Bury Hospice is registered charitable organisation providing hospice services, the service has 12 inpatient beds, however they were only commissioned for and so used eight beds. They also had a day hospice which people attended during the day only and were not admitted as inpatient.

We inspected this service as a response to concerns raised about the storage and administration of controlled drugs and medicines. We carried out an unannounced inspection on 27 February 2019. We did not rate this service at this inspection.

In order to respond specifically to the concerns raised to us we only looked at some aspects of the safe and well led domains. Specifically, we looked at the following key lines of enquiry; in ‘safe’ we looked at incident reporting, medicines management, records and assessing and responding to risk. In ‘well-led’ we looked at culture, governance and monitoring risk in relation to medicines management. Throughout the inspection, we took account of what people told us, what we found on inspection, and what staff told us.

During the inspection, we visited the inpatient ward and day hospice unit. We spoke with ten members of staff including registered nurses, health care assistants, medical staff and senior managers. We spoke with two patients. During our inspection, we reviewed all four sets of notes for inpatients (there were only four inpatients at the hospice at the time of inspection) and one patient record on the day hospice unit.

We found good practice in relation to medicines management:

• During our inspection we found that medicines, including controlled drugs and intravenous fluids were stored safely and in line with best practice guidance and organisational policy.
• There was a culture of safety and reducing risk to patients.
• Staff felt able to speak out if they felt something was wrong or could be improved.
• Managers supported staff to be open and honest, report incidents and put patient safety as a priority.

We found areas of practice that could be improved in relation to medicines management:

• There were gaps in some audit processes and in particular, there had not been a medicines management audit since March 2018.
• Patients records were not stored in a way that reduced the chances of unauthorised access. The records trolley could not be locked due to the malfunctioning of the lock.
• There was a lack of evidence of training and competency assessments for non-registered staff acting as second checker for controlled drugs.
• Room temperatures where medicines were stored were not monitored consistently.

Ellen Armistead

Deputy Chief Inspector of Hospitals (North)

Bury Hospice is a charity which provides a range of hospice services for adults with a life-limiting illness. The hospice is purpose built and provides accommodation on the Inpatient Unit for up to 12 patients. The hospice also has a Day Hospice and Hospice at Home service.

The hospice is purpose built and is situated in a residential area of Bury, not far from the town centre. The hospice is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors.

Services are free to people, with Bury Hospice receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations.

There were six patients being cared for in the Inpatient Unit during our inspection, 20 patients being cared for in the community by the Hospice at Home service and 10 patients attending the Day Hospice.

We inspected Bury Hospice on the 21 and 28 March 2017. The first day of the inspection was unannounced. We last inspected Bury Hospice in April 2016 where we found there were several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the lack of audits on the quality and safety of the service, no formal staff supervision, incomplete training records and no business continuity plan in place to deal with emergencies that could arise and possibly affect the provision of care.

During this inspection we found that the service had met all the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The hospice had a manager registered with the Care Quality Commission (CQC) who was present during the second day of the inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

We were assisted on the first inspection day by the hospice care team manager; a registered nurse with a wealth of nursing and palliative care experience.

The expressions of gratitude relayed to us demonstrated that patients and their families were cared for with the utmost compassion, kindness, dignity and respect. Patients spoke highly of the kindness and caring attitude of the staff. Patients told us they received the care they needed when they needed it and that staff were knowledgeable and committed. Visitors told us they were always made welcome.

Discussions with staff and visitors demonstrated to us that the staff recognised and considered the importance of caring for the needs of family members and friends. Patients were supported at the end of their life to have a comfortable, dignified and pain-free death. The nursing and medical staff showed they were highly skilled in pain and symptom control. The staff we spoke with had an in-depth knowledge of the care and support that patients required.

We saw that patients were assisted in a way that respected their dignity and privacy. We observed respectful, kindly and caring interactions between the staff, patients and visitors. The patients looked extremely well cared for and there was enough equipment available to ensure their safety, comfort and independence were protected.

