The Care Quality Commission
  • Hospice service

Butterwick Hospice Stockton

Overall: Inadequate read more about inspection ratings

Middlefield Road, Hardwick, Stockton On Tees, Cleveland, TS19 8XN (01642) 607742

Provided and run by:
Butterwick Limited

All Inspections

07 - 09 September 2021

During an inspection looking at part of the service

Due to the focused nature of this inspection, we inspected but did not rate the service.

  • The service did not always provide mandatory training in key skills to all staff and did not make sure everyone completed it.
  • The service did not ensure staff received safeguarding training in line with intercollegiate guidance.
  • The service did not always manage safety incidents well and learn lesson from them.
  • The service did not have robust oversight of patient outcome monitoring. They did not use the findings to make improvements and achieve good outcomes for patients.
  • Leaders did not always have the capacity, skills, and abilities to run the service. There remained confusion between senior leaders regarding their roles and accountabilities.
  • Leaders and teams did not always use systems to manage performance effectively. They did not always identify and escalate relevant risks and issues and identify actions to reduce their impact.

However:

  • We saw improvement in the personalisation of care plans. These were comprehensive and reflective of current patient need.

Our inspection found significant concerns and found continued breaches of regulation which meant that the provider had not complied with the warning notice we issued following the inspection in May 2021. We have issued a notice of decision to impose conditions on the provider's registration.

04 - 06 May 2021

During an inspection looking at part of the service

Our rating of this location stayed the same. We rated it as inadequate because improvements made since our last inspection did not yet justify a higher rating:

  • Staff did not always receive the correct level of training on how to recognise abuse but they knew how to report it. Staff did not always complete and update risk assessments for each patient and remove or minimise risks. Staff did not always identify and quickly act upon patients at risk of deterioration.
  • Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, or up to date, but were stored securely and easily available to all staff providing care.
  • The service did not always use systems and processes to safely prescribe, administer, record and store medicines.
  • We were not assured incident reporting had been embedded because we found examples of incidents not being investigated such as medicine discrepancies and poor admission.
  • Staff did not monitor the effectiveness of care and treatment. They did not use the findings to make improvements and achieve good outcomes for patients.
  • Evidence of consent to treatment was not recorded in accordance with the provider’s policy.
  • The provider was undergoing a significant process of change, made up of many different programmes of work. There was an absence of any oversight or management of this. The leadership team had gaps in its skills. The governance structure was new and not embedded. Leaders did not run services well using reliable information systems but did support staff to develop their skills.

However:

  • The service had enough staff of the right competence and skills to provide the respite service and day care service (physiotherapy and therapy) it was providing;
  • The environment was clean and un-cluttered;
  • Staff appeared enthusiastic about working at the service and said they had visible leaders.

Following our inspection, we raised significant concerns with the provider by issuing a warning notice relating to breaches of Regulation 12 and 17. In addition, we issued the provider with requirement notices and told the provider that it must take prompt action to comply with the regulations.

05 November 2019 to 05 December 2019

During an inspection looking at part of the service

Butterwick Hospice Stockton is operated by Butterwick limited. The hospice has seven inpatient beds and a day hospice and provides care for adults from Stockton, Middlesbrough and surrounding areas. We inspected hospice services for adults.

Butterwick Limited is registered as a charitable trust and also receives funding from the NHS.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 05 November 2019 along with an announced visit to the hospice on the 06 December 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? 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.

The only service provided was hospice services for adults.

Services we rate

Our rating of this hospital/service went down. We rated it as Inadequate overall.

We found the following issues that the service provider needs to improve;

  • We saw significant safety concerns in areas such as disclosure and barring checks for staff and registered nurse’s verification checks.

  • There was insufficient attention to safeguarding. Staff did not have the right levels of safeguarding training to meet intercollegiate guidance (2019).

  • Incidents were not always reported and investigations and learning from incidents was not adequately shared. This meant that the risk of incidents happening again was not reduced and we saw evidence of identical, preventable incidents.

