Marie Curie Nursing Service - Care at Home Support Service Care at Home Marie Curie Hospice - Glasgow 133 Balornock Road Stobhill Hospital Grounds

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1 Marie Curie Nursing Service - Care at Home Support Service Care at Home Marie Curie Hospice - Glasgow 133 Balornock Road Stobhill Hospital Grounds Springburn Glasgow G21 3US Telephone: Type of inspection: Announced (Short Notice) Inspection completed on: 5 June 2014

2 Contents Page No Summary 3 1 About the service we inspected 4 2 How we inspected this service 6 3 The inspection 9 4 Other information 23 5 Summary of grades 24 6 Inspection and grading history 24 Service provided by: Marie Curie Cancer Care Service provider number: SP Care service number: CS If you wish to contact the Care Inspectorate about this inspection report, please call us on or us at enquiries@careinspectorate.com Marie Curie Nursing Service - Care at Home, page 2 of 26

3 Summary This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change after this inspection following other regulatory activity. For example, if we have to take enforcement action to make the service improve, or if we investigate and agree with a complaint someone makes about the service. We gave the service these grades Quality of Care and Support 5 Very Good Quality of Staffing 6 Excellent Quality of Management and Leadership 6 Excellent What the service does well The service provides an excellent standard of care and support and is highly valued by service users and their carers. Marie Curie Nursing service is committed to continually improving outcomes for people using the service. The staff team are highly trained and very committed to the work they do. What the service could do better The service had on occasion been unable to provide staff at short notice, however a contingency was being developed. This would ensure that requests for the service would always be met by appropriately trained staff. What the service has done since the last inspection The service had been commissioned to provide a 'fast track' hospital discharge service to support people who wished to be cared for at home instead of remaining in hospital. The service had responded to service user and carer views by co ordinating and managing care at a more local level: there was evidence that this was improving peoples experience of the service. Conclusion Marie Curie Nursing service were providing excellent standards of care and support to people with life limiting conditions. Marie Curie Nursing Service - Care at Home, page 3 of 26

4 1 About the service we inspected The Marie Curie Nursing Service - Care at Home, is a community based service which operates throughout the U.K. The service provider is Marie Curie Cancer Care which is a registered charity. Referrals are made through District Nurses and the allocation of a Marie Curie Nurse is co-ordinated through the referral centre in Wales. The Marie Curie Nursing Service helps people who are approaching the end of their life to remain at home if they wish to do so. The core service is one-to-one overnight nursing from a registered Nurse or Senior Healthcare Assistant, in the patient's home usually for eight or nine hours. Other service types in Scotland are as follows: Grampian - Out of hours rapid response service, Integrated multi patient service. Dumfries & Galloway - Out of hours rapid response service. Falkirk - Out of hours rapid response service, weekend service. Some pilot projects were also in operation for the out of hours rapid response service in Highlands & Wigtonshire. These projects provide input to patients in their own homes for shorter visits, depending on the needs of the patient. The service is allocated on a needs and availability basis and is funded 50% through charitable donations and 50% by the NHS. The Care Inspectorate regulates care services in Scotland. Information about all care services is available on our website at This service was previously registered with the Care Commission and transferred its registration to the Care Inspectorate on 1 April Requirements and recommendations If we are concerned about some aspect of a service, or think it could do more to improve its service, we may make a recommendation or requirement. A recommendation is a statement that sets out actions the care service provider should take to improve or develop the quality of the service but where failure to do so will not directly result in enforcement. Recommendations are based on the National Care Standards, relevant codes of practice and recognised good practice. Marie Curie Nursing Service - Care at Home, page 4 of 26

