by the PCT.The Trust runs Wren unit, a14 bed inpatient unit for detoxification and treatment for young people and young adults with substance dependency or physical health needs. The Trust subcontracts mental health services to West London Mental Health Trust. This comprises a community mental health team offering treatment and support in Feltham, including Albatross Unit, a 10 bed mental health inpatient unit.

Type of service Prison Healthcare Services

Regulated activities Diagnostic and screening procedures

Treatment of disease, disorder or injury


Contents

When you read this report, you may find it useful to read the sections towards the back called ‘About CQC inspections’ and ‘How we define our judgements’. Page Summary of this inspection:

Why we carried out this inspection 4How we carried out this inspection 4What people told us and what we found 4More information about the provider 5Our judgements for each standard inspected:

Respecting and involving people who use services 6Consent to care and treatment 8Care and welfare of people who use services 9Cooperating with other providers 12Cleanliness and infection control 13Safety and suitability of premises 14Supporting workers 15Assessing and monitoring the quality of service provision 16

About CQC Inspections 17How we define our judgements 18Glossary of terms we use in this report 20Contact us 22


Summary of this inspection

Why we carried out this inspection

This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection.

This was an unannounced inspection. How we carried out this inspection

We looked at the personal care or treatment records of people who use the service, carried out a visit on 21 January 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We sent a questionnaire to people who use the service, talked with people who use the service and talked with staff. What people told us and what we found We used the findings of a survey of 155 of the young people carried out the week prior to the inspection by Her Majesty’s Inspectorate of Prisons and we met with a group of six young people, and two young people individually. We met a selection of staff; the prison governor, Head of Health Care, Head of Primary health care, a Clinical Team leader, nurses, psychiatrists, a psychologist, dentist, gym staff and unit officers. We observed two nurses when they were interacting with young people in the health care unit. The survey found only 32% of young people thought the quality of health care in the prison was good or very good. The national comparator was 66%. This meant that young people at Feltham were much less satisfied with the quality of health care than young people at most other young offender institutions in this country. We asked a group of six young people to tell us one thing that would improve the health care services and they said “quicker.” They said there were long waiting times to see a doctor. One young person said that they could see a nurse the day they asked for one but , “Doctor takes time.” We found good availability of GP appointments but young people were not happy with the processes in place to help them see a GP.They felt they did not always have enough information or involvement in the process.One young person said he was happy with the primary health care service and that staff had given him the information and treatment he needed. Another young person said he was not happy as he did not have enough information about his health condition and was waiting for a consultant appointment, which had been requested. There was a range of good health care services provided and good quality assurance procedures in place to monitor quality of care. The provider was aware that there was a need to improve nurses’ communication with young people, attendance at GP appointments and young people’s satisfaction with the health care service. Ongoing treatment and support was provided to young people with long term medical | Inspection Report | HMP/YOI Feltham | January 2013 www.cqc.org.uk 4


conditions and mental health needs, including inpatient care where needed. There were good relationships with other providers both within and outside Feltham to help provide a good coordinated service to young people for both physical and mental health care. There had been recent improvements in infection control standards at the time of our inspection but there was concern that records showed standards had not been maintained at all times. Young people were cared for by staff who were trained to deliver care and treatment to an appropriate standard. There was a risk that recent inability to continue ongoing mental health awareness training by West London Mental Health Trust staff to all staff could lead to staff not understanding young people’s mental health needs, which in turn could impact on young people’s care. You can see our judgements on the front page of this report.

More information about the provider

Please see our website www.cqc.org.uk for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions.

There is a glossary at the back of this report which has definitions for words and phrases we use in the report.

Our judgements for each standard inspected

Respecting and involving people who use services Met this standard

People should be treated with respect, involved in discussions about their care and treatment and able to influence how the service is run

Our judgement

The provider was meeting this standard.

