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Archived: Tynedale Hospice at Home Good

This service is now registered at a different address - see new profile


Inspection carried out on 22 September 2016

During a routine inspection

This announced inspection took place on 22 and 29 September 2016. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

We last inspected the service in August 2014. At that inspection we found the service was not meeting Regulations 10, 13 and 20 of the Health and Social Care Act (Regulated Activities) Regulations 2010, which correspond to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and relate to governance and management of medicines.

Following our inspection in August 2014, the provider sent us an action plan to show us how they would address our concerns. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements.

Tynedale Hospice at Home is a service which supports people for free, who have life limiting illnesses in the Tynedale and West Northumberland area’s and who wish to be cared for in their own homes. The service also provides family services which offers pre and post bereavement support to families (including children), where an individual has been diagnosed with a life limiting illness or has passed away. Free transport is also available for people with life limiting conditions to attend hospital appointments.

The service is registered as a charity. Staff supporting people, consist of nine registered nurses and 11 hospice support workers and over 200 volunteers. The team of staff work closely with local GP’s, district nurse teams and also members of staff from a variety of organisations. At the time of the inspection there were 14 people receiving care and support from the service.

The service was supported via three charity shops selling a range of clothes, bric-a-brac and books and also has the aid of people (local and otherwise) to raise funds in other ways, for example, through sponsorships and donations. The service is backed by volunteers who help, for example, within the family support service, the transport service, in the shops, to raise money, and in many other ways across the service. Funding is also sourced through application to, for example, The Big Lottery Fund.

The service did not have a registered manager in post. The previous registered manager had left the service in July 2016, and a new manager had been appointed and was currently in the process of registering with the Commission. 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.

We found that changes had been made to the way medicines were managed and staff were now meeting the regulations and following safe management of medicines practices.

Audits had been put in place to check on the quality of the service and although the regulations were now being met, there were still some areas of improvement needed to be made within the well led section of the report.

Staff were able to describe what it meant to safeguard people and told us how they would report any suspected abuse and there were policies and procedures in place for staff to follow.

Staff followed risk assessments when providing care and support for people in order to maintain people's safety. Accidents and incidents were clearly recorded. Where any incidents occurred these were discussed and reflected upon in order to make improvements. There were procedures in place should an emergency situation arise, for example a protocol for lone working at night.

Safe staff recruitment processes were followed with the appropriate checks being carried out.

There were sufficient numbers of staff on duty to meet people's needs in a meaningful way and the service had a team of volunteers who provided additional support. The hospice had a bank of staff and volunteers who they could contact if they needed additional workers.

All staff received support individually or as a group and annual appraisals were undertaken. Staff and volunteers received an induction and regular training to ensure they had the knowledge and skills to deliver high quality care which they demonstrated throughout the inspection.

The Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. We found the provider was complying with their legal requirements.

People were supported to receive a nutritious diet and sufficient hydration, if this was part of their care and support plan.

When people needed specialist healthcare support the hospice made referrals to specialist services such as occupational therapy and we saw through people’s records that staff liaised with other healthcare professionals to ensure that people received the correct level of care and support available to them.

The service was responsive and focused on providing a service which people helped plan and develop. There were appropriate systems in place to ensure flexibility to people so that their care needs could be met.

People told us that staff were caring and listened to them. Staff at the service followed local palliative care guidelines which ensured people’s on-going integrated care.

People helped develop their care plans which were person centred. This is when any treatment or care takes into account people's individual needs and preferences. These were reviewed regularly.

People’s hobbies and interests were encouraged. One person told us that staff played Scrabble with them and a relative told us, “The staff will read to [person] if they want, it’s something they liked to do themselves, but it's difficult now.”

People were confident expressing any concerns to staff at the service and knew who to approach if they were not satisfied with the response. There had been one complaint over the inspection period which had been dealt with appropriately.

Staff and volunteers shared similar values and worked closely with each other in a mutually respectful way. There were regular team meetings. There was also a newsletter for anyone involved with the hospice, including staff and volunteers. This gave details of events and stories of people and families involved with using the service.

We have made two recommendations regarding quality assurance checks and audits and communication.

Inspection carried out on 7 and 8 August 2014

During a routine inspection

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was carried out over three days. Two inspectors and a specialist advisor visited the service’s head office on the 7 August 2014. The inspectors visited people who used the service in their homes on the 7 and 8 August. On the third day of our inspection, an expert by experience contacted three people who used the service by phone to obtain their views.

We announced the inspection 48 hours prior to our visit to the provider’s head office, to ensure that the office was accessible and we were able to meet the registered manger or senior member of the service. By announcing the inspection, the registered manager was able to facilitate our requests to speak with staff and organise visits and telephone calls for us to see and speak with people and their relatives.

Tynedale Hospice at Home is a registered charity. It aims to support the primary healthcare team in delivering care to people who have a life limiting illness who wish to be cared for in their own home. The service is provided by registered nurses and support workers. There are close links with the district nursing team and the Macmillan nurses.

The service is registered with the Care Quality Commission to provide the regulated activities, “Personal Care” and “Treatment of disease, disorder and injury.” It provides a range of services including; care in the home; bereavement support; family support; a transport service and a referral service for complimentary therapies. Only the “care in the home” service required to be registered with the Care Quality Commission, because the other services were out of scope of the regulations. There were 23 people accessing the service at the time of our inspection.

Tynedale Hospice at Home moved to a different address in Hexham in November 2013. This was the first inspection we have carried out at the new location.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

There were safeguarding policies and procedures in place. Staff knew what action to take if abuse was suspected. Safe recruitment procedures were followed.

We found concerns with medicines management. Staff assisted some people to take their medicines and we saw relatives sometimes left out medicines for staff to administer to people. It was not clear that staff were always able to identify medicines correctly since they had not been involved with checking the pharmacy label and taking the medicine out of the original packaging to ensure that the correct medicine was being given to the correct person.

We looked at care records and found that specific care plans to provide staff with guidance about medicines management were not in place and care records sometimes did not contain an up to date list of medicines that people were taking. We noted that not all care plans were clear or fully completed. These omissions and lack of recording meant that staff might not be aware of the actions they needed to take to meet people’s needs and ensure their safety. In addition, the registered manager informed us that she carried out audits on care plans and medicines; these however, were undertaken informally and not recorded.

The registered manager told us that staff training and one to one staff meetings known as supervision and appraisals had “lulled.” She also said that she was not fully aware of all the training staff had carried out because working at Tynedale Hospice at Home was a second job for some staff. She explained that staff had often undertaken training and qualifications in their additional jobs with other providers.

People and relatives were complimentary about the service. Comments included, “Couldn't ask for better,” and “Very lucky to have this level of care.”

Staff were knowledgeable about people’s needs. We saw that staff interactions with people were kind and thoughtful. People, relatives and health and social care professionals told us that they considered that Tynedale Hospice at Home provided a responsive service which met the needs of people and their families. One community matron told us, “They’re an incredibly invaluable service for looking after palliative care patients and those with life limiting illnesses.”

Surveys were carried out for people and their representatives. All those surveyed rated every aspect of the service positively. However, insufficient time was allowed for the dedicated leadership and management of the service. The registered manager was the only permanently employed member of staff. Formal audits or checks of certain aspects of the service were not carried out such as care plans, medicines management and training.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to; management of medicines; assessing and monitoring the quality of service provision and record keeping.

You can see what action we told the provider to take at the back of the full version of this report.