Bolton Hospice PROVIDER VISIT REPORT Report of unannounced visit, submitted by the Provider Visitor in compliance with Regulation 26 (Chapter 3) of the Private and Voluntary Healthcare (England) Regulations 2001. Name of Hospice: Bolton Hospice Telephone No: 01204 663 066 Address of Hospice: Queens Park Street, Off Chorley New Road, Bolton BL1 4QT Category of Registration: Independent Hospice Name and Job Title of Visiting Provider: Judith Bromley (Chairman) Grace Hopps (Vice Chair) Date Of This Visit: 9 th August 2016 Date Of Last Visit: 21 st January 2016
GENERAL INFORMATION UPDATE: Using date of last inspection by Care Quality Commission Has there been any change to: Premises since the last inspection? No Trustees or Managers? Staff Numbers Statement of Purpose Alison Barnes and Dawn Moody retired as Trustees. Adrian Crook has been co-opted pending formal appointment as a Trustee at the October AGM. Full Time - 57 Part-Time - 66 Bank - 27 150 Total 98.49 WTE Updated No. of inpatient deaths reported to the Commission: IPU - 93 H@H - 63 Total - 156 Any other notifiable issues reported to the Commission: 3 Grade 3 pressure ulcers Fall resulting in fracture to wrist If Yes to any of the above, please describe:
COMPLAINTS: Overview of the management of complaints in the Hospice based on interviews with staff responsible for responding to complaints and examination of the record. Any issues that do arise we pro-actively address in conversation or via a prompt written response and we encourage our service users to complain but we have not had any formal complaints. Summary of complaints received in the last twelve months: Complaints: Written 0 Complaints: Verbal 7 Complaints Pending an Outcome 0 QUALITY IMPROVEMENT Interview with clinical lead(s) How is quality improvement managed within the Hospice? Audit & Quality Group meets monthly. Spot check undertaken re- infection control issues Pre CQC checks. Clinical Governance Board of Trustees Patient Led Assessment of the Clinical Learning Environment (PLACE) Quality & Standards Committee I Want Great Care Patient Satisfaction Survey NHS Harm Free Care (Safety Thermometer) CQC NHS England Controlled Drug Reporting Quarterly CCG Quality Performance Report Have your Say comment cards Trustees Visits Signed up to Safety
Is there a programme of clinical audit and what topics have been covered? How are reports disseminated? What changes/improvements have been implemented in services over the past 12 months following audit? Are there any concerns about the training and experience of staff (for example any shortages/recruitment difficulties for certain grades/posts)? Do staff feel there is enough equipment or access to specialised equipment or facilities to enable them to care for the patients safely? Any other comments Yes. 24 Hour Telephone Advice Incidence of Pressure Ulcers/Nutrition Assessments/Patient Medical and Nursing Records/Care in the Last Days of Life H@H and IPU Relatives Response/PPC/ACP in Discharge Letters/Cleaning and Decontamination of Equipment/Management of Steroids/Record Keeping/Staff ID Badges/Credibility of the Accountable Officer/Environmental Audit/Mattress Audit/Admission Audit/H&S Audit Team Meetings/Bulletins/Clinical Governance/Newsletters/SMG/Team Leaders Meeting/Audit & Quality Group/CCG/CQC/Quality and Standards Committee/Board of Trustees/Quality Accounts/on our website. Equipped 2 bariatric bedrooms Improved dementia signage Moved volunteers kitchen to improve space and safety Developed plans for Wing B with staff input Moved on with electronic patient records Changed our pharmacy stock provider to Salford Foundation Trust Mandatory Fire Training undertaken Safeguarding training for all staff Developed Patient Food Diary Linked with CCG re reporting patient harms We have staff retiring this year but confident we will recruit into these posts. We have maintained our Skill Blitz days for mandatory updates and competencies. We have struggled to recruit into our Hospice Medical Director role but have managed to retain our Locum Hospice Consultant which has given some stability to the team. Yes I think we are very fortunate and supported by the Board of Trustees to ensure all our equipment is maintained, safe and fit for purpose.
PREMISES AND EQUIPMENT Overview of the condition of the Hospice premises: Decorative order Safe and secure environment for patients Facilities and access to the building and services for the disabled These topics are now addressed through the independent PLACE Inspection process. Health and safety and fire requirements in place Corridors clear of storage and equipment We have a Health and Safety Committee and a Fire Safety Committee who address these issues.
