The Care Quality Commission has told Prospect Hospice in Swindon that it must make significant improvements following an inspection in February. Prospect Hospice’s provides care and support for people living with, and dying from, advanced and progressive life-limiting illnesses. The 16-bed in-patient facility provides respite care, symptom control and care at the very end of life.
The CQC inspectors made an unannounced visit in response to concerns about low staffing numbers, out of date staff competencies, increased safety incidents, low staff morale and allegations of bullying by senior staff.
Following the inspection the CQC issued a Warning Notice 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.
Inspectors found risks to patient safety as systems and processes for recording, monitoring and reviewing significant safety issues were ineffective. This was recognised by the provider but there was no evidence that the systems being implemented would improve their processes.
The inpatient unit had a high number of vacancies, and nursing staff described low morale and increasing levels of fatigue and sickness. In six months there had been 53 recorded medicine errors.
Although CQC did not observe unsafe practice during the inspection - staff training was out of date, and the provider could not demonstrate that all staff were competent to carry out all clinical procedures. There was no formal induction for temporary staff.
In response to a number of complaints about bullying the senior leadership instigated four workshops with staff. Whilst these sessions were well-intentioned, staff said that the workshops made them feel uncomfortable and in some cases humiliated.
The board and senior leadership team did not always seem to be aware of what was happening within the inpatient unit. Key information on staffing and other risk areas were not reported regularly and the board was therefore unsighted and unable to support and challenge the leadership team. Omissions included information about delayed admissions and seven complaints about a member of the senior leadership team.
The CQC’s Head of Hospital Inspection, Mary Cridge, said "Prospect Hospice provides a much-needed service to people nearing the end of their lives. While there is clearly a commitment to provide a good service on all sides – it is troubling to report on the cultural issues and divisions that we found within the team as a whole.
“Since our inspection in February, the hospice has taken some steps to address our main concerns. The safety issues must be addressed as a priority. By the time we return to re-inspect, we hope to see a real improvement for the benefit of 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 closely.”
Following the inspection the CQC issued a Warning Notice 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.
Inspectors found risks to patient safety as systems and processes for recording, monitoring and reviewing significant safety issues were ineffective. This was recognised by the provider but there was no evidence that the systems being implemented would improve their processes.
The inpatient unit had a high number of vacancies, and nursing staff described low morale and increasing levels of fatigue and sickness. In six months there had been 53 recorded medicine errors.
Although CQC did not observe unsafe practice during the inspection - staff training was out of date, and the provider could not demonstrate that all staff were competent to carry out all clinical procedures. There was no formal induction for temporary staff.
In response to a number of complaints about bullying the senior leadership instigated four workshops with staff. Whilst these sessions were well-intentioned, staff said that the workshops made them feel uncomfortable and in some cases humiliated.
The board and senior leadership team did not always seem to be aware of what was happening within the inpatient unit. Key information on staffing and other risk areas were not reported regularly and the board was therefore unsighted and unable to support and challenge the leadership team. Omissions included information about delayed admissions and seven complaints about a member of the senior leadership team.
The CQC’s Head of Hospital Inspection, Mary Cridge, said "Prospect Hospice provides a much-needed service to people nearing the end of their lives. While there is clearly a commitment to provide a good service on all sides – it is troubling to report on the cultural issues and divisions that we found within the team as a whole.
“Since our inspection in February, the hospice has taken some steps to address our main concerns. The safety issues must be addressed as a priority. By the time we return to re-inspect, we hope to see a real improvement for the benefit of 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 closely.”
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