Mount Edgecumbe Hospice is operated by Cornwall Hospice Care Limited. The hospice had eight beds with facilities available to increase this to 14. Cornwall Hospice Care Limited also provided services in Hayle at St Julia’s Hospice.

The hospice provided care and treatment for patients aged 18 years or over, with a life-limiting condition.

We inspected this service using our focussed inspection methodology. This unannounced inspection took place on 19 July 2018. We focussed on the safe and well-led domains following concerns raised to us. The concerns were focussed on staffing levels, staff training, low staff morale and allegations of bullying.

Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

There was a registered manager in post, Dawn Tame-Battell. A registered manager is a person who has registered with the Care Quality Commission 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 2008 and associated regulations about how the service is run.

During the inspection visit we were unable to speak with patients or their relatives as the staff informed us they were too unwell. We spoke with 10 members of staff, working in various roles in the hospice. 

We reviewed four sets of patient records and relevant other documents, including policies, procedures and meeting minutes.

The Care Quality Commission last inspected the service in 2014 and rated the provider as good overall. We have not re-rated the service at this inspection.

We regulate hospice services but we do not currently have a legal duty to rate them when they are inspected as a focussed inspection. We highlight good practice and issues service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• A system of annual mandatory training was provided to ensure staff remained suitably skilled for their job,
• Safeguarding processes were in place to ensure patient safety.
• There were established systems to prevent and protect patients from healthcare associated infections.
• There were systems to manage the environment and equipment, which kept patients safe.
• Patients were monitored for deterioration in their condition.
• Staffing was managed to ensure sufficient staff were available.
• Patient records were well-maintained and stored securely.
• Inpatient medicines were managed safely.
• Incidents were recorded and reviewed to provide learning and prevent reoccurrence.
• External professionals, patients and their representatives had access to a 24-hour support and advice line from the hospice. This also provided a support to patients following their discharge.
• The leadership structure within the organisation was clear and staff were aware of who they reported to.
• Staff were familiar with the organisation’s strategy, vision and values, and were provided with the opportunity to be involved in the development of these.
• The leadership team had taken action to address low morale and allegations of bullying with the provision of meetings and the reintroduction of the staff forum.
• The organisation had taken steps to improve the accessibility of trustees and executives to staff. The number of visits to clinical areas had increased and additional staff meetings were held.

However, we also found the following issues that the service provider needs to improve:

• The system for monitoring staff training did not ensure all mandatory or any additional training had been completed. Safeguarding children training was not provided and not all staff had completed safeguarding adults training. This included volunteers, clinical staff, board members and trustees. Training had not been provided to all staff who were required to investigate incidents.
• Staffing levels were not related to patient dependency.
• The harm level of incidents was not assessed to ensure a consistent response.
• Staff were not familiar with relevant national guidance and recommendations to ensure they were providing up-to-date care and treatment.

Following this inspection, we told the provider it must take some actions to comply with the regulations and it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with one requirement notice for Mount Edgecumbe Hospice. Details are at the end of the report.

Amanda Stanford

Deputy Chief Inspector of Hospitals (South)

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

The inspection was announced with 48 hours’ notice. Due to people’s complex health needs this allowed people and their loved ones time to prepare for our visit.

Mount Edgcumbe Hospice provides specialist palliative care for up to 14 people over the age of 18, with a life limiting condition.  Mount Edgcumbe Hospice provide an ‘in patient unit’ which provides accommodation with up to 14 beds. The staff provide treatment and care for physical symptoms and help people with addressing emotional, spiritual and social wellbeing. They also provide support to families and close friends during the illness and bereavement. The hospice provides a day case treatment from its building in St Austell and hospice doctors provide regular ward rounds at Treliske hospital and specialist palliative input to the oncology outpatient clinics.  At the time of the inspection there were eight people staying at Mount Edgcumbe Hospice.

Mount Edgcumbe Hospice is located near to the local community hospital and housing estate. This meant that the hospice is located in an area which encouraged the whole community to engage with the service.

There was a registered manager in post at the hospice.  A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us that they felt safe when in the care of the hospice staff.  However we noted that safeguarding procedures had not been followed and staff lacked an understanding regarding Mental Capacity Act 2005 (MCA) and Deprivation of Liberties Safeguards (DoLS). This meant there was a potential people could be placed at risk of harm.

Staff working for the hospice understood the needs of people and consulted with them throughout the time they received care. People and their families were involved in the planning of care and were treated with kindness and compassion with due regard to their privacy and dignity. 

Staff were appropriately trained and skilled and provided care in a safe environment. They all received a thorough induction when they started work at the hospice. They fully understood their roles and responsibilities, as well as the values and philosophy of the hospice. The staff had also completed additional training to ensure that the care provided to people was safe and effective to meet their needs.

The provider had robust recruitment processes. They employed skilled staff who took steps to make sure the care provided was based on local and national best practice. Individual staff had taken on special roles, to make sure that best practice was followed by all staff in the hospice.

Mount Edgcumbe Hospice had the resources and had developed positive contacts with other professionals who ensured effective care delivery for people wherever they needed and wanted it. Feedback from all sources was used in a constructive way to improve the service.

There was a strong management team which listened and looked after the staff and volunteers working for the service. There was a clear clinical governance structure in place that involved staff at all levels to establish and maintain the best possible care for people.

We spoke with three people who used the service at the time of our inspection regarding their experiences of the care and treatment provided to them. All of the people we spoke with told us their experience had been positive and we judged that people were treated as individuals and received person centred care and support. Comments made by people we spoke with included; “I have the upmost confidence in the staff and am always consulted before, during and after treatment. I am kept informed and my view is always considered" and “I am always given full information about my care and treatment so that I can make decisions and choices”.

We found the nutritional needs of people were met and that there was a wide choice of food provided that was of a high quality.

Medications were managed safely and staff ensured people received their medication in a timely way and as per their prescriptions.

Staff were supported in their roles and were trained and competent to deliver care to people who used the service.

Records were maintained appropriately and people who used the service were informed about how to access their personal records.

During our visit to Mount Edgcumbe we were able to speak to people using the service, their relatives/friends and staff, in addition to reviewing documentation relevant to the outcomes inspected.The information collected from these different mechanisms, when combined with our observation of the care and support provided, enabled us to conclude that the services both respected and involved the people who were using them.

At Mount Edgcumbe we found a programme of care that clearly supported individuals (or others acting on their behalf) with their needs, from the point at which there were referred to the service. This care programme ensured that people who used the service were protected from the risk of abuse.

All the evidence collected about staffing demonstrated that there were enough qualified, skilled and experienced staff to meet people’s needs and people using the service were extremely positive about the level of care and support provided by the staff.

From the evidence collated it was also clear that people who used the service and staff were asked for their views about their care and treatment and they were acted upon. In addition there was a clear system in place to assess and monitor the quality of the service provided which included an extensive audit programme.

We spoke to four people using the service and they were all extremely happy with the services provided to them. They told us they were given plenty of information and kept up to date on the support and choices available to them in respect of their care and accommodation. They told us they could ask the staff anything and they were very helpful.

Comments included “I am one hundred percent happy with my care”, “I would give them one hundred percent plus a star” and “I cannot see how the service can be improved, it’s excellent”.

People told us the staff were extremely kind and caring and they had plenty of time to spend with them. They told us the nurses were very professional, they listened to them and allayed their fears. Some people told us they were apprehensive about coming into a hospice but had found it a very lovely place. One person said “The staff are jolly and happy – not what we expected!”