  • Staff were not supported with mandatory training and managers had no oversight of the training needs required for the role. Staff did not always have the right competencies to care for their patients.

  • Patients’ care and treatment did not always reflect current evidence-based guidance, standards and practice.

  • There was no formal process to monitor patients’ outcomes. We found there was little appetite by managers to drive improvement.

  • Best interest decisions were not made for those patients lacking capacity.

  • Staff did not understand the vision and values of the hospice. The strategy was not underpinned by detailed realistic objectives and plans.

  • The governance arrangements and their purposes were not fully formed. Financial and quality governance were not integrated to support decision making.

  • There was minimal evidence of learning and reflective practice.

However, we also found the following areas of good practice;

  • Staff demonstrated a thorough knowledge of their patients’ needs and we saw examples of caring, compassionate interactions with patients and their families.

  • Patients and families using the service were very happy with the care they had received and felt they received

  • The service was responsive to concerns when these were brought to its attention and the leadership team were eager to change practice to improve services

Following this inspection, we raised significant safety concerns with the provider. In addition, we told the provider that it must take some actions to comply with the regulations. We also issued the provider with 13 requirement notices that affected Butterwick Hospice. Details are at the end of the report.

I am placing the service into special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate overall or for any key question or core service, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.’

Ann Ford

Deputy Chief Inspector of Hospitals, North

3 March 2016

During a routine inspection

We inspected Butterwick Hospice on 3, 9 and 15 March 2016. The first day of the inspection was unannounced which meant that the staff and registered provider did not know we would be visiting. We informed the registered provider of the dates of our other visits.

Butterwick Hospice (inpatient unit) provides specialist palliative and end of life care to a maximum number of 10 people. The hospice is purpose built and within the building there are additional facilities including a day centre. The hospice is situated in the grounds of the University Hospital of North Tees.

The hospice had 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.

We saw staffing numbers and skills mix were sufficient to provide a good level of care and keep people safe. Experienced palliative care nurses were employed to provide care and support to people. At the time of the inspection the hospice did not employ its own palliative care consultant, however, another palliative care consultant provided cover for three sessions a week and at other times staff at the hospice had access to the palliative consultant rota for advice. We were told that interviews for a palliative care consultant were taking place. After the inspection we were informed that a palliative care consultant had been appointed who will work across the North Tees and Hartlepool NHS Foundation Trust and Butterwick Hospice. They were due to start in September 2016. Medical cover after 5pm was provided by Northern Doctors which is a GP led service.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and the action they would take if abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

The management of medicines was safe and people told us their pain was well managed.

Checks of the building and equipment were completed to make sure it was safe. However, fire drills were not taking place as often as needed. After the inspection the management team contacted the fire authority for advice. They told us they had updated the fire policy in line with the recommendations and fire drills were to be arranged making sure that all staff took part in two fire drills a year.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Staff were able to describe in detail individual risks for people and action they would take to ensure their safety. However, some risk assessments were insufficiently detailed which meant that staff did not always have the written guidance to keep people safe.

We found that safe recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

People told us the food provided was good. Nutritional assessments were undertaken to identify risks associated with poor nutrition and hydration.

Staff understood people’s individual needs and the support they and their family members required. We saw that care was provided with kindness and compassion. People who used the service and a relative spoke very highly about the care and service received.

People’s individual views and preferences had been taken into account when their care or treatment plan had been developed. We saw evidence that end of life care was provided with sensitivity, dignity and respect In addition to this, people who were important to the person had been consulted. However, care plans were not person centred. The service used core care plans which is a pre-printed document; however; these had not been adapted to the individual. Relatives and friends were able to visit the hospice at any time; they told us that they were always made welcome.

People and professionals spoke very highly of the complimentary therapies that were available to both people who used the service and relatives. The hospice provided good family support, counselling and bereavement support.

The registered provider had a system in place for responding to people’s concerns and complaints. People were asked for their views.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

1 September 2014

During a routine inspection

This inspection was carried out by one adult social care inspector. This was a scheduled inspection and the focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led.

