All inspections: St Luke's Hospice Kenton Grange Hospice Harrow & Brent

We carried out a review of the data available to us about St Luke's Hospice Kenton Grange Hospice Harrow & Brent on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about St Luke's Hospice Kenton Grange Hospice Harrow & Brent, you can give feedback on this service.

We carried out a focussed follow up inspection of the Safe, Effective and Well led domains to check compliance with concerns identified in the warning notices issued in October 2021. At this

inspection we found:

The provider had complied with the warning notices issued in October 2021. The provider had made improvements to comply with the provisions of Regulation 12: Safe Care and Treatment, and Regulation 17: Good Governance.
The service now controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean and ensured that all equipment used to provide care or treatment was safe for such use.
The service now provided mandatory training in key skills to all staff and made sure everyone completed it.
The design, maintenance and use of facilities, premises and equipment now kept people safe.
The service used systems and processes to safely prescribe and record medications. They now safely administered and stored medicines.
Staff kept detailed records of patients’ care and treatment. Records were now individualised, clear, and up to date.
Staff now assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way.
The service had enough staff to care for patients and keep them safe.
Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
Leaders were visible and approachable in the service for patients, relatives and staff. Staff felt respected, supported and valued.
Leaders now operated effective governance processes
Leaders and staff actively and openly engaged with patients, staff, the public

However:

The senior leadership was not stable, and the recent changes were yet to be sustained or become embedded in practice
Risk management systems and processes were not coherent and still in early development.
There were no systems and processes in place to develop staff skills in quality improvement or monitor and embed quality improvement in the hospice.

Our rating of this location went down. We rated it as inadequate because:

The service did not always control infection risk well. Staff did not always use equipment and control measures to protect patients, themselves and others from infection. They did not always keep equipment and the premises visibly clean.
The service provided mandatory training in key skills to all staff but did not make sure everyone completed it.
The design, maintenance and use of facilities, premises and equipment did not always keep people safe.
The service used systems and processes to safely prescribe and record medications, but they did not always safely administer and store medicines.
Staff did not always keep detailed records of patients’ care and treatment. Records were not always clear or up to date.
Staff did not assess or monitor patients regularly to see if they were in pain and therefore may not always give pain relief in a timely way.
Leaders did not always operate effective governance processes throughout the service and with partner organisations.
Leaders and teams did not always identify and escalate relevant risks and issues or identify actions to reduce their impact.

However:

The service had enough staff to care for patients and keep them safe.
Staff provided good care and treatment and gave patients enough to eat and drink.
Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.

This inspection took place on the 13, 15 and 16 September 2016 and was unannounced.

St Luke's Hospice Kenton Grange Hospice Harrow & Brent is a registered charity providing specialist palliative and clinical support for people over the age of 18 years with life limiting illnesses irrespective of diagnosis. The services provided included a 12 bed in-patient unit, a day service, outpatients’ service and care in people’s own homes provided by community teams. The hospice also provides support for families, friends and carers of people using its services.

At the time of our inspection there were approximately 760 people using or known to the service. Two of the beds in the inpatient unit were closed to ensure people’s safety whilst there were a number of nurse vacant posts. The number of inpatients varied each day of the inspection.

The service had a registered manager who was the Director of Nursing and Patient Services of the hospice. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 and associated Regulations about how the service is run. The registered manager was supported in the managing and running of the services by the Chief Executive Officer (CEO), Board of Trustees, Medical Director and other management staff.

People were very positive about the care and support they received from highly motivated staff. They told us staff were very kind, listened to them and respected their wishes and preferences regarding their care and support needs. People received a service which was person centred in meeting each person’s individual needs. People were supported to be fully involved and to take the lead in all decisions about the care and support they received. They told us they felt listened to and were respected by staff.

People received care and support from a multi-disciplinary team [MDT] and volunteers. The staff we spoke with from all the services were very enthusiastic about their jobs and had a good understanding of their role and responsibilities. They showed they cared very much about the people they supported and were committed to deliver a high standard of service to people. Staff treated people with sensitivity and respect and had positive and caring relationships with people using the hospice services, people’s families and others important to them. People’s emotional, spiritual and other individual needs were met by staff who were competent, compassionate and caring.