5 A requirement is a statement which sets out what is required of a care service to comply with the Public Services Reform (Scotland) Act 2010 and Regulations or Orders made under the Act, or a condition of registration. Where there are breaches of Regulations, Orders or conditions, a requirement must be made. Requirements are legally enforceable at the discretion of the Care Inspectorate. Based on the findings of this inspection this service has been awarded the following grades: Quality of Care and Support - Grade 5 - Very Good Quality of Staffing - Grade 6 - Excellent Quality of Management and Leadership - Grade 6 - Excellent This report and grades represent our assessment of the quality of the areas of performance which were examined during this inspection. Grades for this care service may change following other regulatory activity. You can find the most up-to-date grades for this service by visiting our website or by calling us on or visiting one of our offices. Marie Curie Nursing Service - Care at Home, page 5 of 26

6 2 How we inspected this service The level of inspection we carried out In this service we carried out a low intensity inspection. We carry out these inspections when we are satisfied that services are working hard to provide consistently high standards of care. What we did during the inspection This announced - short notice inspection was carried out by one Inspector. The Inspector arranged to meet the manager of the service on 3 June 2014 at 10:00 at Marie Curie Hospice - Glasgow. There was a pre-arranged agenda which was worked through concluding the inspection at 4pm the following day 4 June. As part of the inspection, we took account of the completed annual return and self assessment forms that we asked the provider to complete and submit to us. We sent out questionnaires for staff and carers to complete. A number were returned and this is commented on in the main body of the report. During this inspection process we gathered evidence from various sources, including the following: - Discussions with the Regional and Service managers - Discussions with two Practice Educators - Discussions with 2 Clinical Nurse managers - Discussions with the Human Resources Adviser - Discussions with 2 Health and Personal care assistants - Discussion with 1 Senior Nurse - Discussion with 2 Patient Feedback and Involvement staff - Discussion with Expert Voices Group volunteer - Telephone discussion with 1 carer We looked at the following documents: - Patient information pack - Information pack for District Nurses - Feedback questionnaires from service users in all operational regions. - Feedback questionnaires sent to District Nurses and local authority commissioners - Registered Nurse and Health and Personal Care Assistant induction documents - Registered Nurse and Health and Personal Care Assistant Handbooks - Staff training plan and staff training records Marie Curie Nursing Service - Care at Home, page 6 of 26

7 - Competency assessment tools for all care staff - Accident and Incident records - Complaints information - Patient experience report Staff survey - Service review for Stromness and Dounby March Compliments recorded over the last year - Audits programme. Grading the service against quality themes and statements We inspect and grade elements of care that we call 'quality themes'. For example, one of the quality themes we might look at is 'Quality of care and support'. Under each quality theme are 'quality statements' which describe what a service should be doing well for that theme. We grade how the service performs against the quality themes and statements. Details of what we found are in Section 3: The inspection Inspection Focus Areas (IFAs) In any year we may decide on specific aspects of care to focus on during our inspections. These are extra checks we make on top of all the normal ones we make during inspection. We do this to gather information about the quality of these aspects of care on a national basis. Where we have examined an inspection focus area we will clearly identify it under the relevant quality statement. Fire safety issues We do not regulate fire safety. Local fire and rescue services are responsible for checking services. However, where significant fire safety issues become apparent, we will alert the relevant fire and rescue services so they may consider what action to take. You can find out more about care services' responsibilities for fire safety at Marie Curie Nursing Service - Care at Home, page 7 of 26

8 The annual return Every year all care services must complete an 'annual return' form to make sure the information we hold is up to date. We also use annual returns to decide how we will inspect the service. Annual Return Received: Yes - Electronic Comments on Self Assessment Every year all care services must complete a 'self assessment' form telling us how their service is performing. We check to make sure this assessment is accurate. The service submitted a well completed self assessment as requested by us prior to this inspection. Taking the views of people using the care service into account We were unable to talk to service users during our visit. We used information from carers and relatives, all of who reported a high level of satisfaction with the service. Taking carers' views into account 20 people completed and returned our care standards questionnaires, and we talked with 2 carers during our visit. We also looked at the feedback that carers had provided to the service. All were highly complementary about the service. Some, however reported being distressed when they had not had their families visit confirmed, but this was only on the rare occasion. We have included carers comments throughout this report. Marie Curie Nursing Service - Care at Home, page 8 of 26

