Archived: Countess Mountbatten House

Updated 23 April 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.

The inspection took place on 10 December 2014. The inspection was announced, as this was part of a wider inspection of the University Hospital Southampton NHS Foundation Trust. The team inspecting this location consisted of an inspector, a specialist advisor who was a specialist nurse, experienced in caring for people receiving end of life care, and a pharmacist inspector.

Prior to the inspection, we requested information from the trust and this was provided in their pre inspection pack. This is a document which provides some key information and data about the trust. We reviewed the document and other information we hold about the trust, including previous inspection reports.

We spoke with 11 patients, who included some who were living in the community, five relatives, and 19 staff including nurses, community nursing specialists, doctors, health support workers, domestic staff, pharmacist and volunteers, as part of our inspection. We looked at four care plans, records of medicines, records relating to the management of the service, information provided by the trust and local stakeholders.

We would like to thank all staff, patients, families and other stakeholders for sharing their balanced views and experiences of the quality of care and treatment at Countess Mountbatten Hospice.

Updated 23 April 2015

Countess Mountbatten House provides treatment and care to adults with life limiting conditions. The hospice also supports the families of the patients who use the service. The hospice is part of the University Hospital Southampton NHS Foundation Trust, and this was the first inspection of the service.

Countess Mountbatten House is a 25 bed unit, providing specialist end of life care and support for patients and families. There were 22 patients receiving care at the time of the inspection.

The day care unit (the Hazel Centre) supports patients living in the community. There is a dedicated nursing and bereavement team working closely with the clinical nurse specialist, led by consultants at the hospice, and those in the community. Patients benefit and receive care and support from a dedicated multidisciplinary team, including counselling, physiotherapy and occupational therapy teams.

There was no registered manager, as the hospice is part of the trust and does not require a registered manager. A matron was in day to day charge of the hospice. 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.

The hospice had a dedicated staff team with clear visions and values. Staff commented “we work as a team and all pull together”, in order to achieve best outcomes for the patients. Patients and their relatives described the care and treatment they were receiving as “excellent care”. Staff we were told were “very caring” and patients said “they (the staff) can’t do enough for you”. Care and support was provided in a caring, compassionate manner, and the patients’ privacy and dignity were respected.

There were arrangements to assess risks, such as falls and pressure injury, to ensure the safety of patients. Care plans had been developed following assessments by physiotherapy for patients identified as high risk of falls. These provided guidance to staff in order to manage these risks in a consistent way. The staff rotas showed that there were consistently enough staff with the skill mix to provide safe and consistent care.

The CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. Staff were clear about the actions they would need to take if they needed to evoke the DoLS to protect the rights of patients. We were given an example of how staff had ensured the safeguards were initiated and assessments carried out by appropriately trained professionals.

The service had developed ways of ensuring that staff received the training they needed to deliver a high standard of care. Staff had been trained and appointed as ‘champions’. Champions were staff that showed a particular skill or interest in reducing falls, and providing end of life care and infection control, and acted as role models for other staff. Staff told us that they had received training which was appropriate to their roles.

There was a strong commitment and support for the patients and their relatives, before and after death. Patients were treated with compassion and care. They were put at the centre of their care through ongoing consultation and involvement of their relatives and multidisciplinary team, so that care could be tailored to their individual needs.

There was strong clinical leadership at the hospice. There was a clear governance structure from unit level to the trust board. Members of the board made quarterly visits to both the hospice and community services. However, the process to seek patients and their relatives’ views was not fully developed and the trust needed to work with its partners to improve the provision of bereavement and hospice at home services.

Areas for improvement

Action the hospice should take to improve:

The hospice needs to ensure that:

• Staff have training in the use of the electronic patient record system to enable them to access information as needed.

• Strategies are developed to provide support for the families of those who were cared for by the service in the community.

• The hospice at home service is developed with partners, as an integral component of community end of life care.