People received the care, treatment and emotional support they needed as staff and volunteers had the training they needed to develop their skills and provide them with the knowledge and competence to meet people’s individual care needs.

The hospice was committed to promoting high quality end of life care for people by providing education and training for a wide range of health and social care professionals working in the community, hospitals and nursing homes. People with life limiting illnesses and those at the end of their life benefitted by receiving the care and support they needed from skilled and caring staff and were more likely to avoid hospital admission.

The hospice was responsive to people’s feedback and very proactive in working in partnership with an exceptional number of other professionals and organisations to develop best practice and provide people with a range of services that met their individual needs including advice and emotional support.

People received the medicines they needed on time and in a safe manner. People’s pain was monitored closely and managed well.

The hospice provided a 24 hour advice line for people in Harrow that used its services, their families and friends and for health and social care professionals. This service provided a range of advice including management of pain, symptom control for people receiving end of life care or support with managing a life limiting illness in their own home, hospital or nursing home. A rapid response team provided support, care and treatment for people within 24 hours. This and the telephone advice line contributed to people being supported to remain in their preferred place and avoid hospital admission.

People told us they felt safe when receiving care and support from the hospice services. Staff knew how to report concerns internally and to outside agencies and were confident concerns would be addressed appropriately.

There were systems and processes in place to protect people from the risk of harm. Staff knew how to recognise signs of abuse and report any concerns. Risks to people’s well-being were assessed by staff and measures were in place to mitigate risks and keep people safe within the hospice and in their own home. There was a system in place to record, assess and monitor accidents and incidents. Incidents were analysed to minimise avoidable risks and the risk of re-occurrence.

The provider's staff recruitment process made sure that staff and volunteers were suitable to work with people who needed care and support. The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and supported people to make informed decisions about their care. Staff knew when a person did not have the capacity to make a decision about their care and treatment that it would need to be made in a person’s best interest. Staff knew when safeguards needed to be in place to protect people who were unable to make decisions about their care.

People knew how to complain and were confident that they would be listened to and any concerns they raised would be addressed appropriately. People were asked for their feedback about the service they received and staff were committed to learning from people’s experiences and making improvements to the services when this was required.

People told us they enjoyed the meals, were offered choices and had their individual food preferences catered for. The importance of good nutrition was understood by staff and promoted. Risks of malnutrition were assessed and measures to support people to have the nutrition they needed were in place and regularly reviewed.

A range of activities were available for people using the day service or inpatient unit. These included complementary therapies which people spoke very positively about.

Staff and people using the service told us that the service had an open, inclusive and positive culture. Senior staff showed clear lines of responsibility and leadership. They with their staff teams demonstrated a strong commitment to providing people with a safe, high quality and caring service and worked hard to promote, improve, extend and develop the service to reach as many people as possible within Brent and Harrow.

Systems were in place to maintain the safety of the hospice. This included addressing maintenance issues, fire prevention and carrying out health and safety checks of equipment and the building. A high standard of cleanliness was maintained in the hospice. Systems and processes were in place to monitor standards of hygiene and control of infection and to make improvements when needed.

A range of comprehensive and effective systems were in place to monitor and improve the quality of the services provided.

We carried out an unannounced comprehensive inspection of this service on 08 April 2014. A breach of a legal requirements was found. As a result we undertook a focused inspection on13 January 2015 to follow up whether action had been taken to deal with the breach.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 08 April 2014

St Luke's Hospice Kenton Grange provides care to the people of Harrow and Brent who have illnesses that are no longer curable. On the day we visited six people were using the in- patient hospice service. We saw this had 12 beds, six are single rooms with a toilet and hand basin; one four bedded bay with a shared toilet and hand basin but which is used as single sex accommodation only; a two-bedded bay with toilet, hand basin and shower. There are additional shower and bath facilities within the ward area.

