Mount Edgcumbe Hospice

Mount Edgecumbe Hospice is operated by Cornwall Hospice Care Limited. The hospice had eight beds with facilities available to increase this to 14. Cornwall Hospice Care Limited also provided services in Hayle at St Julia’s Hospice.

The hospice provided care and treatment for patients aged 18 years or over, with a life-limiting condition.

We inspected this service using our focussed inspection methodology. This unannounced inspection took place on 19 July 2018. We focussed on the safe and well-led domains following concerns raised to us. The concerns were focussed on staffing levels, staff training, low staff morale and allegations of bullying.

Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

There was a registered manager in post, Dawn Tame-Battell. 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.

During the inspection visit we were unable to speak with patients or their relatives as the staff informed us they were too unwell. We spoke with 10 members of staff, working in various roles in the hospice. 

We reviewed four sets of patient records and relevant other documents, including policies, procedures and meeting minutes.

The Care Quality Commission last inspected the service in 2014 and rated the provider as good overall. We have not re-rated the service at this inspection.

We regulate hospice services but we do not currently have a legal duty to rate them when they are inspected as a focussed inspection. We highlight good practice and issues service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• A system of annual mandatory training was provided to ensure staff remained suitably skilled for their job,
• Safeguarding processes were in place to ensure patient safety.
• There were established systems to prevent and protect patients from healthcare associated infections.
• There were systems to manage the environment and equipment, which kept patients safe.
• Patients were monitored for deterioration in their condition.
• Staffing was managed to ensure sufficient staff were available.
• Patient records were well-maintained and stored securely.
• Inpatient medicines were managed safely.
• Incidents were recorded and reviewed to provide learning and prevent reoccurrence.
• External professionals, patients and their representatives had access to a 24-hour support and advice line from the hospice. This also provided a support to patients following their discharge.
• The leadership structure within the organisation was clear and staff were aware of who they reported to.
• Staff were familiar with the organisation’s strategy, vision and values, and were provided with the opportunity to be involved in the development of these.
• The leadership team had taken action to address low morale and allegations of bullying with the provision of meetings and the reintroduction of the staff forum.
• The organisation had taken steps to improve the accessibility of trustees and executives to staff. The number of visits to clinical areas had increased and additional staff meetings were held.

However, we also found the following issues that the service provider needs to improve:

• The system for monitoring staff training did not ensure all mandatory or any additional training had been completed. Safeguarding children training was not provided and not all staff had completed safeguarding adults training. This included volunteers, clinical staff, board members and trustees. Training had not been provided to all staff who were required to investigate incidents.
• Staffing levels were not related to patient dependency.
• The harm level of incidents was not assessed to ensure a consistent response.
• Staff were not familiar with relevant national guidance and recommendations to ensure they were providing up-to-date care and treatment.

Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice for Mount Edgecumbe Hospice. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)