9 3 The inspection We looked at how the service performs against the following quality themes and statements. Here are the details of what we found. Quality Theme 1: Quality of Care and Support Grade awarded for this theme: 5 - Very Good Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the care and support provided by the service. Service strengths The performance in relation to this statement was excellent. We came to this conclusion after we looked at evidence that the service was involving service users, carers, people who commission the service, and health professionals such as District Nurses who work with the Marie Curie team. Their feedback was sought by satisfaction questionnaires, audits of services, face to face contact during visits and by telephone. As we suggested at our last inspection, the sample size had been increased: this resulted in more people being asked for their views. In addition, managers regularly contacted carers during the period of engagement with the service to ensure the service was meeting their needs and expectations. We saw evidence of support plans being amended in response to service user and carer wishes and personal and domestic arrangements. The service regularly gathered information from service users and families: the reports evidenced that people rated the service highly in terms of involvement in decision making about their care, and in providing them and their families with support. Examples of actions taken by the service as a response to feedback included more coordination of the service at a local level: this had been well received by people using the service as it had helped them to get to know the managers and staff in the local areas, and made communicating needs easier. Marie Curie Nursing Service - Care at Home, page 9 of 26

10 Staff told us this had provided more opportunity to match staff to service users, to develop better relationships with families, to improve the flexibility of the service, and improve the continuity of care. Support plans we looked at evidenced a very person centred approach, and were outcome focused. Service user expectations of the service were identified in consultation with their carers. There was evidence that service users and carers hopes and aspirations were central to their care and support plans. For example, being supported to attend a family event such as a wedding, or achieving better management of symptoms to improve quality of life. Carers needs were also considered as integral to the support plans. We saw evidence that review meetings were undertaken regularly and actively involved people using the service. We saw evidence of concerns and complaints being dealt with promptly, and learning from these outcomes taken forward, for example, improved communication with service users about staffing changes and service provision. The service was excellent at making sure people knew that their involvement was central to the development of the service, and there was evidence of their involvement at all levels within the organisation. Carers were encouraged to utilise their skills and experience in determining the strategic development of services. As a result, the organisation was ensuring that the service would be 'patient led'. Staff we talked to told us how this was influencing the way that they undertook their work. For example the times of visits were more flexible and systems had been put in place to ensure better continuity of staff. This was of benefit to service users in that they were being supported when they wanted and by staff who were familiar and well known to them. Carers were involved and represented in a variety of different forums and support groups. There was evidence from the minutes and other documentation of the 'Expert Voices' group that carers had opportunity to influence the development of services at a local and national level. We were impressed by the commitment and actions of this group in influencing government policy in relation to employers support of carers of those with life limiting conditions. Areas for improvement Whilst the service was gathering a lot of information from a variety of service users and other key people, it should consider how it may better communicate these Marie Curie Nursing Service - Care at Home, page 10 of 26

11 outcomes to people using the service. The service manager had recognised this as an area for further development. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 11 of 26

