Stressed out nurses broke down in tears as government inspectors checked standards at Kirklees health operator Locala.
Emotions spilled over as staff told Care Quality Commission (CQC) officials of their struggles.
Inspectors have now found the organisation “Inadequate”, the lowest rating, in two major areas – Community Adults Services and Community Inpatient Services.
The former is predominantly district nurses while the latter surrounds the quality of care at the Holme Valley Memorial Hospital.
Two other areas – ‘Dental’ and ‘Children, Young People and Families’ – were rated as good.
A 41-page report reveals some staff approached by inspectors began crying as they cracked under the pressure of the government probe.
Over half of the 17 district nurses interviewed said their workloads were too high.
The CQC report, published this week, says: “A notable number of the nurses we spoke with were in tears during the inspection due to the pressure of the workload, which they said had been the situation for several months.”
Later in the report it reveals: “Staff at various levels of the organisation were obviously upset when speaking to the inspection team.”
The report highlights significant staff shortages in the community care teams between August and October last year.
Staff revealed they often had to make more than 20 visits to patients’ homes per shift.
Between July 1, 2016 and September 30, there were 220 occasions were overworked nurses had to do 20 calls or more.
An Examiner source has revealed senior matrons were called onto the front line at the peak of the staffing crisis.
The CQC report highlights a long list of failings, including: dozens of serious incidents that had not been investigated, several examples of serious patient safety issues that had not been noticed, community nurses that were not being supervised properly and acute staff shortages in the district nursing team which had led to delays in care.
Inspectors have also raised serious concerns about risks on Maple Ward at the hospital near Holmfirth.
In July 2016 the CQC found 87 incidents on the ward had not been investigated.
Health and safety standards were not up to scratch, the security of some buildings was poor and there were significant issues with record keeping at Maple Ward.
CQC officials found gaps in the care plans of patients, including those who were terminally ill.
Locala was also criticised for failing in its “duty of candour” responsibilities – laws that require it to be open with patients and relatives about mistakes and incidents.
The report found systems for identifying serious incidents were not robust, including one in Maple Ward that had been brushed under the carpet only to be re-investigated five months later by a new senior member of staff and deemed to be serious.
Other discoveries by the inspection team included 27 medication management errors, many of which are issues with insulin injections for elderly diabetic people in their homes.
In total there were 137 incidents overdue for final approval by the quality manager.
The report concludes: “We saw several examples of serious patient safety issues not being identified or escalated through the governance structures appropriately.”
Locala’s chief executive Robert Flack has apologised for the shortcomings found in the report.
He said: “Locala prides itself on the high quality of care it provides to over 400,000 people across Kirklees, Calderdale and Bradford, and the safety of patients is our number one priority.
“Because we provide such a broad range of community healthcare services we do not receive one overall score from the CQC.
“All the services assessed previously have received either an Outstanding or Good rating. Of the latest four reports, two were rated ‘Good’.
“Across all four reports we were rated Good in the “caring” section, reflecting the commitment and hard work of our staff.
“Inspectors recognised that staff in all our teams are working hard to provide a quality service to patients and their carers or families, and saw examples of outstanding care, with staff showing compassion, kindness and respect at all times.
“We deeply regret there were issues relating primarily to two out of more than 40 services, where there were isolated instances resulting in a small number of patients not receiving the high standards of care we aspire to, and to which they have a right to expect.
“For that we are sorry.
“We had identified these issues prior to the CQC inspection and work was, in most cases, already underway to address the issues.
“Since the inspection seven months ago further significant improvements have been made, which the CQC has acknowledged and they are pleased with the progress we have made.
“Over the past year we have redesigned services, put better procedures and processes in place, made a number of key clinical appointments and improved our governance.
“We strengthened our clinical supervision at Board level by separating the Director of Quality and Director of Operations roles.
“This is having a positive impact on how our services are run locally, and we are confident this will be reflected in future CQC inspections.
“The number of beds on Maple Ward was reduced following last year’s inspection, to enable the introduction of new systems and processes.
“Frustratingly, more recently Maple Ward has had to be closed temporarily.
“However, this is due solely to current insufficient staffing levels and has absolutely no connection to the CQC inspection.
“The CQC commented on the shortage of experienced, qualified district nursing staff in our adult community services.
“The shortage of qualified nurses is not an issue unique to Locala – it is impacting across the NHS nationally.
“We have reviewed staffing requirements across all our services and identified that certain aspects can be resolved by reorganising our staffing.
“This will ensure we have the right people in the right places at the right time, which will enable us to better deliver ‘Care Closer to Home’ services in partnership with NHS commissioners.
“We are continuing to work with the CQC and our partners across the NHS to instigate and embed further improvements across those services where improvements are needed.
“We are confident that this will be reflected positively when the CQC conducts its reassessment and are keen for them to return in order to demonstrate the improvements we’ve made.”