There was good availability of health care and the heads of health care were proactive in seeking young people’s views, but young people felt they were not sufficiently informed and involved in the way the primary health care is run to ensure they were at the centre of their care. Reasons for our judgement

We found that young people had a health screening when they were admitted. For those who did not speak English, there was a telephone interpreting service available so that they could tell prison staff their health needs. All the young people said they saw a nurse on the same day they asked to, but said they felt it took too long to see a doctor. We checked a sample of waiting times to see a GP and the waiting time was only a day or two and there were appointments available, but young people were dissatisfied with the process to get an appointment. They had to make a written application then would be seen by a nurse. The nurse would decide if they needed to see the GP and then an appointment would be made to see the GP. We discussed this process with an officer who said that unit staff had to be available to take the young person to see the GP so the appointment had to be made when the staff were available to do this. Staff told us that the appointment slip was given to the officers on each wing. It was not clear if the process and the appointment date were clearly communicated to young people or whether they were given a written appointment slip as confirmation that they would see the GP. We found that young people did not always attend the appointment they had requested. Young people said their appointment sometimes clashed with other things they had to do such as education. The Head of Primary Health Care told us she planned to start a system where the health care staff would go and tell young people they have a GP appointment the day before the appointment and, if they do not attend, visit them the next day to find out why they did not attend. They hoped this would reduce the number of missed appointments. This may also help staff to ensure they book appointments at a time that best meets the young people’s needs. We met with the Head of Health Care at Feltham. She told us that she had arranged two



meetings for young people in December 2012 to discuss their views on health care. She said that young people had raised some concerns about the attitude of nurses and did not feel they were properly listened to and sometimes not treated with respect. Both the Head of Health Care and the Head of Primary Care told us that they were working with the staff team to try and improve the quality of communication with young people. They were both aware that young people were not satisfied with the health service provision. We met one young person who was waiting for a referral to a hospital consultant. This young person said he had been told he would see this consultant within two weeks and that he had not been kept informed. We discussed this with a staff member and saw that a referral had been made. The young person said he had not been given any information about his health condition and felt very anxious about it. Two young people said some nurses were not responsive to their needs and that, although they came to see them on request, they did not always find them helpful. The provider may find it useful to note that young people’s views and experiences were not always taken into account in the way the primary health care service was provided. They were not always provided directly with enough appropriate information and support in a way they understood in relation to primary health care. We saw written records showing young people in the inpatient units had regular community meetings where they discussed things they would like to improve. This was evidence of some good consultation with young people. We made an improvement action at the last inspection as young people on the inpatient units had a lack of privacy due to having no curtain. The provider had informed us that Velcro curtains were available subject to a risk assessment for young people. We visited Albatross unit and saw that these curtains were not in place in young people’s cells. Staff told us the curtains were available on request but said they had not told young people they could request curtains. The provider may find it useful to note that staff not telling young people that curtains were available, meant that young people’s privacy was not being respected.

Consent to care and treatment Met this standard

Before people are given any examination, care, treatment or support, they should be asked if they agree to it

Our judgement


Where young people did not have the capacity to consent, the provider acted in accordance with legal requirements. Reasons for our judgement

We checked this standard as we made an improvement action at our last inspection in May 2011. We found that the Trust had made the improvements. We spoke with two psychiatrists. They told us that they assessed young people's capacity to give consent. They told us that where there was any doubt that a young person could give consent to treatment they would assess their capacity. The template used was specific to each decision. This meant that young people would be assessed as being able to decide for themselves about whether to accept health treatment, but where they were not able to do so support would be provided to them. One psychiatrist told us that in these cares, a best interest meeting was held to help make the right decision for the young person. They told us that each young person had a health screening when they arrived at Feltham. This included screening to see if they may have a learning disability or other issue which may indicate they may not be able to give informed consent. Young people did not raise any concerns with us about consent. Young people signed consent forms to enable their medical records to be shared with other professionals. They could choose not to have their information shared with others, for example their family, if they wished. Young people gave verbal consent and also signed consent to treatment forms that cover a range of treatment options including medication. Young people had access to independent advocates and the Independent Monitoring Board visited regularly. In an emergency, the prison governor could act as guardian for young people, if one was not available.


