We carried out a review of the data available to us about Bury Hospice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Bury Hospice, you can give feedback on this service.
Bury Hospice is registered charitable organisation providing hospice services, the service has 12 inpatient beds, however they were only commissioned for and so used eight beds. They also had a day hospice which people attended during the day only and were not admitted as inpatient.
We inspected this service as a response to concerns raised about the storage and administration of controlled drugs and medicines. We carried out an unannounced inspection on 27 February 2019. We did not rate this service at this inspection.
In order to respond specifically to the concerns raised to us we only looked at some aspects of the safe and well led domains. Specifically, we looked at the following key lines of enquiry; in ‘safe’ we looked at incident reporting, medicines management, records and assessing and responding to risk. In ‘well-led’ we looked at culture, governance and monitoring risk in relation to medicines management. Throughout the inspection, we took account of what people told us, what we found on inspection, and what staff told us.
During the inspection, we visited the inpatient ward and day hospice unit. We spoke with ten members of staff including registered nurses, health care assistants, medical staff and senior managers. We spoke with two patients. During our inspection, we reviewed all four sets of notes for inpatients (there were only four inpatients at the hospice at the time of inspection) and one patient record on the day hospice unit.
We found good practice in relation to medicines management:
We found areas of practice that could be improved in relation to medicines management:
Ellen Armistead
Deputy Chief Inspector of Hospitals (North)
The hospice is purpose built and is situated in a residential area of Bury, not far from the town centre. The hospice is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors.
Services are free to people, with Bury Hospice receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations.
There were six patients being cared for in the Inpatient Unit during our inspection, 20 patients being cared for in the community by the Hospice at Home service and 10 patients attending the Day Hospice.
We inspected Bury Hospice on the 21 and 28 March 2017. The first day of the inspection was unannounced. We last inspected Bury Hospice in April 2016 where we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the lack of audits on the quality and safety of the service, no formal staff supervision, incomplete training records and no business continuity plan in place to deal with emergencies that could arise and possibly affect the provision of care.
During this inspection we found that the service had met all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The hospice had a manager registered with the Care Quality Commission (CQC) who was present during the second day of the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.
We were assisted on the first inspection day by the hospice care team manager; a registered nurse with a wealth of nursing and palliative care experience.
The expressions of gratitude relayed to us demonstrated that patients and their families were cared for with the utmost compassion, kindness, dignity and respect. Patients spoke highly of the kindness and caring attitude of the staff. Patients told us they received the care they needed when they needed it and that staff were knowledgeable and committed. Visitors told us they were always made welcome.
Discussions with staff and visitors demonstrated to us that the staff recognised and considered the importance of caring for the needs of family members and friends. Patients were supported at the end of their life to have a comfortable, dignified and pain-free death. The nursing and medical staff showed they were highly skilled in pain and symptom control. The staff we spoke with had an in-depth knowledge of the care and support that patients required.
We saw that patients were assisted in a way that respected their dignity and privacy. We observed respectful, kindly and caring interactions between the staff, patients and visitors. The patients looked extremely well cared for and there was enough equipment available to ensure their safety, comfort and independence were protected.
The care records showed that patients were involved in the assessment of their needs. Their preferred place of care at all stages of their illness and the arrangements in the event of their death were documented. The care records we looked at showed that risks to the patient’s health and well-being had been identified, such as poor nutrition, the risk of developing pressure ulcers and the risk of falls. We saw care plans had been put into place to help reduce or eliminate the identified risks.
Suitable arrangements were in place to help safeguard patients from abuse. Policies and procedures for safeguarding patients from harm were in place and staff had received safeguarding training.
The hospice had safe and effective systems in place to manage medication. There was medicine support in place from a pharmacist employed by the local hospital who told us they had a good working relationship with the staff and the doctors.
We found patients and their families were cared for and supported by sufficient numbers of suitably skilled, competent and experienced staff that were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for patients safely.
