The Prospect Hospice in Wroughton, which serves the wider Marlborough area and has an outreach base at Savernake Hospital, was inspected by the government’s regulator, the Care Quality Commission (CQC) in August to check on improvements it had demanded after an earlier inspection.
This is the full text of a statement from the CQC issued today (November 19) – and below it is the full text of the response from the Prospect Hospice:
The Care Quality Commission has told Prospect Hospice that it must make significant improvements following two inspections in August.
CQC inspectors visited the service in Swindon unannounced as part of a focussed inspection to follow up areas of concerns of about low staffing numbers, out of date staff competencies, increased safety incidents, low staff morale and allegations of bullying by senior staff which were identified during an inspection in February 2018.
CQC issued a Warning Notice in March 2018 requiring the hospice to improve its management oversight systems and to ensure that staff received appropriate training, support and appraisal to carry out their roles.
During the inspection on 2 and 3 August inspectors found the requirements of the warning notice had not been met. The provider had submitted an improvement plan but the management team had not made enough progress
Inspectors also identified further concerns, which were incidental to the warning notice. CQC returned to further investigate these concerns on 14 and 15 August 2018.
Inspectors found that there was a lack of clinical leadership. The inpatient unit was led by a nurse, who was working excessive hours and was under significant pressure. The risks associated with her resilience and wellbeing had not been acknowledged or acted upon promptly by the hospice management.
There was a lack of oversight of patients’ records. There were instances where assessments regarding patients’ nutrition, hydration and pressure area care, were not always completed or updated.
The service was not managing patient safety incidents well. There was no formal incident investigation process to ensure that learning from incidents was identified and cascaded to staff to improve patient safety.
The full inspection report can be found at: http://www.cqc.org.uk/location/1-117219570
Mary Cridge is the CQC’s Head of Hospital Inspection: “While Prospect Hospice continues to provide an essential service, it is troubling to report that some of the deep-seated cultural issues that we found within the team are still not being resolved.’
“There have been some improvements. The management of medicines on the inpatient unit had improved and senior management have been taking steps to improve engagement with staff.”
“It is worrying however, that the hospice took the sudden decision, following our inspection to temporarily reduce the number of beds on the inpatient unit from 12 to six. This closure was not well planned, and the impact of this closure on patients and the wider healthcare system had not been assessed.”
“Under the terms of our enforcement action, the hospice must send us regular reports to assure us that significant improvements are made.”
“We will return in due course to check for real improvement that will benefit the patients and their families. In the meantime, we are in regular contact with the leadership at Prospect Hospice and we will continue to monitor this service very closely.”
Prospect Hospice has issued the following statement:
We are disappointed with the latest Care Quality Commission report. We accept that at the time of follow-up visit in August there was still work to do following the original CQC report published in June.
However, we had purposely focused our time up to August on bolstering the team in areas of operations specifically in training, appraisals, staff engagement and service improvement, as well as getting under the skin of the issues that we needed to address so we didn’t leave any stone unturned.
We also appointed Irene Watkins as Interim Chief Operating Officer and arranged for specialist staff to be seconded to the hospice from other organisations in order to focus on delivering the action plan. This took time, but we believe this approach will ensure we deliver sustainable improvements for the long term and not just a quick-fix solution.
We are very confident that we have addressed the issues raised by the CQC, which in the main were to do with processes and administration. We were pleased that the CQC had acknowledged improvements we had made in relation to dealings with our agency staff, medication and staffing levels linked to admissions.
All our training records are now up to date. We have reviewed our monitoring and recording of agency staff. We are also monitoring the complexity of needs of our patients, not just the numbers, to ensure we have the appropriate resourcing in place at any given time.
We would like to thank our patients and families for their patience whilst we’ve had to make internal changes. We are delighted to say that inn our latest patient and families survey overall satisfaction was 95 per cent, with 96 per cent saying they would recommend our services to their family.
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