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Archived: Countess Mountbatten House Good

Inspection Summary


Overall summary & rating

Good

Updated 23 April 2015

Countess Mountbatten House provides treatment and care to adults with life limiting conditions. The hospice also supports the families of the patients who use the service. The hospice is part of the University Hospital Southampton NHS Foundation Trust, and this was the first inspection of the service.

Countess Mountbatten House is a 25 bed unit, providing specialist end of life care and support for patients and families. There were 22 patients receiving care at the time of the inspection.

The day care unit (the Hazel Centre) supports patients living in the community. There is a dedicated nursing and bereavement team working closely with the clinical nurse specialist, led by consultants at the hospice, and those in the community. Patients benefit and receive care and support from a dedicated multidisciplinary team, including counselling, physiotherapy and occupational therapy teams.

There was no registered manager, as the hospice is part of the trust and does not require a registered manager. A matron was in day to day charge of the hospice. 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.

The hospice had a dedicated staff team with clear visions and values. Staff commented “we work as a team and all pull together”, in order to achieve best outcomes for the patients. Patients and their relatives described the care and treatment they were receiving as “excellent care”. Staff we were told were “very caring” and patients said “they (the staff) can’t do enough for you”. Care and support was provided in a caring, compassionate manner, and the patients’ privacy and dignity were respected.

There were arrangements to assess risks, such as falls and pressure injury, to ensure the safety of patients. Care plans had been developed following assessments by physiotherapy for patients identified as high risk of falls. These provided guidance to staff in order to manage these risks in a consistent way. The staff rotas showed that there were consistently enough staff with the skill mix to provide safe and consistent care.

The CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. DoLS are a code of practice to supplement the main Mental Capacity Act 2005. Staff were clear about the actions they would need to take if they needed to evoke the DoLS to protect the rights of patients. We were given an example of how staff had ensured the safeguards were initiated and assessments carried out by appropriately trained professionals.

The service had developed ways of ensuring that staff received the training they needed to deliver a high standard of care. Staff had been trained and appointed as ‘champions’. Champions were staff that showed a particular skill or interest in reducing falls, and providing end of life care and infection control, and acted as role models for other staff. Staff told us that they had received training which was appropriate to their roles.

There was a strong commitment and support for the patients and their relatives, before and after death. Patients were treated with compassion and care. They were put at the centre of their care through ongoing consultation and involvement of their relatives and multidisciplinary team, so that care could be tailored to their individual needs.

There was strong clinical leadership at the hospice. There was a clear governance structure from unit level to the trust board. Members of the board made quarterly visits to both the hospice and community services. However, the process to seek patients and their relatives’ views was not fully developed and the trust needed to work with its partners to improve the provision of bereavement and hospice at home services.

Areas for improvement

Action the hospice should take to improve:

The hospice needs to ensure that:

  • Staff have training in the use of the electronic patient record system to enable them to access information as needed.

  • Strategies are developed to provide support for the families of those who were cared for by the service in the community.

  • The hospice at home service is developed with partners, as an integral component of community end of life care.
Inspection areas

Safe

Good

Updated 23 April 2015

Patients told us they felt “very safe and well looked after”. The service was clean, well maintained, and infection control procedures were adhered to by all staff.

Staff had completed training and understood their responsibility in protecting patients in their care.

There were sufficient numbers of staff, with the right competencies, skills and experience available to meet the needs of the patients.

The staff followed their processes for assessing risks, such as falls and pressure injury, to ensure the safety of patients.

Medicines were appropriately managed and patients received their medicines as prescribed, including medicines for effective pain control.

Effective

Good

Updated 23 April 2015

Care plans had been developed which were aligned to National Institute for Health and Care Excellence (NICE) guidance and evidence-based practice for end of life care.

Following the withdrawal of Liverpool Care Pathway (LCP), the trust had commenced the Achieving Priorities of Care document pilot, which aims to develop an end of life pathway.

Patients and their relatives expressed a high degree of satisfaction with pain control to ensure patients comfort. Patients received appropriate support with diet and fluids, including supplements in order to meet their nutritional needs.

Staff had the necessary training and skills to provide specialised care and support to a high standard. The hospice provides 24/7 specialist palliative (end of life) care service for patients with advancing cancer. Following the inspection the trust told us they are providing support to an increasing number with non -cancer diagnoses.

Some staff were designated 'champions' and provided guidance in specific areas of care and peer support. Multidisciplinary working was well established and enhanced the delivery of seamless care.

'Do not attempt cardio-pulmonary resuscitation' (DNA CPR) forms were used appropriately. Where a person lacked capacity to make decisions we saw that the Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff, and appropriately implemented for patients’ protection.

Caring

Good

Updated 23 April 2015

Patients and their relatives told us the staff were kind, caring and provided “excellent care”.

We observed care was provided in a caring, sensitive and compassionate manner. Patients and their relatives were involved in their care and treatment.

Relatives were supported to stay close to their loved ones, and care was provided in a holistic way, and took into account their spiritual and psychological needs.

The team of volunteers and chaplaincy provided good support and help to the patients, their relatives and the staff.

Responsive

Good

Updated 23 April 2015

The service was responsive.

Patients’ individual needs and choices were taken into account and arrangements were in place to meet their care, spiritual and religious needs.

There was good access to beds at the hospice, and community support provided advice and weekend visiting for urgent cases only. Calls were directed to the hospice due to limited support out of hours.

Patients with non-malignancy requiring management of symptoms control were treated in the community by the community palliative medicine team. The trust had identified currently there are no facility to admit patients for symptom control and they are looking at developing this service.

The day care service provided valuable support to patients and their families. This included therapy sessions and regular carers group meetings.

The palliative care team worked cohesively with the clinical nurse specialist in ensuring seamless service when patients are discharged into the community.

There was a complaint process, which was followed, and people were able to raise their concerns with the staff.

Well-led

Good

Updated 23 April 2015

There was a strong nursing leadership; the chief executive was approachable and the board made quarterly visits to the hospice and to the community team.

There was a clear governance structure from unit level to the board. Staff were clear about incident and statistic reporting through their electronic reporting system, and how this was used to inform practice improvements across the trust. Staff said there was also good medical leadership with a consultant palliative clinical lead, who led the hospice team.

Staff were passionate about care, and their visions and values, of putting patients as main focus of their care.

The process to seek patients and their relatives’ views was not fully developed. Questionnaires were being developed to seek views of patients and relatives, as this was not happening to support service development and improve outcomes for patients.

A bereavement service had been provided by the hospice until a few months ago, but funding for this this had stopped. There was a trust wide bereavement service based at Southampton General Hospital that covered the hospice. Further work was needed with partners to ensure bereavement services are established as an essential component of palliative care to support bereaved relatives in the community.

The hospice did not provide a hospice at home service. There was a palliative care support service provided by a neighbouring community trust. The hospice management needs to work with partners to develop a hospice at home service as an integral component of community end of life care, bringing the skills, ethos and practical care associated from the hospice into the home.

Arrangements for the monitoring of the storage of medical gases, used by the Hospice, should be improved to ensure it is safe and secure.