All areas of the hospice were secure, well maintained and accessible for people with limited mobility. In addition good infection control procedures were in place; making it a safe environment. Systems were in place for carrying out regular health and safety checks and we saw that equipment was serviced and maintained regularly.
Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.
We saw that patients were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. Patients who were at risk of malnutrition and poor hydration had their food and fluid intake monitored to help ensure their well- being.
We were told that a change in the management board structure of the hospice had enabled staff to understand the clear levels of responsibility and accountability within the whole hospice team
To help ensure that patients received safe, effective care and support, systems were in place to monitor the quality of the service provided. Systems were also in place for receiving, handling and responding appropriately to complaints.
Services are free to people, with Bury Hospice receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations.
There were six people being cared for in the In Patient Unit during our inspection, 18 people being cared for in the community and 10 people attending the Day Hospice.
We inspected Bury Hospice on the 13, 15 and 19 April 2016. The first day of the inspection was unannounced. We last inspected Bury Hospice on 11 July 2013 where we found all the regulations that we looked at had been complied with.
The home had a manager registered with the Care Quality Commission (CQC) who was present during the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.
We found there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.
There was no auditing of the quality and safety of the service to ensure people were kept safe.
We found that staff had not received regular formal supervision; necessary to enable them to feel supported and be able to discuss their progress and training needs.
An inspection of the training records showed they were incomplete. Failing to keep records to demonstrate that staff have been appropriately trained and have the necessary skills to safely care for people places people who use the service at risk of harm. There were no records to show that checks had been undertaken to show that the registered nurses who worked at the hospice had a current registration with the Nursing and Midwifery Council (NMC).
There was no business continuity plan in place to deal with emergencies that could arise and possibly affect the provision of care.
People spoke highly of the kindness and caring attitude of the staff. The expressions of care and gratitude relayed to us, demonstrated that people were cared for with the utmost compassion, kindness, dignity and respect.
We saw that people’s privacy was respected and people were assisted in a way that respected their dignity. We observed respectful, kindly and caring interactions between the staff, the people who used the service and visitors. People looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected.
The care records showed people were involved in the assessment of their needs. A person’s preferred place of care at all stages of their illness and the arrangements in the event of their death were documented. The care records we looked at showed that risks to people’s health and well-being had been identified, such as poor nutrition, the risk of developing pressure ulcers and the risk of falls. We saw care plans had been put into place to help reduce or eliminate the identified risks.
People were supported at the end of their life to have a comfortable, dignified and pain-free death. The clinical staff showed they were highly skilled in pain and symptom control.
Visitors were made welcome and the staff recognised and considered the importance of caring for the needs of family members and friends.
We found the medication system was safe and we saw how the staff worked in cooperation with other healthcare professionals to ensure that people received appropriate care and treatment. The healthcare professionals we contacted told us they had no concerns about the service.
Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.
Staff sought people’s consent before they supported them. The staff we spoke with had an in depth knowledge of the care and support the people who used the service required.
We found that suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.
We found people were cared for by sufficient numbers of suitably skilled, competent and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.
All areas of the hospice were secure, well maintained and accessible for people with limited mobility. In addition good infection control procedures were in place; making it a safe environment for people to live and work in.
We saw that food stocks were good and people were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met. People who were at risk of malnutrition and poor hydration had their food and fluid intake monitored to help ensure their well- being.
Suitable arrangements were in place for reporting and responding to any complaints or concerns.
Patients' care records contained enough information to show how they were to be supported and cared for.
The design, layout and maintenance of the hospice premises ensured that patients, staff and visitors were kept safe.
Adequate equipment and adaptations were available to promote the patient's independence and comfort and assist in their safe moving and handling.
Patients were cared for by staff that were properly trained, supported and supervised.
Regular monitoring of the services and facilities provided was in place to help protect patients against the risk of inappropriate or unsafe care.