Marie Curie Nursing Service - Care at Home Support Service

Marie Curie Nursing Service - Care at Home Support Service 133 Balornock Road Stobhill Hospital Grounds Springburn Glasgow G21 3US Inspected by: (Care Commission Officer) Type of inspection: Sarah Gill Announced Inspection completed on: 24 October 28 1/13

Service Number Service name CS2519316 Marie Curie Nursing Service - Care at Home Service address 133 Balornock Road Stobhill Hospital Grounds Springburn Glasgow G21 3US Provider Number dummy Provider Name SP232375 Marie Curie Cancer Care Inspected By dummy Inspection Type Sarah Gill Care Commission Officer Announced dummy Inspection Completed Period since last inspection 24 October 28 14 months dummy Local Office Address Central West Region 4th Floor 1 Smithhills Street Paisley PA1 1EB Tel: 141 843 423 Fax: 141 843 4289 dummy 2/13

Introduction The Marie Curie Nursing Service is a community based service which operates throughout the UK. The service provider is Marie Curie Cancer Care which is a registered charity. The service was registered with the Care Commission on 1 November 25. Referrals are made through the District Nurses and the allocation of a Marie Curie Healthcare Assistant is coordinated through the referral centre in Wales. Marie Curie Healthcare Assistants provide care for adults who are seriously ill and for whom active treatment is no longer an option. Their stated aim is to work along with other care providers to assist service users to remain at home for as long as possible. Marie Curie Healthcare Assistants provide care during an allocated shift from a minimum of 3 hours to between 8-1 hours. The service is allocated on a needs and availability basis and is funded 5% through charitable donations and 5% by the NHS. Based on the findings of this inspection the service has been awarded the following grades: Quality of Care and Support - 5 - Very Good Quality of Staffing - 5 - Very Good Quality of Management and Leadership - 5 - Very Good This inspection report and grades represent the Care Commission"s 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. Please refer to the care services register on the Care Commission"s website (www.carecommission.com) for the most up-to-date grades for this service. Basis of Report Before the Inspection The Annual Return The service submitted a completed Annual Return as requested by the Care Commission. The Self-Assessment Form The service submitted a self-assessment form as requested by the Care Commission Regulation Support Assessment The inspection plan for this service was decided after a Regulation Support Assessment (RSA) was carried out to determine the intensity of inspection necessary. The RSA is an assessment undertaken by the Care Commission Officer (CCO) which considers complaints activity, changes in the provision of the service, nature of notifications made to the Care Commission by the service (such as absence of a manager) and action taken upon requirements. The CCO will also have considered how the service responded to situations and issues as part of the RSA. This assessment resulted in this service receiving a low RSA score and so a low intensity inspection was required. The inspection was based on the relevant Inspection Focus Areas and associated National Care Standards, recommendations and requirements from previous inspections and complaints or other regulatory activity. 3/13

During the inspection process Staff at inspection This announced inspection was carried out by Care Commission Officer, Sarah Gill. Evidence Information was gathered from a number of sources including: The Marie Curie User Survey, Patient Information Pack, Monthly Clinical Audit, Service Level Agreements, District Nurse Hand-over, Induction Folder, Sample of 3 Staff files, Corporate Plan and Clinical Governance Arrangements. Examination of Disciplinary Procedure. 22 staff questionnaires were returned. Inspection Focus Areas and links to Quality Themes and Statements for 28/9 Details of the inspection focus and associated Quality Themes to be used in inspecting each type of care service in 28/9 and supporting inspection guidance, can be found at: http://www.carecommission.com/ Action taken on requirements since last Inspection There was one requirement made in the previous inspection report of 8 August 27. 1. The Provider must develop a policy and procedure on restraint. A policy including aspects of restraint guidance had been developed. This policy was not fully explicit as to the approach for staff training, risk assessment and documentation process to be used by staff. The Manager agreed that a revision of this policy would take place. The Requirement was partially met. (See Recommendation 2.) Comments on Self Assessment The self assessment of the service's performance was carried out and submitted to the Care Commission prior to the inspection. Aspects of this self assessment were sampled and verified during the inspection. The self assessment had been completed by managers of the service, involvement of staff and service users could be considered. View of Service Users The service had mechanisms for seeking and recording the views of service users. View of Carers The service had mechanisms for involving and seeking views from family carers. 4/13

Quality Theme 1: Quality of Care and Support Overall CCO Theme Grading: 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 Service users were offered the opportunity to comment on the quality of information supplied at the commencement of service. A "Patient Information Pack Questionnaire" was supplied. The feedback from this questionnaire had been used by the service to review and update the information supplied. The questionnaire also identified who had completed it. There was a User Involvement Group which met to consider aspects of patient and carer involvement. This group met quarterly and there was an action plan resulting from these meetings. The User Survey was sent out to Team Managers to randomly pick 5 patients, this was collated into a national survey. The User survey covered aspects of care and support and offered free text for comments to be made. There was also a telephone feedback line Marie Curie Direct. The level of service user and carer involvement was regular and consistent. Areas for Development There were some limitations to the collection of service user feedback. The involvement of staff members could create a bias. This was being considered by the service as a future development of involving volunteers or another third party to assist in collecting and evaluating service user views. There was a variety of feedback methods in use but the challenge of gaining feedback from service users with communication support needs had not been fully explored. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations Statement 3: We ensure that service user's health and wellbeing needs are met. Service Strengths 5/13

