Background to this inspection
Updated
29 March 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 checked 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.
We gave the registered manager 3 working days’ notice due to the type of service it provides. To enable the registered manager to contact people who use the service and family members and advise them of our inspection and ask if they would be happy for us to talk with them.
The inspection site visit activity started on 20 February 2018 and ended on 21 February 2019.
The inspection was carried out by two inspectors and three Experts by Experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.
We reviewed the information we held about the service, including statutory notifications that the provider had sent us. A statutory notification is information about important events which the provider is required to send us by law.
We contacted 26 commissioners by e-mail requesting feedback about the service.
We did not visit people in their own homes as they were receiving end of life care. We liaised with the registered manager as to the most appropriate way to seek the views of people using the service. We spoke with 29 family members of people who were using or had used the service by telephone on 21 and 22 February 2018.
We spoke with 17 staff who had different roles and responsibilities either in person or by telephone across the geographical area on the 20 and 21 February 2018. Staff included the registered manager, health care assistants, senior registered nurses, registered nurses and clinical nurse managers.
We looked at information held and recorded about people’s care on the computer system. We looked at the recruitment files of three members of staff. We also looked at a range of policies and procedures and records related to the monitoring of the service, which included complaints and quality assurance audits.
Updated
29 March 2018
This inspection took place on 20 and 21 February 2018. Due to the sensitivity of the care provided by the service, the provider was given 3 working days’ notice of our visit. This was so people who used the service could be told of our visit and asked if they would be happy to speak with us.
Marie Curie Nursing and Domiciliary Care Service, Central Regional (MCNS Central) is a registered provider of palliative and end of life care services to adults with terminal illnesses across the Central Region. The service supports people in their own homes. The geographical area includes Lincolnshire, Leicestershire, Staffordshire, Stoke, Derbyshire, Birmingham, Solihull, Warwickshire, Walsall and Dudley. At the time of our inspection there were 300+ people receiving a service.
This service is a domiciliary nursing and care agency. It provides personal and nursing care to people living in their own houses and flats in the community. It provides a service to adults. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.
People were referred to the service by healthcare professionals, the main referral source were District Nurses. Clinical Commissioning Groups (CCGs) commission the service. Staff worked as an integrated team with other health professionals such as District Nurses and GPs. A majority of the care was provided by nurses and healthcare assistants overnight to people in their own homes.
A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated Regulations about how the service is run.
Family members were overwhelmingly complimentary about the service. Praising staff for the compassion and kindness shown to their relative and to themselves. Family members had confidence in the knowledge and skills of staff, and the positive impact this had on their relatives care. Family members spoke of the collaborative approach of the staff and other health care professionals and the positive impact it had on their relatives care. Family members told us the service provided was tailored to their relation’s individual needs and that they had complete confidence in the staff, whom they trusted and felt safe with.
Commissioners of the service and health care professionals who worked alongside staff were consistent in their praise of the service provided by MCNS – Central. Comments referred to the satisfaction of those using the service. They referred to the collaborative working approach that led to the provision of a high quality service to those at the end of their lives and their families. Commissioners made reference to the service in its determination to continually improve services through collaboration and by identifying new ways of working to improve.
Staff demonstrated a commitment in the implementation of the provider’s values and mission in the delivery of end of life care. Staff’s knowledge and understanding of the service was keenly demonstrated through their enthusiasm to engage with us talking about the service and their role and areas of responsibility. Staff were passionate about the service they provided and sought to provide a person centred approach to people’s end of life care and in the support of family members.
People were treated with kindness and their individuality respected. Staff promoted people’s dignity and all interactions between staff, those using the service and family members were positive to ensure the best outcome for people.
Staff worked collectively with people using the service and their relative to ensure they were central to any decisions about end of life care and treatment. Staff provided end of life care, to ensure people had a dignified and pain free death as well as providing support to family members during and after their relative’s death.
The organisation structure of the service meant there was strong, clear and visible leadership. All staff had specific areas of responsibility and worked consistent with the provider’s value and mission to deliver high quality end of life care. There were robust systems to measure the quality of the service, and opportunities were provided for those using the service and their family members to comment upon and influence the development of the service. The service worked in conjunction with other organisations to improve end of life care for people and had been accredited externally for its work.
Staff worked as part of an integrated team with other health professionals such as District Nurses and GPs. Most of the care provided for people was overnight care in their own homes. District Nurses in the main developed care plans, detailing the care and treatment people needed. Staff from MCNS Central followed these care plans, which included any potential risks and how these were to managed.
Staff knew how to keep people safe, and how to report any concerns or incidents. The registered manager was proactive in learning from incidents and events, and had brought about changes to practices. There were enough staff to keep people safe and the proactive approach of the provider in promoting staff safety along with local agreements with external organisations meant staff were available to meet people’s needs.
Staff from MCNS Central had clearly defined protocols and systems for the management and administration of medicine, which included coordinated working with health care professionals. This ensured people’s symptoms and pain were managed safely and effectively.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrict way possible; the policies and systems in the service supported this practice and staff worked collaboratively with family members to ensure the people’s care and treatment was in their best interests.
People’s needs were met as there were sufficient staff who had the necessary skills and knowledge to meet their needs. The provider, registered manager and staff had a strong commitment to training and personal development, through on-going training, support, reflective practice, supervision and appraisal. Staff’s developmental plans were reflective of the provider’s values and mission to provide high quality care for people at the end of their life.