Care and welfare of people who use services Met this standard

People should get safe and appropriate care that meets their needs and supports their rights

Our judgement


Care and treatment was planned and delivered in a way that was intended to ensure young people’s safety and welfare. A range of physical and mental health services were available. Young people experienced care, treatment and support that met most of their needs but were dissatisfied with some aspects of health care. Reasons for our judgement

A survey carried out by HM Inspectorate of Prisons the week prior to our inspection showed only 32% of young people thought the quality of health care in the prison was good or very good. The national comparator was 66%. 40% of young people at Feltham said it was easy to see a doctor, compared to 65% in other institutions. We asked eight young people what they thought of the health care service that they had experienced. One young person said he was happy with the care he had received. He said he had a non urgent health concern and that from the time he had asked to see nurse to the time he had seen the GP was 4-5 days. He said he was happy with this; he understood the treatment and knew when and how he would be given the medication prescribed to him. The other young people we spoke with were not satisfied. They felt it took a long time to see a doctor. One said, “doctor takes time, dentist takes time.” Dental services were provided by a private dentist, Dr Abdul Khan. We have carried out an inspection of dentalservices which are contracted separately by the PCT. Only one young person raised concerns about the quality of care provided by the doctor and that was about providing information he could understand about his condition. The others said it was “good” or “not too bad.” Staff on one wing told us that if no staff are available to take a young person to GP appointment then the appointment is not automatically rearranged and they have to make a new application, and that some young people have missed their morning medication because the nurse comes at a time when they are in education. We did not see evidence of this. The young people we asked said they got their medicines on time. The provider may find it useful to note that if there is any failure to ensure young people saw their GP when needed or any failure to ensure they had their prescribed medicines at the appropriate time then there is risk that their health needs may not be met. We met the GP who was a locum working for four weeks. He told us that he had extensive experience working in prisons and thought the health care provided in this prison was good. We looked at provision for young people with long term medical conditions. We saw that health care staff had the names of every young person who had a long term condition. Nurses ran clinics for young people with epilepsy. We looked at the medical records for, and met, one young person with epilepsy. The young person said he felt vulnerable and was not confident that he was being looked after properly. We met with a member of staff | Inspection Report | HMP/YOI Feltham | January 2013 www.cqc.org.uk 9


in the prison gym. He told us that they offered remedial gym sessions twice a week for young people who have pre-existing medical conditions and a controlled gym programme for young people who have epilepsy. There was a treatment room where young people with type 1 diabetes attend for blood sugar monitoring. We saw that each young person had their own box labelled with their name with the equipment they needed. There was also ongoing monitoring and care for young people with asthma by specially trained nurses. There was an optician and radiology service in the health care unit. The GP called in a radiographer when a young person needed an x ray. Staff told us that if a young person had a suspected fracture they would be taken straight to the local hospital. These services all provided ongoing support for young people with medical needs. Wren unit was an inpatient unit which could accommodate fourteen young adults and young people who had substance misuse needs for detoxification and treatment, or physical health needs. At the time of this inspection there were no young people (only five young adults) in Wren unit. Staff told us that from 1 April when there will be a new health care provider at this prison, Wren unit will look after young people and young adults with mental health needs as well as those who need treatment for substance misuse and physical health needs. None of the young people we met had been to Wren unit so had no comments about the care provided there. The other inpatient unit in the prison was Albatross unit. This was a ten bed inpatient mental health unit. At the time of the inspection there were two young adults but no 15 to 18 year olds staying on Albatross. There were two nurses and a psychiatrist working in the unit when we visited. Young people there could take part in yoga and art therapy if they would like to. There was a gated cell for young people who required constant observation. None of the young people we met had any experience of Albatross unit so could not comment on the care provided there. All young people received initial screening on arrival and those with a high level of drug and/or alcohol use were immediately referred to the clinical substance misuse service. Appropriate first night treatment provision was in place, but clinical need was low. In the past 12 months, 13 young people had been admitted to Wren unit for observation and treatment. Seven completed alcohol detoxification and three had required opiate substitute regimes. Outpatient support was available for those who needed it. Primary care and substance misuse nurses were trained to deliver smoking cessation advice and young people could access nicotine replacement therapy on their first day after a follow-up health screen. An average of 15-20 young people per month used nicotine replacement therapy.

There was good care coordination for young people with a high level of need requiring specialist interventions and the clinical substance misuse team worked jointly with youth offending teams to ensure treatment continued when young people were released. A specialist and experienced clinical substance misuse team offered a high level of clinical and psychosocial support.