12 Statement 3 We ensure that service users' health and wellbeing needs are met. Service strengths The performance in relation to this standard was very good. We came to this conclusion because all aspects of this statement were met or exceeded. The outcomes experienced by service users were of a very high quality. Initial referrals were instigated by the District Nurse and the care request was then added to the database which was managed from a contact centre in Wales. A "Nurse Match" system was then used to search for availability of staff. Certain criteria was used to try to obtain the best match available. If a match could not be found this was flagged to the Senior Nurse for Marie Curie locally and attempts would be made to resolve this. Any instances of "unmet need" were recorded as incidents and reported on through clinical governance systems. This system would try to ensure that this was monitored and actions taken to reduce this to a minimum. The service is currently developing contingency arrangements to assure better availability of staff. A skills list was drawn up with Nurses, this was recorded at the referral centre as to whether the Nurse was able to carry out specific technical tasks such as blood transfusion and the use of syringe drivers. This information was used to try to provide the best match for the care request made. We looked at the interview and selection criteria for Marie Curie staff and this was drawn up to recruit staff with experience of palliative care and end of life care. These were important skills to ensure that staff were able to meet the needs of service users. There were comprehensive policies and procedures to guide Marie Curie staff in delivering good quality care and support. We could see this from the induction process, the workbooks used for professional development and the competency checks that were being carried out with staff to ensure that they were up to date in key areas of practice. Staff that we spoke with were aware of policies and procedures and were impressed by the level of support that they received in order to do their jobs well. There were good training opportunities, support from Practice Educators and Nurse Specialists, and other key health professionals. Staff told us this input ensured that their practice was up to date, and that they maintained their skills and competencies. Managers recognised the challenges this type of work could have on staff, and they Marie Curie Nursing Service - Care at Home, page 12 of 26

13 were pro active in ensuring staff always had access to help and support when they needed it. Staff we talked to told us this support was always available, and discussed the benefit of it to them. We observed good open lines of communication between staff and the management team during our visit. There were detailed handovers about cases which ensured staff were well informed about the needs of the people they were providing support to. The feedback that we viewed from family carers about the care and support provided by Marie Curie staff was very complimentary about the staff and the standard of care. Some comments included: 'They not only cared for my Aunt, but also made sure I was managing too'. 'The care was excellent.' 'I can't fault the nurses, they are great'. 'All the staff were fantastic, kind and professional. We would not have coped without them'. 'You all do an excellent job, the two girls that attended my mum were so caring, kind and gentle'. 'This service allowed me to fulfill my husbands wishes of being cared for at home'. 'The service, support and professional care and advice was excellent'. District Nurses across Scotland who were surveyed by Marie Curie reported a high level of satisfaction with the service in meeting the needs of their patients. Marie Curie Nursing Services were working with the Childrens Hospice Association Scotland to assist service users to have a smooth transition should they choose Marie Curie to provide them with care when they reached adult hood. The service had provided a very informative resource pack for potential service users and their carers. Areas for improvement It was evident that the main cause for concern from service users, carers and commissioners was the infrequent occasion when Marie Curie could not provide staff to undertake a scheduled visit, or when there was a delay to attending a service user. This resulted in people not having access to the support they needed, when they Marie Curie Nursing Service - Care at Home, page 13 of 26

14 needed it. We saw evidence from feedback that this had caused service users and carers distress. They expressed concern that they were often informed of non availability of staff at short notice. The service were developing a contingency to minimise this risk: they recognised this was an area needing to be addressed promptly. Measures being taken meantime include improved co-ordination of staff at a more local level, and more timely communication with people using the service. Grade awarded for this statement: 5 - Very Good Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 14 of 26

15 Quality Theme 3: Quality of Staffing Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service strengths The performance in relation to this standard was excellent. We came to this conclusion because there was robust comprehensive evidence of regular patient/ carer, Commissioner, and District Nurse involvement in feeding back on the quality of staffing. There had been involvement of District Nurses in the recruitment of Marie Curie staff. This shows a good open working relationship with District Nurses as referrers and therefore users of the service. There had also been involvement of the "Expert voices" patient/ carer group in some aspects of recruitment of staff. This again shows that Marie Curie are involving service users and carers in aspects of staffing and recruitment. The services Patient experience report (March 2014) identified a high level of satisfaction with the quality of Marie Curie staff. Feedback about staff was very positive. Some comments from district Nurses recently surveyed: 'Excellent service. Beneficial to district staff and more importantly tremendous support to family and patient'. 'The service provided was seamless, updated every morning and able to handover. Excellent service as it is, with experienced staff delivering best practice'. 'Service is excellent, definitely improves quality of life for patients dying at home'. 'Service provides a huge comfort and support to our palliative patients and their relatives'. Marie Curie Nursing Service - Care at Home, page 15 of 26

