15 June 2016
During a routine inspection
The service worked in conjunction with GPs and community based nurses and is provided to people who live within a 20 mile radius of Stow on the Wold in Gloucestershire. This included the surgeries at Stow on the Wold, Bourton, Burford, Northleach, Winchcombe and Moreton in Marsh. A local resident, who had wanted to remain at home for her own end of life care, instigated the setting up of the service up 21years ago by the local GP and district nurses. The charity has made the decision to remain small, person-centred and responsive and to only provide qualified nurses.
There was a registered manager 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.
At the time of the inspection the service was supporting eight people. Health and social care professionals could refer people to the service for support or people and their families could refer themselves. Kate’s Home Nurses worked in partnership with the district nurses who were the lead healthcare professional.
The service provided to people was safe. This was because the nurses were trained on how to safely use any moving and handling equipment and had received safeguarding adults and children training. Risks to people’s health and welfare were well managed. Safe recruitment procedures were followed to ensure that only suitable nurses were employed. This meant appropriate measures were in place to protect people from being harmed.
The service offered support to people who were either experiencing a period of acute illness as part of a life limiting illness or were at the end of their lives. The service had a flexible workforce in order to be able to accommodate demand for the service. All eligible referrals were accepted and an assessment was made, so that support can be given when capacity allowed. In the meantime the coordinator often offered to be on call overnight (or give nursing care herself) if no nurse was available, for those people requiring symptom control. If a referral was not eligible, the service signposted onto other services. This may be because the person lived ‘out of area’. However it was evident the nurses were compassionate about their role and often pulled out all the stops to enable people to be nursed at home for their final hours, days or weeks.
All nurses had a programme of mandatory training to complete plus other training courses that were relevant to the palliative care service they provided. New nurses to the service had an induction training programme to complete. They were shadowed by one of the nurse coordinators until they were ready to work alone and were competent to carry out their role to the high standards expected. The nurses had the necessary skills and qualities to provide compassionate and caring support to people and their families.
People were supported to make their own choices and decisions where possible. The nurses had received training about the principles of the Mental Capacity Act (2005). Where people lacked the capacity to make decisions nurses worked within implied consent but checked with family members and healthcare professionals before providing care and support.
Nurses supported people to eat and drink safely as part of the care they delivered and liaised with the district nurses and the person’s GP when needed. Where people were unable to eat and drink, mouth care and oral hygiene were provided in order to keep people comfortable.
The nurses developed good working relationships with the people they were looking after and their families. These working relationships were short but intense. The nurses were well supported emotionally by their colleagues, the registered manager and the trustees, through regular supervision, team meetings and team debrief sessions.
People were involved in making decisions about the care and support they needed and the service provided was led by their needs and wishes. People’s care needs were reviewed at every visit by the nurses and adjusted, taking into account deterioration in people’s abilities. The nurses worked in partnership with the district nurses. Communication between the nurses, the nurse coordinators and the district nurses ensured that any changes in people’s health was reported and significant information was passed on.
The service was well led with good management and leadership provided by an experienced registered manager and the nurse coordinators. The trustees who were not involved in the day to day business were kept fully informed of how the service was performing. Where things did not go as well as expected, they looked at the reasons why and made adjustments accordingly. There was a continual programme of review to drive forward improvements.
The service had a regular programme of audits in place to check on the quality and safety of the service. Any accidents, incidents, near misses and complaints would be used to identify any learning in order to drive improvements the service could make. The arrangements in place ensured the service was safe, effective, caring, responsive and well led.
The service was linked with the National Association of Hospice at Home and the registered manager, nurse coordinators and CEO attended meetings and conferences. They linked with other hospice providers and this enabled them to share, and learn about, good and best practice.