The care records showed that patients were involved in the assessment of their needs. Their preferred place of care at all stages of their illness and the arrangements in the event of their death were documented. The care records we looked at showed that risks to the patient’s health and well-being had been identified, such as poor nutrition, the risk of developing pressure ulcers and the risk of falls. We saw care plans had been put into place to help reduce or eliminate the identified risks.

Suitable arrangements were in place to help safeguard patients from abuse. Policies and procedures for safeguarding patients from

Bury Hospice is a charity which provides a range of hospice services for adults with a life-limiting illness. The hospice is purpose built and provides accommodation on the In Patient Unit for up to 12 people. The hospice also has a Day Hospice and Hospice at Home service. In addition the hospice offers a 24 hour telephone advice line for professionals, people who use the service and their families. The hospice is close to public transport routes and is situated in a residential area of Bury, not too far from the town centre. The hospice is set in well-maintained gardens with adequate parking and clearly defined parking areas for disabled visitors.

Services are free to people, with Bury Hospice receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations.

There were six people being cared for in the In Patient Unit during our inspection, 18 people being cared for in the community and 10 people attending the Day Hospice.

We inspected Bury Hospice on the 13, 15 and 19 April 2016. The first day of the inspection was unannounced. We last inspected Bury Hospice on 11 July 2013 where we found all the regulations that we looked at had been complied with.

The home had a manager registered with the Care Quality Commission (CQC) who was present during the inspection. A registered manager is a person who has registered with CQC to manage the service. Like registered providers they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

We found there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

There was no auditing of the quality and safety of the service to ensure people were kept safe.

We found that staff had not received regular formal supervision; necessary to enable them to feel supported and be able to discuss their progress and training needs.

An inspection of the training records showed they were incomplete. Failing to keep records to demonstrate that staff have been appropriately trained and have the necessary skills to safely care for people places people who use the service at risk of harm. There were no records to show that checks had been undertaken to show that the registered nurses who worked at the hospice had a current registration with the Nursing and Midwifery Council (NMC).

There was no business continuity plan in place to deal with emergencies that could arise and possibly affect the provision of care.

People spoke highly of the kindness and caring attitude of the staff. The expressions of care and gratitude relayed to us, demonstrated that people were cared for with the utmost compassion, kindness, dignity and respect.

We saw that people’s privacy was respected and people were assisted in a way that respected their dignity. We observed respectful, kindly and caring interactions between the staff, the people who used the service and visitors. People looked well cared for and there was enough equipment available to ensure people’s safety, comfort and independence were protected.

The care records showed people were involved in the assessment of their needs. A person’s preferred place of care at all stages of their illness and the arrangements in the event of their death were documented. The care records we looked at showed that risks to people’s health and well-being had been identified, such as poor nutrition, the risk of developing pressure ulcers and the risk of falls. We saw care plans had been put into place to help reduce or eliminate the identified risks.

People were supported at the end of their life to have a comfortable, dignified and pain-free death. The clinical staff showed they were highly skilled in pain and symptom control.

Visitors were made welcome a

During our visit to the hospice we spoke with one patient and three relatives. The patient we spoke with told us, “The staff are wonderful and they all know what they are doing. I am so well cared for”. The relatives we spoke with told us how satisfied they were with the care, the staff and the facilities provided. Comments made included, “Fantastic place” and “Would not want to be anywhere else”.

Patients’ care records contained enough information to show how they were to be supported and cared for.

The design, layout and maintenance of the hospice premises ensured that patients, staff and visitors were kept safe.

Adequate equipment and adaptations were available to promote the patient’s independence and comfort and assist in their safe moving and handling.

Patients were cared for by staff that were properly trained, supported and supervised.

Regular monitoring of the services and facilities provided was in place to help protect patients against the risk of inappropriate or unsafe care.