We carried out an unannounced comprehensive inspection of this service on 08 April 2014. A breach of a legal requirements was found. As a result we undertook a focused inspection on13 January 2015 to follow up whether action had been taken to deal with the breach.
You can read a summary of our findings from both inspections below.
Comprehensive Inspection of 08 April 2014
St Luke's Hospice Kenton Grange provides care to the people of Harrow and Brent who have illnesses that are no longer curable. On the day we visited six people were using the in- patient hospice service. We saw this had 12 beds, six are single rooms with a toilet and hand basin; one four bedded bay with a shared toilet and hand basin but which is used as single sex accommodation only; a two-bedded bay with toilet, hand basin and shower. There are additional shower and bath facilities within the ward area.
The Hospice also offers a day service where people can be supported in a safe and uplifting environment, this is open every day with a different emphasis daily to meet different people’s needs. Nurses, doctors and a social worker are available each day.
We spoke with three people who were using the hospice and three relatives during our inspection. Overall, people praised the hospice, comments included “It’s a lovely atmosphere here,” “the staff make me feel safe,” and “it’s very peaceful here and welcoming.” Most people we spoke with told us that the hospice provided everything they and their relatives needed.
All the people and relatives we spoke with felt safe at the hospice and said the staff listened to them and responded quickly to their changing needs. They were involved in planning their own care and staff were aware of people’s likes and dislikes and their cultural and religious needs.
We saw that people’s important documents were kept up to date and they, as well as friends and relatives (if requested by the person), were involved in making decisions. We saw that people had the support of professionals and others when making difficult choices.
People said that staff were knowledgeable, kind, caring and approachable. People were able to quickly access doctors and other professionals such as physiotherapy and counselling services.
People had access to range of activities. They said they enjoyed having a massage or attending music or art therapy, we saw that relatives were also offered relaxing treatments.
We saw that the hospice had areas where people and their families could have privacy. People’s rooms had access to a garden and a private patio area. Their beds could be taken outside on to this if they wished. Families and friends were able to say overnight either in the same room as their relatives or in a separate room for family and friends.
We saw that people had well-co-ordinated care when they moved from different services. The hospice had good relationships with other services, such as the Clinical Nurse Specialist (CNS) based at the local hospitals, which ensured people received effective care and support.
People had their comments and complaints listened to and acted on. There was an effective complaints system in use In the hospice. We saw that complaints were reviewed by the manager, the senior leadership team and well as the board of trustees.
The hospice promoted a positive culture that was person-centred, open inclusive and empowering. People spoke positively about the approach of staff and managers. Staff we spoke with were aware of their roles and responsibilities. There was a consistency between what the managers, staff and board of trustees said were the key challenges, achievements and risks at the hospice.
The hospice had a registered manager who had the day to day support of the Chief Executive Officer (CEO) and an active board of trustees. They demonstrated good leadership of the hospice and it was evident that the manager was well known to the staff.
We looked at the prescribing of medicines, medicines storage and supplies and administration systems for medicines. We saw medication was kept securely. However, we could not be assured of safe practice with recording of prescriptions and prescribing of some medicines which could have led to medication being administered incorrectly.
We saw medicines were being kept securely and only accessible to staff authorised to handle medicines. Medicines were being kept in a locked drug trolley or in a locked treatment room. Controlled drugs were being appropriately stored.
However, we could not be assured of safe practice in the recording of prescriptions for controlled drugs and other prescriptions that were being used at the hospice. We saw that these were not being recorded in a way that that would assure that they were being used appropriate.
When syringe drivers were being prescribed, (these are used to give medication continuously under the skin, often used for managing people’s pain) the prescription did not specify how long the medicines should be administered over. This could lead to medicines being administered over an incorrect time period and puts people at risk of receiving too much or too little medicine.
These problems were evidence of a breach of a health and social care regulation. You can see what action we have asked the provider to take at the back of this report.
Focused inspection 13 January 2015
After our inspection of 08 April 2014 the provider wrote to us to say what they would do to meet the legal requirements for the breach relating to aspects of the management of medicines.
We undertook this unannounced focused inspection to check they had followed their plan and to confirm that they now met legal requirements. We found the provider had followed their plan in relation to this regulation. This means legal requirements for the management of medicines had been met.
Improved arrangements were in place for the recording of prescriptions [FP10 and FP10CDF] used in the service. A new prescription and medication administration record was in use along with additional records for the application of medicines supplied as patches. A clear competency database was maintained for all nurses training relating to medicines handling.
We also found improvements had been made with the recording of Do Not Attempt Resuscitation [DNAR] orders. They showed that cardiopulmonary resuscitation (CPR) had been discussed with the person using the service who had then made the decision whether or not they wished to be resuscitated, and this decision was recorded.