Sirona Care & Health C.I.C.

Updated 13 November 2025

Date of assessment: 3 February 2025 to 5 February 2025

Sirona care & health Community Interest Company (Sirona) was established in October 2011 and is the sole provider of NHS and local authority funded adult and children’s community healthcare services across Bristol, North Somerset and South Gloucestershire (BNSSG). Sirona is a not-for-profit social enterprise committed to serving its communities and funded by the NHS and local authorities. Sirona does not have shareholders and does not pay dividends; any surplus is re-invested back into the community.

Sirona’s services span across all ages from birth to end of life and range from preventative and pro-active support to keep people as well and independent as possible through to complex care and support in individuals’ own homes to prevent admission to hospital or to support people following discharge.

Sirona services are provided across several different locations in the BNSSG area as well as in individual’s homes, in over 250 care homes and in schools. They serve approximately 940,000 people in this area.

Sirona provides the following assessment service groups:

• Community mental health services for people with learning disabilities or autism.

• Community health services for adults.

• Community health inpatient services (four inpatient rehabilitation units).

• Community end of life care.

• Community health services for children, young people and families.

• Urgent care services (two minor injury units and one urgent treatment centre).

Sirona is registered for the following regulated activities:

• Accommodation for persons who require nursing or personal care.

• Diagnostic and screening procedures.

• Treatment of disease, disorder or injury.

We carried out a well led assessment of the provider which commenced with a 3-day site visit on 3, 4 and 5 February 2025. This assessment was due to concerns over the previous 12 months about the quality of care across various services including community health services for adults and community health services for children, young people and families. We also had concerns with regards to the stability of leadership of the organisation following some recent unexpected changes at board level.

Before carrying out this well led assessment, we carried out assessments of community health services for adults, community health services for children, young people and families and community mental health services for people with learning disabilities or autism to check how well the overall organisation strategy and risk management aligns with local services.

During the well led assessment, we identified breaches of the legal regulations relating to good governance.

Updated 16 January 2025

Sirona is a community interest company that provides community health and adult social care services and was established in October 2011. Sirona provides a number of services for people with a learning disability including health services and social care.
Sirona deliver community adult learning disability services across Bristol, South Gloucestershire, and North Somerset. The teams main bases are Church House (South Gloucestershire), New Friends Hall (Bristol) and Castlewood (North Somerset).
At the last inspection we said Sirona must ensure that the care records systems it has in place do not pose unnecessary risk for staff and service users. This was because they had multiple and different record systems in use. At this inspection we found that Sirona had met this requirement and had consolidated its records into one system. However, we saw that the system in use could be difficult to navigate and staff told us that it was very intensive to check old records as they had been batch uploaded and it required them to manually search through 100 pages for the information they were looking for in each uploaded batch.
We carried out this inspection on site on the 29 and 30 January 2025. We had received information to suggest the quality of care had declined at the service and so we carried out a focused inspection. At this inspection, we inspected enough parts of the effective domain to re-rate this key question as well as looking at parts of the safe, responsive and well led domains.
We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
We rated effective as good because:
Staff assessed peoples` needs and formulated treatment plans based on recommended treatments by the National Institute for Health and Care Excellence (NICE). They assessed these needs in a timely way.
There was a range of staff from different professions to ensure that people benefitted from a multidisciplinary care team. Staff received supervision regularly. Most of the care records we reviewed (10 out of 11) showed good documentation around mental capacity and best interest meetings.
Staff held regular and effective multidisciplinary meetings and had good working relationships with local teams inside and outside the organisation . We heard from other service providers who spoke positively about the service.

Safe, Well led and Responsive stayed the same, at good, because:
Staff involved people with a learning disability in care planning and risk assessments in the 11 records we reviewed. Care was observed during clinic and domiciliary visits across a range of professions and clinical needs.Staff communicated with people with a learning disability so they understood their care and treatment.
The governance framework was clear about what would be discussed by whom to make sure essential information was shared and discussed. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

Updated 9 January 2025

We carried out a responsive assessment of community health services for children, young people and families at Sirona care and health Community Interest Company.

Established in October 2011, Sirona Care and Health Community Interest Company is the sole provider of NHS and local authority funded adult and children’s community healthcare services across Bristol, North Somerset and South Gloucestershire (BNSSG). Sirona is a not-for-profit social enterprise committed to serving its communities and funded by the NHS and local authorities.

Services provided include community paediatrics, early years speech and language therapy, health visiting, school nursing, neurodevelopmental nursing, attention deficit hyperactivity disorder (ADHD), and autism spectrum assessment services.

During this inspection we reviewed community paediatrics, the autism spectrum assessment service, an outreach vaccination session at a migrant health hotel, health visiting and school nursing services. We also held focus groups for staff.

The overall rating for this service is good.

