Background to this inspection
Updated
20 November 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by one inspector and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a provider of palliative and end of life care services to adults with terminal illnesses across the North East. The service supports people in their own homes.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
Due to the sensitivity of the care provided by the service, the provider was given 3 working days' notice of our visit. This was so people who used the service could be told of our visit and asked if they would be happy to speak with us.
Inspection activity started on 1 October 2019 and ended on 3 October 2019. We visited the office location on 2 October 2019.
What we did before the inspection
We reviewed all the information we held about the service, including changes, events or incidents that the provider is legally obliged to send us within the required timescales. We contacted professionals in local authority commissioning teams, clinical commissioning groups and safeguarding teams. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with one person using the service and 10 relatives over the telephone. We spoke with five members of staff: the registered manager, three clinical nurse managers and the practice development facilitator.
We looked at four people's care plans, risk assessments and medicines records. We reviewed staff training and recruitment documentation, quality assurance systems, a selection of the service's policies and procedures, business plans and lessons learned documentation.
After the inspection
We spoke with a further three external health and social care professionals and four members of staff over the telephone.
Updated
20 November 2019
About the service
Marie Curie Nursing and Domiciliary Care Service, North East Region (MCNE) is a registered provider of palliative and end of life care services to adults with terminal illnesses across the North East. The service supports people in their own homes.
At the time of our inspection there were over 200 people receiving a service.
This service is a domiciliary nursing and care agency. It provides personal and nursing care to people living in their own houses and flats in the community. It provides a service to adults. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.
People were referred to the service by healthcare professionals. The main referral source were District Nurses. Clinical Commissioning Groups (CCGs) commission the service. Staff worked as an integrated team with other health professionals such as District Nurses and GPs. The majority of the care was provided by nurses and healthcare assistants overnight to people in their own homes.
People’s experience of using this service and what we found
People and their relatives consistently used a range of superlatives to describe the service. It was run exceptionally well. The culture, ethos and impact of the service was understood by all staff and delivered passionately and with pride in the work they did.
Staff demonstrated a commitment to the provider's values and mission in the delivery of end of life care. They were supported to show autonomy, creativity and compassion by a leadership team with an excellent range of skills and experiences.
Partnership working was key to the service’s ongoing success and its ability to influence the outcomes for people not only using the service, but across the North East in other care settings. They were seen as leaders in their field and contributed extensively to the sharing and development of best practice.
The service had clear and visible leadership. Staff had specific areas of responsibility. They regularly shared learning and maintained excellent working relationships with healthcare professionals and academics.
There were robust systems to measure the quality of the service, and opportunities were provided for those using the service and their family members to comment upon and influence the development of the service.
Staff's knowledge and understanding of people’s needs at the end of their lives was exceptional. Feedback from relatives and external professionals was consistently outstanding about how staff put people at ease and supported them.
The Rapid Response team were able to provide a unique service to local healthcare professionals who needed to refer people when their needs changed quickly.
Staff were well supported to perform this emotive and challenging role by a leadership team that genuinely cared about the wellbeing of its staff.
Concerns and complaints were meaningfully and rigorously analysed, with lessons learned and service-wide improvements rolled out where identified. The culture was one of continuous learning and creativity, with person-centred care at the heart of all developments.
Staff got to know people well in the overnight stays and formed strong bonds with people. People were treated with kindness and their individuality respected. Staff promoted people's dignity and all interactions between staff, those using the service and family members were positive to ensure the best
outcome for people.
People’s individualities, varying levels of independence and equality characteristics were respected and upheld.
Family members consistently described staff in terms that likened them to friends and family members. Staff successfully reduced people’s anxieties through their calm approach and range of training.
People's needs were met as there were sufficient staff who had the necessary skills and knowledge to meet their needs. There was a range of mandatory and additional training in place to fully equip staff to perform their roles. There were creative and inclusive approaches to training and an evident focus by the provider on supporting staff to pursue areas of professional interest.
Commissioners of the service and health care professionals who worked alongside staff were consistent in their praise of the service provided by MCNE.
Staff knew how to keep people safe, and how to report any concerns or incidents. The registered manager was proactive in learning from incidents and events, and had brought about changes to practices. There were enough staff to keep people safe. There were proactive approaches with external organisations to ensure staff could safely meet people's needs.
There were clearly defined protocols and systems for the management and administration of medicine.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff worked sensitively and collaboratively with family members to ensure people's care and treatment was in their best interests.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 27 April 2017)
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.