Action taken since last provider visit 21 st January 2016 Issue Identified Suggested Action Responsibility Action Taken Completion Date Staff ratios on each shift Continue to review and flex in line with patient complexity and demand CND & IPU Service Lead Progressed This is constantly reviewed The day after a night shift counting as an off duty day Electronic records Patients held in Reception before admission Temperature control in Reception Access to activity space for inpatients Volunteer led services Double check that this is the standard practice Faster implementation of paper light plans System to be devised to avoid this happening CND & IPU Service Lead SMG & JMcA IPU Service Lead & CK-D This is an accepted industry standard approach Progressing to schedule Communicated with ambulance service Discussed with staff April 2017 February 2016 Incorporate into building work plans r Wing B CEO & CND Will be addressed by building work Autumn 2017 Incorporated into Wing B CEO & CND Will be addressed Autumn 2017 building plans by building work Look into opening BHSS on CND Monday next one On-going Mondays scheduled for June Site map Produce a Hospice site map CK-D Done March 2016 Public awareness raising of Hospice services further improve public awareness of Hospice services Integrated Communications Strategy Part of the 2016 /17 Integrated Communications Strategy On-going
Provider Visit : Tuesday 9 th August 2016 Summary of Staff Interviews An overarching aim of the unannounced provider visit was to speak to a broad spectrum of staff to listen to any general or specific issues raised in relation to the differing areas, eg:- fundraising, clinical, administration & support services. The Five CQC inspection areas: Safe, Effective, Caring, Well led and Responsive were also a focus for the visit. The reviewers spent the whole day at the hospice, meeting with 18 staff members, a mix of senior medical staff, both trained nurses and students, representatives from fundraising and support services and 3 volunteers. The trustees also met with 2 patients and their carers. Whilst mindful of the CQC inspection areas, the provider visit gave the trustees the chance to be more visible to the whole hospice team and to demonstrate a we listen, we discuss, we action attitude wherever possible. The feedback from all the interviewees has been grouped as accurately as possible within the CQC headings and the text below comes from direct quotes of the interviewees. Safety There are always enough staff to deliver high quality care. All policies and guidelines are well documented and accessible to all in the ward office and quiet room plus emailed to everyone. Good MDT, handovers and clinical records. Locating key members of staff in the new expanded layout of the hospice is problematic at times. This requires a timely response to the bleep system which staff should be reminded of. Effective A staff handover was observed and demonstrated professional comprehensive reporting. The leadership is good feel well supported and part of the team. Everyone sees the CEO bulletin. The volunteer role is effective and beneficial in the office situation as well as elsewhere. The student nurses stated that staff are very knowledgeable and happy to teach. Brilliant training provided. Although recognising that the Consultant is part time, we may benefit from increased visibility on the ward. The lack of a second speciality doctor is difficult for the medical team. There is sometimes inconsistency/ changes in care planning from whichever doctor is on duty leading to fragmented care.
Caring Lovely place and atmosphere, the patients are happy here. There is time to sit, listen and talk with patients and families. This is how I think nursing should be provided. Patient care is never compromised. The amazing kitchen staff are always ready to accommodate whatever the patient fancies. Well Led The restructuring in fundraising has been very positive. There are plenty of opportunities for a broad spectrum of professional development and training. There are good communication channels across the hospice, team meetings plus written updates from CEO. Very open policy and feel able to ask anything. I feel that we are kept very well informed. The preceptorship programme is good, felt very well supported. The senior nurses are so professional and knowledgeable, offer amazing support and they really know their staff. Felt listened to at appraisal realistic targets set with responsibility. The resident doctor is supportive and readily shares her knowledge. Responsive The new kitchen with the perch stool for volunteers is great. Looking forward to the new water fountain it will be great for patients. The NMC revalidation support provided is excellent. There is always someone to talk to after a difficult shift. Miscellaneous points and hindrances There are no lids for hot food when walking down long corridors and puddings are left uncovered on corridor waiting to be delivered to patient s rooms. Phase 2 of the redevelopment due to start, a little concerned regarding the new canopy and the turning point of the drive for big lorries, eg the oxygen delivery lorry only just thought about it as have had the opportunity to comment on the design.
Staffing There is good team working across the fundraising department with a common focus. Open plan working in fundraising plus the availability of quiet rooms has been very positive with staff previously working across silos. Enjoy working here. I love my job. We are one big team. Frequency of nights can be a problem but shared out across all staff. The staffing is right for 18 beds however, complex patients and complex families do make it more stressful at times. Conclusions The overarching impression gained from the provider visit was of a well led hospice where excellent patient care is provided. No safety concerns were identified. All staff reported good opportunities for training in a supportive environment. The professional clinical training from both the senior nursing and medical team on the ward area was the subject of praise. There are a number of specific actions and suggestions that should be considered via the action plan below.
ISSUES SUGGESTED ACTION RESPONSIBILITY ACTION TAKEN Although recognising that the Seek ways of enabling staff to be CEO & Dr M Consultant is part time, we more aware of the Consultants may benefit from enabling presence on the ward -All day every increased visibility on the Monday, Tuesday end of the day, ward most of every Wednesday and end of the day Thursday The lack of a second speciality doctor is difficult for the medical team Continue with Recruitment Drive and agency cover arrangements CEO COMPLETION DATE There is sometimes inconsistency/changes in care planning from whichever doctor is on duty leading to fragmented care There are no lids for hot food when walking down long corridors and puddings are left uncovered on corridor waiting to be delivered to patient s rooms Phase 2 of the redevelopment due to start, concerned regarding new canopy and the turning point of the drive for big lorries, e.g. the oxygen delivery lorry Review information hand-over processes particularly where changes have been made to the care plan To be discussed with catering so they can provide some clarity on this (they do have a 5 star food hygiene rating) Has been discussed with the architect and will be mentioned again CEO & Medical Team CND CEO There is little opportunity for collaborative working/ interaction between fundraising and clinical teams We will look at more training and other opportunities for interaction between teams Management Team Leaders meeting
The mid-year restructuring of fundraising has raised concerns in relation to the set year fundraising targets Concerns raised regarding providing cover for a long period of time during staff shortage and recruitment without remuneration Concerns expressed regarding the senior management restructure and the use of an outside agency for HR advice Concerns were expressed that the main hospice number is frequently used for Furniture Plus Locating key members of staff in the new expanded layout of the hospice is problematic at times. This requires a timely response to the bleep system which staff should be reminded of Could volunteer training be delivered by email/electronically? To be addressed vis on-going Departmental team meetings Matter addressed This will be kept under review by SMG Constantly publicize the correct number and seek ways to direct people to the correct number Discuss best use of bleep with Medical Team This will be considered AA AA SMG CK-D CEO and Medical Team Meeting CK-D