Tynedale Hospice at Home

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

This means we looked for evidence that people were protected from abuse and avoidable harm.

We checked that risks to people’s safety were identified, assessed and managed well, and that systems were in place to prevent mistakes and reduce the likelihood of harm. We also looked for evidence that when things went wrong, the service learnt from incidents and took action to improve safety. We considered how leaders promoted a culture where people’s safety was prioritised, concerns were listened to, and improvement in safe practice was part of everyday work.

At our last assessment we rated this key question good. At this assessment the rating has remained 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.

We scored the service as 3. 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.

The service promoted a positive learning culture where staff understand that raising concerns, reporting incidents and suggesting improvements are a core part of their role. Staff described feeling able to speak up and were aware of routes to escalate concerns, including access to senior managers. There was evidence of a just culture, with an emphasis on learning rather than blame.

Incidents and near misses were reported and reviewed, and staff told us they received feedback on learning outcomes. Managers used these opportunities to identify themes and trends, and there was evidence that learning was applied to improve practice. For example, we were told that record-keeping errors had occurred following the introduction of a new computer system. In response, these issues were reviewed and staff were given opportunities to discuss the challenges they were experiencing and were supported to address them. Learning was shared across the team to promote improvement and reduce the risk of similar errors occurring again.

Staff were supported following incidents, including informal debriefs, and compassionate engagement with patients and families was maintained.

There had been no reported never events in the preceding year. Never events are serious, largely preventable safety incidents which should not occur if the available preventative measures are followed.

Mandatory training was available and monitored, with systems in place to remind staff when updates were due. Although staff numbers were small, all clinical staff were up to date with essential training. Leaders monitored compliance and took action where gaps were identified to ensure patient safety was not compromised.

We scored the service as 3. 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 or monitored. They made sure there was continuity of care, including when people moved between different services.

The service had referral and admission pathways, with referrals accepted from a range of professionals including hospital teams, GPs and community services. Referrals were reviewed to ensure patients met the criteria and to support timely and appropriate admission. Information about the service and reasons for referral were explained to patients and their families to support informed decision making.

A registered nurse (RN) care coordinator was available Monday to Friday, with support provided by an on-call and traceability system outside of those hours. Community Nursing teams and wider multidisciplinary teams could refer patients via telephone or email.

There were effective systems in place to support safe transitions of care. Staff described good communication and information sharing with partners, including community teams, GPs and acute services. Clinical records were clear, accessible and supported continuity of care, with key information such as advance care plans and patients’ preferences routinely recorded and shared.

Staff followed the verification of expected adult death policy, which ensured trained and competent registered nurses verified deaths safely and respectfully in line with nursing and midwifery council (NMC) guidance. Care was person-centred, considering cultural and religious needs. Clear processes supported good documentation, communication with families, and appropriate escalation.

Handover processes were established to support continuity, coordination and the safe delivery of care across the hospice at home service and with external partners. A standardised ‘Huddle’ template was used to record key patient information, planned care and identified risks.

A formal handover took place weekly. This included a review of the nursing caseload, patient complexity and current care provision. Discussions also identified patients who were deteriorating or families requiring additional support. This process supported service planning and prioritisation.

We scored the service as 3. 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 service had safeguarding policies in place that reflected current national guidance, and staff were aware of how to access and follow them. Staff described being confident in recognising and reporting safeguarding concerns, including risks to patients and those close to them, such as family members or carers. We saw several examples where the safeguarding policy had been followed appropriately.

We heard that, in response to volunteer feedback about the safeguarding policy, clearer guidance was developed. This included more explicit actions for staff to follow, as well as information on how to access support and respond to concerns outside of usual working hours.

There were established links with local safeguarding teams and access to specialist advice, including outside of normal working hours.

Appropriate checks were completed during recruitment, including disclosure and barring service (DBS) checks, and safeguarding was embedded within staff induction. Staff, volunteers and other roles such trustees received training suitable for their responsibilities and understood the actions required if concerns were identified.

Staff safeguarding training compliance was 100%. Staff completed the level of safeguarding training required under the intercollegiate guidelines. This included training on safeguarding children. Trustees and senior leaders had oversight of safeguarding and received appropriate awareness training.

The principles of the Mental Capacity Act (2005) were understood and applied in practice, with staff supporting patients to make decisions wherever possible. Where patients lacked capacity, best interest decisions were made with appropriate involvement from families and others important to the person. Documentation reflected consideration of patients’ wishes, beliefs and values.