West London Mental Health Trust provided psychology and psychiatry services in the prison. A Community Psychiatric Nurse was available seven days week to work with individual young people. The prison governor told us that youth counselling is offered to all young people. The psychologist told us that cognitive behaviour therapy and life skills work was provided to individual young people as needed. The community mental health team in the prison attended weekly meetings with the behaviour management group so that young people with mental health needs received support and help. The psychiatrists told us that any young person who requested it could be seen by a psychiatrist and every young person receiving treatment had an assessment and treatment plan. They were not


given a copy but could have one if they requested.

Young people benefitted from a speech therapist who worked with them and also advised prison staff on how to communicate with young people who had additional communication needs.

There were arrangements in place to deal with foreseeable emergencies. We saw that there was emergency medical equipment in place on the health care unit and on Bittern where some health care staff were based during the day. A Clinical Team Leader/staff nurse told us they checked the equipment daily. The team leader carried a radio so that they could be contacted by staff and go straight to any medical emergency. Both inpatient units had an emergency trolley. Staff said medical emergencies are rare. Each wing had a first aid kit and ligature cutters for staff to use in the event of an emergency.

External hospital appointments were recorded clearly for all health care staff to see to ensure young people were supported to attend their external hospital appointments.

Young people had sexual health treatment and education as needed.

Staff told us that anger management therapy had recently stopped due to a lack of staff resources. The provider may find it useful to note that a failure to provide anger management therapy, where this was an assessed treatment need of a young person, meant some young people’s identified needs may not be met.

Cooperating with other providers Met this standard

People should get safe and coordinated care when they move between different services

Our judgement


Young people’s health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Reasons for our judgement

Health care staff told us that they liaised regularly with other providers to help ensure young people’s health needs are met. The Head of Primary Health Care said that they had established clear communication with the prison gym. Young people might disclose a long term medical condition to gym staff that they had not told health care staff about. The two teams shared information to help meet young people’s health needs. The provider has a draft information sharing agreement with HM Prison service on inter agency health care records. Nurses reported that the prison had a good working relationship with a local hospital and that young people who needed to attend the fracture clinic were seen quickly if nurses phoned and informed the hospital. The psychiatrists told us they had a good working relationship with the local mental health secure hospital for young people and that a transfer from the prison to the hospital went smoothly. Central and North West London NHS Foundation Trust worked closely with West London Mental Health Trust in the prison to meet the mental health needs of young people.


Cleanliness and infection control Met this standard

People should be cared for in a clean environment and protected from the risk of infection

Our judgement


Young people were cared for in a clean environment at the time of our inspection but there was evidence that in the recent past they were not protected from the risk of infection because appropriate guidance had been not been followed in maintaining a clean hygienic environment. Reasons for our judgement

The Head of Health care told us that there are quarterly infection control audits. We saw the most recent audit. This showed that clinical areas had not been maintained to a satisfactory standard of cleanliness. These rooms had been cleaned and were clean at the time of our inspection. Some consulting rooms were not suitable for clinical procedures as they did not yet meet the required standards but staff told us these rooms were only used for smoking cessation and sexual health advice work and not medical examinations. There were no hand towels in the clinical room on Bittern unit. An action plan to address infection control issues had been implemented. The provider may find it useful to note that a failure to maintain a clean and hygienic clinical environment at all times means young people may not be protected against the risk of acquiring infection.


Safety and suitability of premises Met this standard

People should be cared for in safe and accessible surroundings that support their health and welfare

Our judgement


Young people, staff and visitors were protected against the risks of unsafe or unsuitable premises where health care was provided. Reasons for our judgement

An improvement action was made at our last inspection as the communal area on Albatross unit was cold. We saw that this area was now warm. Staff said that the heating had been repaired. We saw from community meeting minutes on this unit that patients had repeatedly complained of the showers being cold. Staff told us that this had now been resolved and that the water had to be left running for a while to heat up before the shower was used. We saw that the general standard of cleanliness in all health care areas inspected was satisfactory during the inspection. The health care waiting area had been refurbished and was a welcoming area for young people. There was a television playing health related information programmes, comfortable seating, books and age appropriate décor. The toilets had a facility for young people to check their own height and shoe size. We asked two young people what they thought of the waiting area. One said, “It’s nice” and the other said, “it’s cool.”


