Hospice at Home West Cumbria

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that safety was a priority for everyone, and leaders embedded a culture of openness and collaboration. We checked that people were safe and protected from bullying, harassment, avoidable harm, neglect, abuse and discrimination. We also checked people’s liberty was protected where this was in their best interests and in line with legislation.

The service had a good learning culture. When people raised concerns about safety and ideas to improve, the primary response was always to learn and improve. There was strong awareness of the areas with the greatest safety risks. Solutions to risks were developed collaboratively. Managers investigated incidents thoroughly and the provider was open and transparent when things went wrong. People were protected by a strong approach to safeguarding. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were no serious incidents reported in the last 12 months at the service. Staff and leaders we spoke with described a good safety culture. They reported all incidents that they should report, and all incident reports were reviewed by the clinical governance committee.

They also reported external incidents. For example, we saw when they discovered prescribing errors, these were reported back to the external prescribing GP or clinician.

Staff understood the duty of candour. They were open and transparent and gave patients and families a full explanation if things went wrong, in accordance with policy.

Staff received feedback from investigation of incidents, both internal and external to the service.

The evidence showed a good standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

The service’s referral and admission processes ensured that all essential information about the patient was received to determine if the patient’s needs could safely be met.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and when they were discharged from the service.

The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

The safeguarding adults policy was in date and referenced national best practice guidance, legislation and local authority safeguarding board arrangements. It also included guidance on female genital mutilation and how to report it.

The safeguarding lead was trained to level 4 in accordance with Intercollegiate guidance and they received quarterly safeguarding supervision. All staff, volunteers and trustees were trained in safeguarding to a level appropriate to their role, knew how to make a safeguarding alert, and did that when appropriate.

Staff we spoke with gave examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. The safeguarding lead maintained a log of all safeguarding referrals, attended safeguarding strategy meetings and recorded the outcomes where known.

The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were now clearly defined ceilings of care in place, and all newly referred patients were triaged and risk assessed by qualified and experienced nurses, to ensure all care needs could be met by the service. Those whose needs could not be met were referred to alternative providers.

At referral, any existing plans, for example, emergency health care plans and personalised care plans, were checked and added to the electronic healthcare record. There was now a procedure in place to enable service users to consider, discuss and agree escalation plans for their clinical care, in the event of a deterioration in their condition.

Staff communicated with patients and their carers so that they understood their care and treatment, including finding effective ways to communicate with patients who had communication or mental capacity difficulties.

There was a statement on assisted dying on the website which acknowledged that people have their own thoughts and wishes around their end of life, and they encouraged everyone to talk about dying and share their wishes with their loved ones. As part of this, patients were encouraged to write an Advanced Care Plan, which enabled them to make advance decisions (to refuse treatment, sometimes called a living will) when appropriate.

The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff had all the equipment they needed to do their job. The provider invested in new specialist equipment to help develop the lymphoedema service.

Hydraulic and lifting equipment was maintained and serviced in accordance the Provision and Use of Work Equipment Regulations 1998, (PUWER).

A fire risk assessment was completed for the clinical premises, and we saw fire drills were conducted 6 monthly.

Staff were also able to obtain specialist equipment required to deliver care in people’s homes. For example, moving and handling aids.

The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staffing was almost at establishment except for 2 assistant practitioner posts and a healthcare assistant (HCA) position which were out to advertisement. Recently recruited positions included 1 registered nurse (RN), an HCA and a bank RN, and these were undergoing pre-employment checks prior to starting. However, the current vacancies did not impact on the service’s ability to provide safe staffing for patients, as managers flexed staff between the support at home and home nursing teams and used their own bank staff when needed.

There was adequate access to 24-hour medical advice and guidance. For example, staff contacted the patient’s GP during normal working hours and out of hours, they accessed the trust out of hours nursing service or on call services with an advanced practitioner from another hospice, under formal agreement.

Managers provided new staff with structured induction and held supportive meetings throughout their probationary period.

All staff, trustees and volunteer staff received and were up to date with mandatory training appropriate to their role. Leaders and the business support team had oversight of training compliance via an online tracker. Staff were prompted when e-learning training was due and the current percentage compliance rate was 99.64%, which exceeded the provider’s 95% target. The training was appropriate for the patient group using the service.

All appraisals were up to date or booked for the year and recorded on a tracker to enable manager oversight.

Managers provided staff with supervision (meetings to discuss care management, to reflect on and learn from practice, and for personal support and professional development) and appraisal of their work performance.

The clinical lead received 6 weekly supervision meetings with the medical advisor, who was a specialist palliative care consultant.

The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. All clinical areas were clean, had appropriate furnishings and were well-maintained. Cleaning records were up to date and demonstrated that the clinical areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing. They completed hand hygiene e-learning training on induction and team leaders conducted periodic observations to monitor compliance. Current compliance was 100%.

The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines management policies were adapted from those used at the local NHS trust. Staff followed good practice in medicines management and received annual refresher training in management of syringe drivers.

Staff discussed effectiveness of pain management during shift handover and initiated reviews by the GP or community nursing team when required.