Staff demonstrated awareness of the Deprivation of Liberty Safeguards (DoLS) and the need for appropriate legal frameworks where relevant.

We scored the service as 3. 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.

The service supported a person-centred approach to risk, where patients were encouraged to maintain independence and achieve their preferred outcomes at the end of life. Staff demonstrated an understanding of positive risk taking and worked with patients and families to balance safety with individual wishes. Where patients had capacity, their decisions were respected.

Risk assessments were holistic, individualised and regularly reviewed. They covered key areas such as nutrition, moving and handling and communication. Risks and mitigation plans were shared with the multidisciplinary team and, where appropriate, with patients and their families to support informed decision making. Care plans reflected changing needs and included clear guidance on when to escalate concerns or adjust treatment.

Staff were trained to recognise and respond to deterioration, including identifying reversible conditions and escalating appropriately. Systems were in place to support timely access to medical advice, including out of hours.

Where behaviours of distress or agitation occurred, staff used de-escalation techniques and person-centred approaches to maintain safety.

We scored the service as 3. 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.

The service ensured that environments used to deliver care in patients’ homes were safe and appropriate. A first visit care risk assessment was completed which was used to identify and reduce any risks linked to delivering care in the home environment.

The assessment considered a range of key factors, including access to the property, lone working arrangements and moving and handling needs. It also reviewed fire safety, environmental hazards, pets within the home, and any other risks that could affect the safety of the patient or staff.

All relevant information was recorded clearly and shared with staff involved in the patient’s care. Staff took steps to maintain privacy, dignity and comfort, including ensuring appropriate support for patients and families at end of life.

The service considered individual patient needs, including those with mobility difficulties or requiring specialist equipment. Staff worked with partner services to ensure necessary equipment was available in the community. Staff knew how to report faulty equipment and confirmed that concerns were acted on promptly.

We scored the service as 3. 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.

The service had systems in place to ensure safe and effective staffing, with recruitment processes aligned to national standards, including appropriate checks for all staff and volunteers. Staff told us they were well supported through induction and ongoing training. Workforce planning considered patient need, acuity and caseloads within the community.

Multidisciplinary team working was embedded, with access to a range of professionals such as physiotherapists, occupational therapists and pharmacists through established referral pathways. Staff understood their roles and worked within their scope of practice, with support from senior clinicians when required.

Training, supervision and appraisal processes were in place and aligned to role requirements. Staff had access to mandatory and specialist training, including end of life care, safeguarding, mental capacity and recognising deterioration. Compliance with mandatory training was monitored, and leaders took action to address gaps. At the time of inspection, clinical staff mandatory training compliance was 100%. Compliance for non clinical staff was 98.4%, which was above the providers compliance target of 95%.

We scored the service as 3. 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.

The service had clear infection prevention and control policies aligned with national guidance, and staff demonstrated a good understanding of their responsibilities. In the community setting, staff assessed infection risks within patients’ homes and took appropriate action to reduce the risk of transmission. This included the use of personal protective equipment (PPE), hand hygiene and safe handling of equipment.

Staff followed best practice principles such as bare below the elbows and appropriate use of PPE when delivering care. They supported patients and families to understand and follow infection control measures, particularly where there was a known or suspected infection. Communication systems ensured that any new or emerging infection risks were shared promptly with staff.

The service monitored infection control practice through audits and oversight, for example we saw evidence of observed practice reviews which assessed compliance with hand hygiene technique, use of PPE, bare below the elbow guidance and wider infection prevention practices during patient care delivery.

Clinical staff were issued with portable hand hygiene kits containing soap, moisturiser, disposable towels and waste disposal bags to support effective handwashing where facilities within the home were limited. Staff additionally carried hard surface wipes and PPE as standard when providing care in the community.

We scored the service as 3. 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 happen.

The service had policies and procedures in place for medicines management that reflected national guidance and supported safe practice in the community. Staff had access to medicines advice, including pharmacy support, and described being able to seek guidance when needed.

Controlled Drugs (CDs) were checked, administered, and recorded accurately in line with legal and local requirements.

Only registered nurses gave injectable medicines. Hospice support workers (HSWs) did not touch or adjust syringe drivers and reported any concerns straight away.

HSWs gave non-injectable medicines only when trained and assessed as competent and followed local policy.

The service supported safe practice through training, supervision, and regular checks, and worked with patients and carers to make sure care was safe and appropriate. We reviewed the medication administration audit and saw compliance was 100%.

We heard how staff worked closely with GPs, community nursing teams and wider palliative care services to support safe medicines management within the community setting.