Care Plus Group (North East Lincolnshire) Limited

Updated 12 April 2017

Care Plus Group are a social enterprise and take the specific form of a Community Benefit Society. The company provide community district nursing and end of life care in the North East Lincolnshire area.

End of life and palliative care is provided by all community district nursing teams; however there were three identified teams within the Care Plus Group which specifically offered end of life and palliative care. These are the Macmillan specialist palliative care team, the Haven team and the cancer survivorship team.

The Macmillan specialist palliative care team provided information and advice regarding pain and symptom control to patients, carers and all professionals within the scope of current palliative care knowledge. Two members of the team were permanently based within a local hospital to provide on-going support and discharge intervention.

The Haven team consists of a team manager, team co-ordinator, senior nurses, senior care workers, care workers and Marie Curie Health Care Assistants. The team provide health and social care to those patients and families in their own homes. The senior nurse provided in-reach services to the local hospital to support those who were identified for discharge home.

The cancer survivorship team which was a small group of four staff, consisting of a complex case manager, two community care nurses and a support worker. There was in addition an end of life consultant who was jointly appointed to work within The Care Plus Group and the local hospice. The service is for those categorised as a cancer survivor, people in remission or not undergoing active treatment or are living with a progressive disease.

We spoke with 42 members of staff including advanced nurse practitioners, senior nurses, locality lead nurses, community district nurses, healthcare assistants, student nurses and administrative staff. We also spoke to an end of life consultant. During the inspection visit, the team spoke with three patients and eight relatives. We visited several community nursing teams. We visited four patients in their own homes, observed care being delivered and looked at 14 patient records.

At this inspection, we focused on all five areas: safe, effective, caring, responsive and well-led.

Updated 12 April 2017

Updated 12 April 2017

This service was not rated as we do not currently rate this type of organisation.

At this inspection we found:

• Staff were aware of their safeguarding responsibilities and knew how to report concerns.
• Staff had access to up to date evidence based policies, procedures and guidelines and care was provided based on national guidance.
• Staff had the necessary qualifications and skills to carry out their roles effectively and had regular supervision and appraisals.
• There were good examples of multidisciplinary teamwork.
• Staff were aware of their responsibilities regarding the Mental Capacity Act.
• Feedback from patients was positive; staff were seen to be caring and compassionate.
• Services were planned and delivered to meet people’s needs. Patients could access services in a timely way.
• Staff spoke positively about working for the organisation and staff engagement was encouraged.
• The organisation engaged well with the public and employed a number of volunteers.

However:

• We were not assured that there were robust processes in place to ensure all staff received feedback about incidents.
• We were not assured that action plans for serious incidents addressed all the issues sufficiently.
• No caseload weighting tools were used to inform staffing levels and data was not used consistently to inform complexity and support staffing.
• Local risk registers were not in place and risks identified by service leads were not captured fully on the corporate risk register.

Updated 12 April 2017

This service was not rated as we do not currently rate this type of organisation.

At this inspection we found:

• Local risk registers were not in place and risks identified by service leads were not captured fully on the corporate risk register.
• Patient risk assessments were not accessed by all staff delivering end of life care.
• Learning from incidents was not shared regularly with staff.
• The service contributed to a multi-agency strategy; however staff were not clear about their particular service area.
• There was a lack of clear transition procedures for patients moving between services resulting in the possible delay of delivery of services.
• Staff told us they felt a sense of disconnect between some of the teams delivering end of life care.

However:

• All staff understood how to report incidents and could explain the process confidently.
• Staff had the necessary qualifications and skills to carry out their roles effectively and had regular supervision and appraisals.
• All staff worked proactively to ensure patient care was prioritised.
• Feedback from patients was positive; staff were seen to be caring and compassionate.
• Services were planned and delivered to meets patient’s needs.