16 Areas for improvement The comments made in statement 1.1 are also applicable to this statement. In addition, we saw evidence that the service had been responsive to comments about improving communication systems for referrals and ensuring availability of staff. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 16 of 26

17 Statement 3 We have a professional, trained and motivated workforce which operates to National Care Standards, legislation and best practice. Service strengths The performance in relation to this standard was excellent. We came to this conclusion because all aspects of this statement were met or exceeded. The outcomes experienced by service users were of a very high quality. Discussions with the Human resource adviser evidenced that staff were being recruited to best practice standards. All necessary checks were being undertaken prior to employment. This included the completion of an application form, health check, references, interview check with specific questions about palliative care and a check with Disclosure Scotland that the applicant was not barred from working with vulnerable adults or children if this was applicable. The Nurses were checked with the Nursing and Midwifery Council (NMC) professional register. We checked the induction framework and found that this was comprehensive and specific to the different job roles within the service. All staff were made aware of important policies and practices specific to palliative and end of life care. There was a skills checklist which was sent to the referral centre which co-ordinates the allocation of Marie Curie staff to the requests for patient care made by the District Nurses. We spoke to the Clinical Nurse Managers who described the systems that were used to obtain the best match of staff to the care request that had been made. There were on-going training and development plans for all staff. We talked with a selection of staff who were able to confirm that they had regular staff training and that checks on competency were also being made. If an area for development was identified then training goals were set and this was re-checked. Staff were being provided with training specific to patient need, for example home ventilation, dementia care. Some staff had opportunity to undertake advanced professional training and the service was assisting with funding in this respect. A team of Practice Educators co- ordinate and facilitate staff training and development, and are always available to the staff team. The service had developed a schedule of observations of practice of care and nursing staff: these were being undertaken to ensure good quality practice was being Marie Curie Nursing Service - Care at Home, page 17 of 26

18 maintained. Staff have supervision sessions every six weeks: staff we talked to told us they found these useful and allowed them to discuss their practice and identify any training and support needs. In addition to attending learning events, staff could access a wide range of topics via e learning: staff saw this as positive, as it allowed them to access training from home at any time of the day. All of the staff we met with during our visit were very empathetic and committed to providing the best standard of care to patients, and families. Some staff were happy to work 'split shifts' to ensure continuity for those in their care. Areas for improvement If the service contingency plan includes the provision of agency or casual staff, consideration should be given as to how the service will ensure these staff maintain their competencies. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 18 of 26

19 Quality Theme 4: Quality of Management and Leadership Grade awarded for this theme: 6 - Excellent Statement 1 We ensure that service users and carers participate in assessing and improving the quality of the management and leadership of the service. Service strengths The performance in relation to this standard was excellent. We came to this conclusion because there was robust comprehensive evidence of regular patient/ carer, Commissioner, and District Nurse involvement in feeding back on the quality of management and leadership. We spoke with a representative of the "Expert Voices" group which was made up of family carers who had experience of using Marie Curie services. There had been extensive opportunities to review policies and get involved in giving comment and feedback on the development of the service. There had been staff involvement in the service's self assessment, this was confirmed by staff we talked to during our visit. The service had also used social media to gather views and comments via facebook and their own website. We observed good open lines of communication between all grades of staff during our visit: staff told us they could always pick up the phone for advice or assistance. Senior staff we talked to were intuitive about the impact of working with this patient group and were very sensitive to the needs of the staff. This demonstrated an open organisation that was keen to involve the public and professionals in the improvement of the service. Areas for improvement The comments made in statement 1.1 are also applicable to this statement. Marie Curie Nursing Service - Care at Home, page 19 of 26

