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Prospect Hospice Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 5 September 2019

Prospect Hospice is operated by Prospect Hospice Limited. The service provides community and inpatient hospice care. The inpatient service is registered as a 16-bedded facility which provides respite care, symptom control and care for 12 patients at the very end of life.

During this inspection we inspected the inpatient unit and their community services.

Prospect@Home provides hands-on care in the patients’ home, night and day. It has a team of nurses, nursing assistants and specially-trained home support volunteers who work alongside the patient’s own GP, community nurses and others involved in a patient’s care. It provides coordinated care, designed and delivered to meet the wishes of patients who wish to be supported at home. The Prospect clinical nurse specialist team are community based and offer care and support to people in their homes. This team supports patients and their family soon after diagnosis and for as long as they are needed. They also have nurses dedicated to supporting patients who live in care homes, working alongside care staff to support and care for the patient.

Within the past 20 months the hospice has been inspected three times. The hospice was inspected in February 2018, at that inspection we issued a warning notice warning notice for Regulation 17: Good Governance. Another inspection took place in August 2018 which was a focused inspection to review the provider's actions in respect of the warning notice. While some improvements had been made, these were not enough to provide full assurance. As a result we imposed conditions upon the provider's registration which included monthly risk and health and safety reports. For the most recent inspection, we inspected this service using our comprehensive inspection methodology. We carried out this unannounced inspection on 25 and 26 June 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.

Inspection areas

Safe

Requires improvement

Updated 5 September 2019

Our rating of safe went down. We rated it as Requires improvement because:

  • Staff completed, but did not always update risk assessments for each patient to minimise risks.
  • Managers regularly reviewed staffing levels and skill mix, however, they did not always ensure there were enough staff in the clinical specialist nursing team.
  • Nursing staff did not always keep detailed records of patients’ care and treatment. Records were not always clear, up-to-date or easily available to all staff providing care.
  • Staff did not manage prescription documents in line with the provider’s policy. NHS prescription stationery use was not tracked as required by national guidance.
  • Staff recognised and reported incidents and near misses. Managers investigated incidents but did not share lessons learned with the whole team and the wider service.

However:

  • The service provided mandatory training in key skills to all staff and made sure most staff completed it. This was an improvement from the last inspection in August 2018.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. This was an improvement on the last inspection in August 2018.
  • The service, on the whole, controlled infection risk well. They used control measures to prevent the spread of infection before and after a patient died. They kept equipment and the premises visibly clean. This was an improvement on the last inspection in August 2018.

Effective

Requires improvement

Updated 5 September 2019

Our rating of effective went down. We rated it as Requires improvement because:

  • The service did not provide care and treatment based on national guidance and evidence-based practice. Managers did not always check to make sure staff followed guidance.
  • Staff did not always document their assessment of patients regularly to manage their pain. Patients did not raise concern about this and were provided with pain relief when required.
  • Staff did not fully monitor the effectiveness of care and treatment as there was no participation in relevant quality improvement initiatives. They could not assure themselves where improvements were required to achieve good outcomes for patients.
  • The service did not ensure records of training evidenced that staff were competent for their roles in the community clinical nurse specialist team.

However:

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care and communicated effectively with other agencies.
  • Key services were available seven days a week to support timely patient care.
  • The service made adjustments for patients’ religious and cultural needs.
  • Staff gave patients practical and emotional support to help them live well until they died.
  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

Caring

Good

Updated 5 September 2019

Our rating of caring stayed the same. We rated it as Good because:

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.
  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

Responsive

Requires improvement

Updated 5 September 2019

Our rating of responsive went down. We rated it as Requires improvement because:

  • The service did not always plan and provide care in a way that met the needs of local people and the communities served.
  • The service did not always take account and record patients’ individual needs and preferences.
  • Waiting times from referral to achievement of preferred place of care and death were not documented in line with good practice.

However:

  • The hospice was designed to meet the needs of families and relatives of patients.
  • Patients could usually access the specialist palliative care service when they needed it.
  • The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff.

Well-led

Requires improvement

Updated 5 September 2019

Our rating of well-led went down. We rated it as Requires improvement because:

  • The service had a vision for what it wanted to achieve, however, this was under review with plans for future development with the whole staff team.
  • Some staff did not always feel respected, supported and valued. The culture did not always encourage, openness within the organisation. However, this had improved since our last inspection and the senior leadership and staff had worked hard to support staff and recognised this was an area for continued support.
  • The service did not have overarching governance systems to systematically improve service quality or safeguarded high standards of care.
  • The service did not have imbedded systems to identify risks, or an overarching plan to identity, eliminate or reduce them, and cope with both the expected and unexpected.
  • The service did not always collect, analyse, manage and use information well to support all its activities.

However:

  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care and there were new members of the senior leadership team.
  • Trustees were visible and involved.
  • Staff told us they really enjoyed working in the hospice.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services.
Checks on specific services

Hospice services for adults

Requires improvement

Updated 5 September 2019

We rated this service overall as requires improvement. Safe, effective responsive, and well-led require improvement. Caring was good.