Kate's Home Nursing

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that there was an inclusive and positive culture of continuous learning and improvement that was based on meeting the needs of people who used services and wider communities. We checked that leaders proactively supported staff and collaborated with partners to deliver care that was safe, integrated, person-centred and sustainable, and to reduce inequalities.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant there was consistency of leadership. Leaders and the culture they created assured the delivery of high-quality care.

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.

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Managers consulted and used the experience of trustees to develop a future strategy for providing a high-quality sustainable service. Staff could explain how they were working to deliver high quality care. Staff had been asked for their views of service provision previous activities of the service along with current challenges were considered in developing the strategy.

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they provided and could explain clearly how staff worked to provide high quality care. There had been changes in the leadership and management of the service over the previous 12 months. Recent reviews of the service and how it was provided had prompted further actions. For example, policies had been updated and new policies developed where there were gaps, partnering services with other hospice providers had created demand for the service and trustees had been recruited for the skills they could contribute in their field of expertise.

Staff found their managers were approachable and visible and were a supportive part of the team.

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. All feedback was shared with staff. Any negative comments were dealt with quickly and sensitively by staff and managers who contacted the person who had raised concerns.

Staff could meet with the senior leadership team and trustees to give feedback. Managers were available 24 hours a day and senior leader was at the location base most days. Staff had contact with trustees in a variety of ways such as in multi-agency meetings, when trustees who lived locally visited the base and at team building or fund-raising events. Staff were aware of freedom to speak up champions in the service but felt they could speak openly with managers and leaders if they had a concern. Freedom to speak up champions had attended addition training for this role.

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff could work flexibly around the demands of their home lives. Demand for the service varied and staff informed managers of their availability to work. Staff were paid for the hours they worked. Managers put reasonable adjustments in place for staff members to help them carry out their role. Staff preferences of travel distance were considered when allocating patients to nursing staff.

We scored the service as 3. The evidence showed a good standard. The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

There was a clear framework of what must be discussed at meetings to ensure that essential information, such as learning from incidents and complaints, was shared and discussed.

Staff had implemented recommendations from reviews of deaths, incidents and complaints. Portable suction equipment had been procured following review of patient care. This meant staff had ready access to equipment which would improve the comfort of patients when they were near the end of their life.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. For example, there were one or two records which did not have preferred place of care completed and no rationale for this. Staff were reminded to complete assessment forms fully.

Staff, managers and leaders knew how to access audit results and short summaries were provided in governance, trustee and team meetings for discussion. However, details of the results were not shown at these meetings and could be a missed opportunity to identify areas for improvement. Staff and trustees felt they had the information they needed about performance of the service.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Managers promoted the service for awareness of community teams and to improve timely referrals to Kate’s Home Nursing service.

Managers identified and managed risk. A comprehensive document detailed risks, calculated a score, and recorded progress of actions taken to reduce risks. Staff could escalate risks at any time and received feedback about actions taken. This included business continuity in times of flu or adverse weather conditions.

Where there were financial constraints, they did not compromise patient care. There had been a reduction in demand for the service in recent months. Managers reviewed reasons and were of the opinion this was an after effect of the covid 19 pandemic. Leaders had taken steps to broaden their geographical reach and adapt how they provided care to improve sustainability of the service. This had included working in partnership with other larger hospices, ensuring GP surgeries were fully aware of the service they provided and encouraging earlier referrals from other services.

Staff had access to the equipment and information technology needed to do their work. New laptops had been procured to provide more effective working for staff when they were away from the nursing base.

Information governance systems included confidentiality of patient records. Where paper records were held, staff followed a clear policy for when and how to retain and destroy them.

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Managers and leaders engaged with external stakeholders. They attended meetings with commissioners and other community service providers. Staff were clear they worked in partnership with other services to provide appropriate care for patients and relatives. Staff and managers communicated freely with other services with a focus for improving patient care. Support continued to families after a patient had died. The service provided and staff attended a ‘bereavement café’ that relatives of patients could attend. This was well attended by people who had experienced a bereavement who spoke positively of the support they received.

Patients and staff could meet with members of the provider’s senior leadership team to give feedback.

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to develop opportunities for improvements and innovation and this led to changes in care delivery. Staff took part in debrief sessions about cases where Kate’s Home Nursing had provided care. These were focused on identifying where they could improve the patients’ and relatives’ experiences at a difficult and emotional time. Nursing staff valued the debriefs and shared any actions with their team. Information or areas of improvement were shared at multi-agency meetings and with other hospices in the region. The nurse manager shared messages, compliments, actions and areas for improvement in a newsletter ‘Julie’s Jewels’.