20 Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 20 of 26

21 Statement 4 We use quality assurance systems and processes which involve service users, carers, staff and stakeholders to assess the quality of service we provide Service strengths The performance in relation to this standard was excellent. We came to this conclusion because all aspects of this statement were met or exceeded. The outcomes experienced by service users were of a very high quality. The service used a clinical governance framework to monitor and improve the quality of the service. There were actions plans in place relating to "user involvement", "risk", "workforce development" and "clinical effectiveness". There was an audit programme in place with timescales and charts to monitor the progress of these audits. Current audits in progress were in relation to medicines management, falls and documentation. The service used a process of staff survey, carers stories and district nurse, and other key stakeholder evaluations to provide feedback on the service. The feedback on the quality of the service was extremely positive from all of the staff, District Nurses, commissioners and carers Complaints and incidents were logged on the on-line system. This provided a summary of the issue and tracked that investigation and actions were taken. We saw evidence of measures being taken to improve the availability of staff and communication with patients and their families. Service provision was also becoming more flexible in response to patient need. Staff told us they wanted the service to be 'patient led' We saw evidence of effective systems in place to monitor the standard of the service, identify risks, and to ensure prompt action was being taken to deal with issues. There was evidence of strong management and leadership at all levels within the service, a culture of learning, and a developing workforce. Areas for improvement As commented in statement 3.3 the system of practice observations of staff should be incorporated into the services' quality assurance system. This should be extended to any agency or casual staff. Grade awarded for this statement: 6 - Excellent Number of requirements: 0 Number of recommendations: 0 Marie Curie Nursing Service - Care at Home, page 21 of 26

22 Marie Curie Nursing Service - Care at Home, page 22 of 26

23 4 Other information Complaints No complaints have been upheld, or partially upheld, since the last inspection. Enforcements We have taken no enforcement action against this care service since the last inspection. Additional Information None. Action Plan Failure to submit an appropriate action plan within the required timescale, including any agreed extension, where requirements and recommendations have been made, will result in the Care Inspectorate re-grading a Quality Statement within the Quality of Management and Leadership Theme (or for childminders, Quality of Staffing Theme) as unsatisfactory (1). This will result in the Quality Theme being re-graded as unsatisfactory (1). Marie Curie Nursing Service - Care at Home, page 23 of 26

24 5 Summary of grades Quality of Care and Support Very Good Statement 1 Statement Excellent 5 - Very Good Quality of Staffing Excellent Statement 1 Statement Excellent 6 - Excellent Quality of Management and Leadership Excellent Statement 1 Statement Excellent 6 - Excellent 6 Inspection and grading history Date Type Gradings 17 May 2013 Announced (Short Notice) Care and support Staffing Management and Leadership 5 - Very Good 6 - Excellent 6 - Excellent 19 Jun 2012 Announced (Short Notice) Care and support Staffing Management and Leadership 6 - Excellent 6 - Excellent 6 - Excellent 27 Mar 2012 Re-grade Care and support Not Assessed Staffing Not Assessed Management and Leadership 5 - Very Good 22 Feb 2012 Re-grade Care and support Not Assessed Staffing Not Assessed Management and Leadership 1 - Unsatisfactory 28 Sep 2010 Announced Care and support 6 - Excellent Staffing Not Assessed Marie Curie Nursing Service - Care at Home, page 24 of 26

25 Management and Leadership 6 - Excellent 15 Oct 2009 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership Not Assessed 24 Oct 2008 Announced Care and support 5 - Very Good Staffing 5 - Very Good Management and Leadership 5 - Very Good All inspections and grades before 1 April 2011 are those reported by the former regulator of care services, the Care Commission. Marie Curie Nursing Service - Care at Home, page 25 of 26

26 To find out more about our inspections and inspection reports Read our leaflet 'How we inspect'. You can download it from our website or ask us to send you a copy by telephoning us on This inspection report is published by the Care Inspectorate. You can get more copies of this report and others by downloading it from our website: or by telephoning Translations and alternative formats This inspection report is available in other languages and formats on request. Telephone: enquiries@careinspectorate.com Web: Marie Curie Nursing Service - Care at Home, page 26 of 26