The Hospice also offers a day service where people can be supported in a safe and uplifting environment, this is open every day with a different emphasis daily to meet different people’s needs. Nurses, doctors and a social worker are available each day.

We spoke with three people who were using the hospice and three relatives during our inspection. Overall, people praised the hospice, comments included “It’s a lovely atmosphere here,” “the staff make me feel safe,” and “it’s very peaceful here and welcoming.” Most people we spoke with told us that the hospice provided everything they and their relatives needed.

All the people and relatives we spoke with felt safe at the hospice and said the staff listened to them and responded quickly to their changing needs. They were involved in planning their own care and staff were aware of people’s likes and dislikes and their cultural and religious needs.

We saw that people’s important documents were kept up to date and they, as well as friends and relatives (if requested by the person), were involved in making decisions. We saw that people had the support of professionals and others when making difficult choices.

People said that staff were knowledgeable, kind, caring and approachable. People were able to quickly access doctors and other professionals such as physiotherapy and counselling services.

People had access to range of activities. They said they enjoyed having a massage or attending music or art therapy, we saw that relatives were also offered relaxing treatments.

We saw that the hospice had areas where people and their families could have privacy. People’s rooms had access to a garden and a private patio area. Their beds could be taken outside on to this if they wished. Families and friends were able to say overnight either in the same room as their relatives or in a separate room for family and friends.

We saw that people had well-co-ordinated care when they moved from different services. The hospice had good relationships with other services, such as the Clinical Nurse Specialist (CNS) based at the local hospitals, which ensured people received effective care and support.

People had their comments and complaints listened to and acted on. There was an effective complaints system in use In the hospice. We saw that complaints were reviewed by the manager, the senior leadership team and well as the board of trustees.

The hospice promoted a positive culture that was person-centred, open inclusive and empowering. People spoke positively about the approach of staff and managers. Staff we spoke with were aware of their roles and responsibilities. There was a consistency between what the managers, staff and board of trustees said were the key challenges, achievements and risks at the hospice.

The hospice had a registered manager who had the day to day support of the Chief Executive Officer (CEO) and an active board of trustees. They demonstrated good leadership of the hospice and it was evident that the manager was well known to the staff.

We looked at the prescribing of medicines, medicines storage and supplies and administration systems for medicines. We saw medication was kept securely. However, we could not be assured of safe practice with recording of prescriptions and prescribing of some medicines which could have led to medication being administered incorrectly.

We saw medicines were being kept securely and only accessible to staff authorised to handle medicines. Medicines were being kept in a locked drug trolley or in a locked treatment room. Controlled drugs were being appropriately stored.

However, we could not be assured of safe practice in the recording of prescriptions for controlled drugs and other prescriptions that were being used at the hospice. We saw that these were not being recorded in a way that that would assure that they were being used appropriate.

When syringe drivers were being prescribed, (these are used to give medication continuously under the skin, often used for managing people’s pain) the prescription did not specify how long the medicines should be administered over. This could lead to medicines being administered over an incorrect time period and puts people at risk of receiving too much or too little medicine.

These problems were evidence of a breach of a health and social care regulation. You can see what action we have asked the provider to take at the back of this report.

Focused inspection 13 January 2015

After our inspection of 08 April 2014 the provider wrote to us to say what they would do to meet the legal requirements for the breach relating to aspects of the management of medicines.

We undertook this unannounced focused inspection to check they had followed their plan and to confirm that they now met legal requirements. We found the provider had followed their plan in relation to this regulation. This means legal requirements for the management of medicines had been met.

Improved arrangements were in place for the recording of prescriptions [FP10 and FP10CDF] used in the service. A new prescription and medication administration record was in use along with additional records for the application of medicines supplied as patches. A clear competency database was maintained for all nurses training relating to medicines handling.

We also found improvements had been made with the recording of Do Not Attempt Resuscitation [DNAR] orders. They showed that cardiopulmonary resuscitation (CPR) had been discussed with the person using the service who had then made the decision whether or not they wished to be resuscitated, and this decision was recorded.