Supporting workers Met this standard

Staff should be properly trained and supervised, and have the chance to develop and improve their skills

Our judgement


Young people were cared for by staff who were trained and supported to deliver care and treatment safely and to an appropriate standard. If mental health awareness training provided by mental health professionals to all staff does not continue there could be a risk of other staff not understanding young people’s mental health needs, which in turn could impact on young people’s care. Reasons for our judgement

The Head of Health care told us that all health care staff had an induction when they start work. They all had level 2 training in child protection. Half the staff team had also completed level 3 child protection training and there were plans for all staff to be trained to this level which was positive. Staff received appropriate professional development. Health care staff had also completed additional training in relevant topics for the job such as a diploma in asthma, diabetes or substance misuse, and cognitive behaviour therapy for the mental health staff. We saw evidence that staff attended regular clinical supervision. The Head of Primary Health Care also met with her team weekly to provide training, information and development. Staff told us that they had recently had to stop the ongoing mental health awareness training due to staff shortages (West London psychology staff). The provider may find it useful to note that a failure to ensure all staff have sufficient knowledge about mental health issues means that lack of knowledge could have an impact on the quality of the nurses’ interactions with young people, and young people’s mental ill health may not always be recognised and treated quickly. This inspection took place at a difficult time for staff. It was a period of uncertainty as this provider will stop providing the health care service in Feltham and a new provider will take over on 1 April. There were some staff vacancies and some staff would be leaving. The Community Mental Health team in the prison was employed by West London Mental Health Trust, who will cease to provide this service from 1 April. At the time of the inspection, these staff were experienced, qualified and well trained to meet young people’s needs.


Assessing and monitoring the quality of service provision

Met this standard

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care

Our judgement


The provider had an effective system to regularly assess and monitor the quality of service that young people receive. The provider was aware of young people’s concerns and was working to make improvements to the service which would make young people more satisfied with their health care. Reasons for our judgement

There was evidence of the provider operating good quality assurance procedures which identified areas for improvement and resulted in clear measurable action plans which were also monitored to ensure they were completed. We saw audits on epilepsy and asthma care, emergency response equipment and procedures, infection control and young people’s satisfaction. We discussed young people’s poor perception of the prison health care services with the Heads of Health care in the prison. They said they were aware that nurses’ communication with young people needed to improve and that this was being addressed with staff. They had been proactive in listening to young people’s views and acting on them. They also told us of plans to improve attendance at GP appointments. The provider took account of complaints and comments to improve the service. As the provider will cease providing the health care services at Feltham on 1 April 2013, it will be important to ensure the work of improving the young people’s perception of their health care service is continued by the new provider. The provider may find it useful to note that if a clear action plan for improving young people’s satisfaction with health care services is not in place, the necessary improvements may not be completed.


About CQC inspections

We are the regulator of health and social care in England.

All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care.

The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. We regulate against these standards, which we sometimes describe as “government standards”.

We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of dentists and other services at least once every two years. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming.

There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times but we always inspect at least one standard from each of the five key areas every year. We may check fewer key areas in the case of dentists and some other services.

When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service’s records and check whether the right systems and processes are in place.

We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it.

Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to re-inspect a service if new concerns emerge about it before the next routine inspection.

In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers.

You can tell us about your experience of this provider on our website.


How we define our judgements

The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection.

We reach one of the following judgements for each essential standard inspected. Met this standard This means that the standard was being met in that the

provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made.

Action needed This means that the standard was not being met in that the

provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete.

Enforcement action

taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people.


How we define our judgements (continued)

Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. We make a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation) from the breach. This could be a minor, moderate or major impact. Minor impact – people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact – people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact – people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly

We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards.


Glossary of terms we use in this report

Essential standard

The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20)

Regulated activity

These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided.


Glossary of terms we use in this report (continued)

(Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term ‘provider’ means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a ‘service’. Regulations

We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. Responsive inspection

This is carried out at any time in relation to identified concerns. Routine inspection

This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection

This is targeted to look at specific standards, sectors or types of care.


Contact us

Phone: 03000 616161 Email: [email protected]

Write to us at:

Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

Website: www.cqc.org.uk

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