Updated 9 January 2025

We carried out this assessment between 21 January 2025 and 3 February 2025. Sirona Care and Health C.I.C. is a community interest company, not for profit, who provide services for the NHS. They provide a range of services for children and adults in the community setting. We only assessed community services for adults. Since our last inspection in 2016 the geographical locations, and some services, have changed providers. In April 2020 Sirona took over the provision of services previously provided by Bristol Community Health and North Somerset Community Partnership. Sirona services are now provided across 100 different locations as well as in individual’s homes within the Bristol, North Somerset and South Gloucestershire area.

When we last inspected community service for adults in October 2016, it was rated as good overall. There was 1 breach of regulations at the October 2016 inspection, relating to staff not having the correct level of safeguarding training to ensure that people were safe from abuse. We found this had been met at this assessment. We did this assessment due to the length of time since the last inspection and due to emerging concerns around the management of deteriorating patients, wound management and not completing records in a timely way.

We inspected 12 quality statements across the safe, effective, caring, responsive and well-led key questions.

Safety events were investigated, and learning was shared to promote good practice. However, some of the actions taken had not resulted in all staff being able to recognise deteriorating patients or wounds. We found staff mostly provided safe care and treatment. However, staffing levels were not always able to meet the demands of the service which resulted in some patient’s visits being deferred. Staff were trained, but not all had the right skills, knowledge and experience to meet people's needs. Some staff told us they did not have the time to undertake role specific training or mandatory training. Staff delivered care and treatment mostly following evidence-based practice and most people had good outcomes. The service and staff were well-led by local leaders who embodied the values of their service. There was governance and risk management processes, but these were not effective in reducing risks to patients.

The service was in breach of the legal regulations relating to staffing and good governance.

Safe:

The service had a learning culture, but this was not always embedded into practice. Managers investigated incidents and actions were identified but these did not reduce the risk and repeated incidents continued to occur. There were not always enough staff with the right skills, competencies and experience in the community setting. Staff received training but at times struggled to fit it in due to the demands on the service. This also impacted on the delivery of regular appraisals, used to maintain high-quality care. Staff made sure infection control procedures were followed to minimise any risks to patients.

Effective:

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was mostly based on latest evidence and good practice. The service monitored people’s outcomes to improve care and treatment.

Caring:

People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People had choice in their care. Staff mostly responded to people in a timely way, but the service deferred visits due to demand which could potentially place patients at risk of harm.

Responsive:

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. People were involved in planning their care and understood options regarding their treatment.

Well-led:

Local leaders were visible, knowledgeable and supportive, helping staff develop in their roles and were aware of the risks in their service and actions were identified to reduce these. However, this did not always achieve the outcome required. Record keeping was not in line with the provider’s policy and actions to address these were ineffective. There was a lack of key performance indicators for some services so they could be monitored for waiting times. Governance tools had not ensured timely actions were taken in relation to risks. There was a culture of continuous improvement with staff mostly given time and resources to try new ideas.

Updated 9 February 2022

Updated 28 March 2017

Overall, end of life care and treatment was rated as outstanding because:

High quality, effective and responsive treatment and care was evidenced as established in practice and provided to patients and those people close to them. National guidance and best practice was seen to be understood and followed. Staff at all levels were well supported and encouraged to develop their knowledge and clinical skills.

The majority of Sirona end of life care was provided in patients’ homes by district nursing teams, most of who were based with GP surgeries. End of life care was also provided within the three community hospitals located in Bath (St Martin's Hospital), Paulton and Thornbury.

There was a truly holistic approach to care and support to patients and those people close to them. Pain and symptoms were regularly reviewed and management plans put in place. Staff proactively and consistently looked for ways to ensure wherever possible, that patients and families hopes and wishes were achieved. Across the services we observed numerous examples of staff who worked in partnership with patients and collaboratively, flexibly and effectively with other professionals, teams and services to provide coordinated care.

Processes were in place to promote equality of access to end of life treatment and care regardless of each patient’s individual differences or personal circumstances. This included the development of end of life care plans for patients with particularly complex or vulnerable needs, and staff training to provide this.

There was a clear end of life strategy in place which was based on service user feedback, national strategy and with local commissioners input. Identified goals and action plans were seen to be kept under regular review. The service was well led and staff were proud of the end of life treatment and care they provided.

Care was safe. Patients had risks assessed, reviewed and actions put in place. Medicines to manage pain and other symptoms were prescribed and provided in advance of requirement. Staff had access to a range of end of life training and were well supported in their roles.

The culture was ‘can do’ and positive. Patients and those people close to them were consistently highly satisfied, with reports that the level of care and attention to detail far exceeded expectations. Practice was truly holistic, patient centred, compassionate and sensitive at all times.

Some improvements were required to the detail recorded on treatment escalation plans and to systems and processes used to monitor and evaluate risks and quality information specific to end of life patients. Improvements were required to the compliance level of staff with safeguarding children and vulnerable adults training.

Updated 9 February 2022