Hospice at Home Carlisle and North Lakeland

Updated 12 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place between 16 and 29 May 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service. The inspection was carried out by one inspector.

Before our inspection we reviewed all the information we held about the service. We also examined notifications received by the CQC. Notifications are reports about changes, events or incidents that the provider is legally obliged to send us within the required timescales. We contacted local authority commissioning teams, as well as 12 health and social care professionals for their views about the service. These included district nurses, discharge liaison co-ordinators, clinical nurse specialists and social workers.

During the inspection we spoke with four people and four relatives about the services they received from Hospice at Home Carlisle and North Lakeland. We spoke with the registered manager, clinical lead, senior staff nurse, an occupational therapist, a lymphoedema nurse specialist, a bereavement counsellor, four health care assistants, two patient co-ordinators, the HR manager and the chair of the trustees. We also contacted 15 other nursing and care staff by email for their views.

We looked at eight people’s records We examined the recruitment, supervision and training records for four staff members and training records for the staff team. We also looked at the organisation’s governance systems including audits, meetings and incident analysis.

Updated 12 July 2018

This inspection took place between 16 and 29 May 2018 and was announced. This was the first inspection of the service since it registered to a new address in April 2017.

Hospice at Home Carlisle and North Lakeland is a registered charity which provides 24 hour nursing services to people in their own homes who are suffering from a life limiting or terminal illness. It also provides occupational therapy, physiotherapy, lymphoedema, complementary therapies and bereavement services.

People felt safe and comfortable with the staff who provided the service. Staff were clear about their responsibilities to identify any risks or concerns so that these could be addressed to safeguard the people who used the service. Staffing was based on the current needs of people using the service. Sufficient time was allowed for visits so that people's care was not rushed.

The service was effective at providing care to people in their own homes. A range of planned and reactive services were provided by skilled, experienced nurses and healthcare assistants. A training strategy made sure all staff received mandatory and specialist training relevant to their role.

There was good communication across different teams within the service so that people received an holistic range of services and therapies to support their care. The service also worked well with a range of other health care services to make sure people received co-ordinated care and support.

People, relatives and other care professionals were unanimous in their positive praise of the caring, compassionate support provided by all the staff. This included nursing, care and office staff. People were treated with respect and dignity. People were provided with personalised care that was specific to their needs. They felt fully involved in discussions about their care and said staff listened to what they wanted. Where people were receiving end of life care the service worked within nationally recognised best practice guidelines to make sure people received compassionate, dignified support.

The culture and values of the service were paramount to individual staff members and were embedded in the organisation as a whole. Staff felt “valued” and “privileged” to work for the service that made a difference to people’s lives.

The service was very well-managed and organised, with a structure that provided staff with leadership and support. Good governance arrangements were in place with clear lines of accountability and continuous drive towards new initiatives and development.

Further information is in the detailed findings below.