The Care Plan and initial assessment was carried out by the District Nurse and so the Carers responsibility was to carry out care and support needs as directed for the period of that shift. There were local arrangements in place to ensure that Carers allocated were able to contact the caseholding District Nurse or NHS 24 if there was a rapid change of condition for a patient during a shift. The service were rigorous in their approach to ensuring that care needs were met. There was a monthly clinical audit, with 12 topics being covered throughout the year. The documentation audit was seen with a resulting action plan. The allocation of shift and prioritisation was carried out electronically at the central base. There was a record kept of unmet needs and a report of unallocated shifts was compiled to help inform discussions with the NHS who are the contractor of the service. Arrangements were in place through the service level agreement with the NHS as to how the District Nurse provided handover information and the feedback from the Carer using both written feedback in the patient's home and electronically using the central care management system. The service provider was innovative in trying to address unmet need and the "National Reactive Service" was being developed to try to reduce the number of inappropriate hospital admissions and increase the number of patients able to die at home. Health Boards will be offered this service. Areas for Development All Aspects of this Quality Statement were met or exceeded. CCO Grading 6 - Excellent Number of Requirements Number of Recommendations 6/13

Quality Theme 2: Quality of Environment Overall CCO Theme Grading: 7/13

Quality Theme 3: Quality of Staffing Overall CCO Theme Grading: 5 - Very Good Statement 1: We ensure that service users and carers participate in assessing and improving the quality of staffing in the service. Service Strengths Service users had had the opportunity to provide feedback on the quality of care workers using the User Survey. There was also the option of using the Marie Curie Direct telephone line to provide comments and feedback on the allocation of care workers and how this was working out. There had been involvement of service users/ carers in the training and development of Healthcare Assistants. This was a National Project. There had also been involvement of service users and carers in looking at the current recruitment practices and helping to develop a person specification. Areas for Development All aspects of the Quality Statement were met or exceeded. See 1.1 for areas for development. CCO Grading 6 - Excellent Number of Requirements Number of Recommendations Statement 2: We are confident that our staff have been recruited, and inducted, in a safe and robust manner to protect service users and staff. Service Strengths Three staff files were examined and all recruitment checks had been carried out and recorded appropriately. There was evidence of staff induction. This was very comprehensive. There were systems in place to ensure regular staff supervision and appraisal. 22 staff questionnaires were returned to the Care Commission. All of these confirmed that staff had been interviewed and had induction training prior to working with service users. All 8/13

confirmed that they were aware of key policies and procedures and how to access them. In addition all confirmed that they had been provided with appropriate opportunities for further education and training and gave examples of the types of sessions they had attended. None of the staff who completed a questionnaire felt there was a training need which was not being met by the service. Positive comments were made by staff about the high standards of care and support for staff provided by Marie Curie Nursing Service. Areas for Development The level of awareness of the "children and younger people" policy was likely to be low amongst staff. Although, child protection issues were being included in the induction programme the local arrangements and contact details had not been made clear. (See recommendation 1.) The restraint policy made reference to the use of physical restraint even although staff were not provided with training on this issue. The policy did not give a specific statement as to how a risk assessment for the use of restraint should be carried out, recorded and reviewed. This issue is likely to involve collaborative work with the NHS as the District Nurse remains the assessor of the care plan. (See recommendation 2.) CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 9/13

Quality Theme 4: Quality of Management and Leadership Overall CCO Theme Grading: 5 - Very Good 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 There was a Trustee Board with lay person involvement. The service was UK wide with a Scottish marketing group. The group in Scotland has been trying to consider service user involvement throughout all aspects of Marie Curie services work. A consultative organisation "elucidation" was being used to assist with developing user involvement. There were many examples of groups and projects which had involved service users and carers. There had been a national event to consider the Corporate Plan and service priorities which had involved service users and carers. Areas for Development The involvement of service users and carers in the grading process could be developed further. CCO Grading 5 - Very Good Number of Requirements Number of Recommendations 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 There were developing systems for managing clinical governance within the service. This included groups for clinical risk, user involvement, workforce development and clinical effectiveness. There were systems for recording accidents and incidents and these informed the risk register which was being updated using a traffic light system. Hazard notices were assessed and flagged up to the clinical risk group. 1/13

All policies were reviewed within a set timescale and there was an electronic reminder system to assist with this. The Manager gave verbal confirmation that the service would notify the Care Commission of any staff dismissal on the grounds of misconduct. Areas for Development The disciplinary procedure had not been updated to take account of the need to notify the Care Commission of any staff dismissal on the grounds of misconduct. CCO Grading 6 - Excellent Number of Requirements Number of Recommendations 11/13

Regulations / Principles National Care Standards 12/13

Enforcement There has been no enforcement action against this service since the last inspection. Other Information None. Requirements None. Recommendations 1. The "Children and young people" policy should be updated and made applicable to Scottish legislation. Staff should be made aware of their responsibilities with regards to what to do in the event of a child protection incident and local contact details should be made clear. (National Care Standards for Care at Home, standard 4 - Management and Staffing Arrangements.) 2. The restraint policy should be reviewed to make it clear what the approach will be to ensure staff training, risk assessment and documentation to support decision making. This should be based on good practice such as the Mental Welfare Commission Guidance "Rights, Risks and Limits to Freedom." (National Care Standards for Care at Home, standard 4 - Management and Staffing Arrangements.) Sarah Gill Care Commission Officer 13/13