19, 21 and 22 October 2015.
During a routine inspection
This inspection of the Hospice at Home Carlisle and North Lakeland took place over three days 19, 21 and 22 October 2015. This was the first comprehensive inspection of the service following its registration in October 2014.
Hospice at Home Carlisle and North Lakeland (the service) is a registered charity providing 24 hour nursing and personal care services to people in their homes who are suffering from a life limiting or terminal illness. The service operates from offices with The Eden Valley Hospice.
The service aims to provide care and support to adults who have palliative and end of life care needs and also for their families and carers.
The hospice at home service provides a nursing service, occupational therapy and a Lymphoedema service.[Lymphoedema is a chronic condition where excess fluid is retained in the tissues causing a painful swelling]. There is a complimentary therapy service provided that includes massage, Reflexology, Reiki, aromatherapy and breathing and Yoga techniques. [Complimentary or ‘holistic’ therapies are therapies that aim to treat the whole person, not just the symptoms of a disease]. There is also a family support service and a bereavement care service available. All services are provided free of charge.
The agency had a registered manager in post. 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 2008 and associated Regulations about how the service is run.
People using the service and their relatives told us they had “confidence” in the skills of staff and that staff were “caring” and “professional”. People said their privacy was respected and told us they made choices that suited their care needs and personal preferences.
Staff had been given training in recognising abuse and how to report any possible abuse or poor practices. The service provided staff with a broad range of training relevant to their roles and they were kept up to date with all training needs and supported in keeping their knowledge and skills updated. New staff had been given structured induction and mentoring in their roles. Training was given a high priority in the organisation and staff were encouraged to fully develop their skills and knowledge.
Effective staff recruitment systems were in place and these ensured that only applicants who met the service’s job specifications regarding qualifications, experience, character and caring abilities were employed. There were registration and security checks done to make sure all staff were still suitable to work with people in their homes.
Regular supervision and annual appraisals were used to support staff in their work. The staff and management team used reflection and incident analysis to help them make changes to improve the care and support they gave so that they responded quickly to a person’s needs. All accidents and incidents were recorded and analysed to allow for lessons to be learned and appropriate steps be taken to prevent any recurrence.
The service worked very closely with the hospice and hospital palliative care teams, GPs, the Macmillan team, community nursing services, social services and charitable organisations. This helped to make sure there was smooth cross service working to provide appropriate care to meet people’s different physical, psychological and emotional.
There were systems in place to assess and to manage risk. For example, to protect people from the risks associated with medicines, falls, pressure sores and moving and handling. For staff the lone worker procedures and risk assessments for work place stress and specific training needs helped keep staff safe as well.
Systems were in place for responding to concerns and complaints. Relatives told us they could raise any concerns or make suggestions and be listened to. Staff were also clear about how to raise any safety or practice issues with the management team and said they felt they would be well supported. Regular reviews of people’s care were held and people were encouraged to take full part in discussing how their needs were being met.
The service had policies in place in relation to the Mental Capacity Act 2005 (MCA). The MCA provides legal safeguards for people who may be unable to make decisions about their care. We spoke with staff that showed a clear awareness of the importance of supporting people to decide for themselves about their care and treatments.
There were clear and effective systems in place to continually monitor the quality of the service being provided and to identify and implement areas for further service development.