Background to this inspection
Updated
28 September 2015
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 provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 1 and 2 July 2015. The provider was given 24 hours’ notice of our visit. This was so people who used the service could be told of our visit and asked if they would be happy to talk to us.
The inspection team consisted of three adult social care inspectors, a pharmacy inspector, a specialist advisor with experience of palliative and end of life care (palliative care is specialised medical care focusing on providing people with relief from the symptoms and stress of a serious illness) and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who has used this type of care service.
Before our inspection visit we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We found the information in the PIR was an accurate assessment of how the service operated. The provider also sent us a list of people who used the service, their relatives, community professionals and care staff. We sent questionnaires to a selection of those people to find out what they thought of the service provided.
We reviewed other information we held about the service. We looked at information received from relatives and the statutory notifications the manager had sent us. A statutory notification is information about important events which the provider is required to send to us by law. We spoke with local health authority commissioners responsible for contracting and monitoring people’s care at the hospice.
At our inspection we spoke to a range of people about the service. They included 13 people (either in the in-patient unit or in the day therapy unit) and 10 visiting family members. We spoke with the registered manager, the lead nurse for community palliative care, specialist palliative care pharmacist, the day services manager, six nurses (including a community nurse specialist) and four health care assistants. We also spoke with two bereavement counsellors, two members of the therapy team, the principal social worker, practice educator, a member of the chaplaincy team, the facilities manager, two members of the facilities team and three volunteers.
We reviewed three people’s care plans to see how their support was planned and delivered. We looked at a selection of medication records to check medicines were managed safely. We spent time observing staff interacting with people and their relatives. We reviewed management records of the checks made to assure people received a quality service.
Updated
28 September 2015
This inspection took place on 1 and 2 July 2015. Due to the sensitivity of the care provided within the hospice, the provider was given 24 hours’ notice of our visit. This was so people who used the service could be told of our visit and asked if they would be happy to talk with us.
Marie Curie Hospice West Midlands is a registered charity for the delivery of care and treatment for people across the West Midlands who are affected by life-limiting conditions. Care and support is provided to people by a range of health and social care professionals and volunteers. This is provided through a 24 bed in-patient unit, a day unit and support in people’s own homes. At the time of our inspection there were 19 people receiving care in the in-patient unit.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People told us there were enough staff to meet their needs and keep them safe. Staff had the necessary knowledge, information and support to ensure people were kept safe from abuse. Staff told us they reported any concerns to the social work team at the hospice. There was a ‘no blame’ culture with staff encouraged to report any clinical incidents or accidents. These were fully investigated and used as a learning tool to drive improvements in the delivery of care and safeguard people from harm.
People received care from a multi-disciplinary staff team who were qualified, supported and trained to meet their needs. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate the required knowledge and skills to meet people’s needs effectively. Staff received supervision and support and there were also reflective practice sessions where they could discuss any issues associated with their work. Volunteers received training to assist them in their role in giving practical and emotional support to people and their friends and family.
A well-established pharmacy team provided good clinical services to ensure people’s medicines were managed safely. The team regularly attended clinical meetings to discuss people’s individual pain management requirements and ensure good clinical practice was followed.
The rights of people who were unable to make important decisions about their health or wellbeing were protected. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People, friends and relatives were consistently very positive about the caring and compassionate attitude of the staff. They told us they were completely satisfied with their care. They spoke of excellent relationships with staff who understood their needs and preferences and who devoted time to them. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected.
There was a holistic approach to people’s care with the physical, psychological, social and spiritual needs of each person given equal importance, together with the needs of those closest to them. Staff respected people’s cultural and spiritual needs and people told us they received the religious and spiritual support they wanted and needed from a multi-faith chaplaincy team.
Relatives told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. Bereavement support was available to people and their families and friends. This provided emotional and practical support to those who required it. A specialist team provided bereavement support to the children and young families of people receiving palliative care.
There were very few complaints and concerns raised. The provider had a positive approach to using complaints and concerns to improve the quality of the service. Each complaint was assessed to establish the lessons learned and where necessary, appropriate action taken to improve the service provision for everyone using the services at the hospice.
The management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. The management team demonstrated a strong commitment to providing people and those closest to them with a safe, high quality and caring service and promoted high standards.
Staff worked closely and in partnership with external health and social care professionals and other national organisations to improve the service within the hospice and health provision in the local community and nationally. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure the best possible outcomes for people with life-limiting conditions and those closest to them.
The provider continually assessed the needs of people who used the service and the care and support they required. For example, the hospice was working to develop the service it provided to people living with dementia. The provider had a forward plan which involved raising the awareness of what a hospice can provide to people with life limiting conditions, apart from end of life care.