Background to this inspection
Updated
12 September 2016
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 5 April 2016 and was unannounced.
The inspection was carried out by one inspector, a member of the CQC pharmacy team, a specialist professional advisor and an expert by experience. The specialist advisor had experience working as a nurse within the community and within the field of palliative care. The expert by experience had experience of using healthcare services.
Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This 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. The PIR was completed and returned to the Care Quality Commission. We found the information in the PIR was an accurate assessment of how the service operated.
We also reviewed the information that the provider had sent to us which included notifications of significant events that affect the health and safety of people who used the service.
We spoke with six people who were accessing the Lymphoedema service for treatment on the day of the inspection. We spoke with a patient receiving Lymphoedema treatment on the local hospice ward. We spoke with the Director of Clinical Services, the Quality and Governance Manager, three nurses, one health care assistant, the head of education and training, a lecturer/practitioner, a clinical nurse specialist and the estates manager.
We viewed nine people’s records to see how their treatment and support was provided. We looked at the arrangements for managing people’s prescribed dressings and treatments to check these were managed safely. We also looked at the arrangements in place and records for staff recruitment, training and quality assurance audits. We viewed feedback from patient surveys.
Updated
12 September 2016
This inspection took place on 5 April 2016 and was unannounced.
Wolverhampton Lymphoedema Service is a specialist service offering treatment and advice for people who experience Lymphoedema, (swellings and inflammations usually of the arms and legs). This may be due to damage to the Lymphatics through accident, infection or cancer and its treatment. The Lymphoedema service covers the Wolverhampton and Dudley areas by appointment between Monday to Friday. The services offered by Wolverhampton Lymphoedema Service supplement and complement existing service provision at the main Compton Hospice. Staff can refer people to internal services such as bereavement support, complementary therapies, physiotherapy and the day centre. At the time of the inspection there were five people attending appointments at the clinic.
The registered manager had retired and an interim manager was present. 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.
There were shortfalls with the arrangements for managing people’s dressings and creams. Although immediate action was taken to rectify this the provider’s safety monitoring should have picked this up to ensure the arrangements in place were safe, sustained and effective.
People told us that they felt safe when attending for their appointments and had no concerns about the way that staff supported them. Staff had been trained to recognise harm or abuse and knew how to report this to promote people’s safety.
Staff were aware of and followed the risk assessments developed by health care professionals with primary responsibility for the provision of people’s care. Treatment plans identified risks to people’s well-being and we saw staff monitored and communicated any concerns with relevant healthcare professionals.
People’s safety was promoted and all accidents and incidents were regularly reviewed by the management team and action taken to improve safety. Policies and procedures were in place to promote the safety of staff when working alone within the community.
People were very happy with the availability of staff when they attended for their appointments. They had not experienced any cancellations or delays and had access to staff outside of the usual clinic times for emergency advice and support.
Staff had access to a dedicated training team who provided specialist training opportunities and support to them. Arrangements were in place so that staff could reflect on their practice and develop their competencies.
People were referred to a range of healthcare professionals to maintain their health and wellbeing, including effective pain and symptom management. Additional support was available via well-being clinics, physiotherapy and bereavement support if people wished to access this.
People told us that staff were compassionate, patient and listened to them. People had positive relations with staff which reassured them when attending for treatment.
Staff obtained consent from people before treatment commenced. Staff worked collaboratively with other providers where people’s capacity to consent to treatment was not clear. Decisions regarding people’s resuscitation status were known and recorded to protect their decision making.
Staff provided advice and support to people to manage their diet where this was part of their treatment programme.
People had a flexible service designed to respond to their needs which included out of hours support to obtain advice and support with their condition. Appointments were arranged to suit people’s personal commitments. Links with other providers and educational and promotional initiatives had resulted in improved awareness and referrals so people’s condition was recognised earlier. These initiatives were implemented to respond to people’s diverse needs.
People felt the service was well run and that they had opportunities to comment and influence the quality of the service provided. The provider demonstrated a strong commitment to developing a specialist Lymphoedema service and staff were fully committed to this vision; evident through the range of promotional community events they had implemented.
There were systems in place to monitor the standards of the care and treatment provided. Regular management meetings took place to review all aspects of the service provided and the results of this were cascaded to staff to ensure improvements were implemented. The provider service worked collaboratively with local and national hospice providers to monitor the effectiveness of their Lymphoedema service which is part of their palliative and end of life care services.