At the time of the visit there were 7 people using the service. Our inspector spoke with one visiting relative and one person who used the service. We reviewed records relating to the management of the regulated activity, which included two sets of care records relating to people who used the service and a range of documentation used when assessing and monitoring the quality of service provision.

Is the service safe?

We found that the provider had systems in place to ensure that risks were readily identified and assessed to ensure the safety of people who used the service. Staff had completed safeguarding of vulnerable adults training and this training was up to date with staff able to explain safeguarding processes confidently.

Is the service effective?

We found that visitors were able to visit their relatives and friends at the service freely in line with people's wishes.

People had their care and treatment needs assessed prior to admission to the service. Relatives or representatives could have involvement with these assessments in line with people's wishes. Specific plans of care were developed from these assessments ensuring that all care delivered to people was done so following discussion about their identified needs. People were encouraged to express their wishes about how they wanted their care to be delivered.

Is the service caring?

We saw that the service offered a range of holistic care and relaxation techniques to people who used the service. Staff we spoke with spoke with kindness and compassion about the care that they provided to people. Care and support was offered to people who used the service as well as their family members and friends.

Is the service responsive?

Care plans demonstrated that where the needs of people changed this triggered reassessment and planning of care. Where appropriate this included intervention and input from a range of healthcare professionals such as GP's, nurses, social workers and relatives. We saw that clinical decision making was supplemented by a member of the Trust palliative care team where necessary.

Is the service well led?

The provider had developed quality assurance systems to actively monitor and assess the quality of the service they provide. The documentation we looked at demonstrated that incidents were reported, investigated and analysed for learning outcomes.

The provider had developed mechanisms to capture the feedback and experiences of people who used the service, their relatives or representatives and this was used to take forward actions to improve the service.

What people told us:

We spoke with one relative and two people who used the service. Comments made to us included, "You cannot put a price on this place, they (staff) have been amazing, so very caring, we have asked ourselves so many times where they find them, they are unbelievable." "They have helped us so much, I don't know how we would be coping if we didn't have the care and support from here." "I don't know how they do it, but for a place filled with so much sadness, the staff manage to bring out so much happiness."

On the day that we visited we were unable to speak with many people who used the service as they were resting or receiving holistic care. One person we did speak with told us that they had attended the hospice a number of times for respite care. They told us that they always felt very well informed from the moment they arrived at the service. We spoke about staffing levels and they told us that they had never experienced any issues with staff, they told us, "They are all great, nothing is too much trouble." They said that alarm bells were responded to quickly and said that staff were very attentive.

31 July 2013

During a routine inspection

During the inspection we spent time observing the interactions with staff and patients who used the service. We spoke with two patients who used the service and one relative of a patient. We also spoke with the manager, the clinical lead, one of the physicians and three staff.

We saw that staff were attentive and treated patients with dignity and respect. Staff responded quickly when patients called for help. We saw that staff communicated well with people and explanations of care were given in a way that could be easily understood. One patient said, "The doctors are brilliant, they fully explained things in a way we understood." "Privacy and dignity are well respected and I feel safe and secure.'

We found that patients had nursing and treatment plans in place that were up to date and reflected their medical and nursing needs. We also found that staff worked in collaboration with other health and social care professionals.

We found that patients were cared for in an environment that was homely, clean, well maintained and safe. Although, attention was needed to the hot water temperatures to two wash hand basins.

We found that patient's needs were met by sufficient staff with appropriate skill, knowledge and training. We did, however see that the training and support system for staff was under review.

We saw that there were systems in place should patients want to raise concerns or complaints about the service.

20 June 2012

During a routine inspection

During this inspection, we concentrated on the in-patient unit within the hospice.

We spoke with two people who were in-patients at the hospice. They told us that they were treated with dignity and respect at all times. They also told us that they were fully involved in decisions about their treatment and care plans.

One person told us, "I have been involved in my treatment and care plans at all time, I have been fully consulted and am aware of my discharge plan/arrangements." They also said, "I am always treated with dignity and respect and the staff always introduce themselves."