Archived: George Marsh Centre

Updated 29 December 2016

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

This inspection took place on 15 and 16 September 2016 and was announced. We gave the provider 48 hours’ notice of the inspection as the service is community based and we needed to be sure staff would be available to speak with us. The inspection team consisted of two inspectors, a specialist nurse advisor and an expert by experience who had personal experience of end of life care. We used the expert by experience and an inspector to make telephone calls to people in the community.

Before the inspection we reviewed information we held about the George Marsh Centre. This included statutory notifications of significant events the service is required to provide to the CQC.

We also looked at the hospice’s most recent annual quality accounts report which services’ commissioned by the NHS are required to complete. This report gives information about the quality of the service they provide.

During our inspection we spoke with 16 people who were receiving support from the community team based at George Marsh Centre and nine relatives. We spoke with various staff which included four community nurse specialists, an assistant practitioner, a consultant and the registered manager of the service. We also met three other head office staff. We attended the weekly multi-disciplinary team (MDT) meeting and accompanied clinical nurse specialists on two of their home visits.

We looked at documentation which related to the running of the service and its governance. We also looked at computer and paper records relating to nine people who used the service and staff recruitment and training records for three members of staff.

After the inspection we talked over the telephone with two community healthcare professionals who have contact with staff based at the George Marsh Centre.

Updated 29 December 2016

This inspection took place on 15 and 16 November 2016 and was announced. This is the first inspection of the service since its registration in December 2014.

George Marsh Centre is the base for one of the North London Hospices community teams that are registered with the Care Quality Commission. This service offers community services to people living in the London Borough of Haringey who have life-limiting or life threatening illnesses. At the time of the inspection they were supporting approximately 150 people. The other community services operate from Finchley and Enfield, in addition to inpatient beds at Finchley.

The North London Hospice offers an integrated service for people who have life limiting or life threatening conditions. It also provides educational support and advice, a bereavement service and district nurse support. There is a single point of contact for people in the community who are then referred onto the most appropriate service.

The community team consists of 10 people which includes clinical nurse specialists (CNS), an assistant practitioner, a social worker, administrative support, and a consultant and team leader. Anyone in the community is initially able to refer themselves or other people who have a life-limiting or life threatening illness. The service offers advice and support to people and their families. They also take on a broader role of educating others involved in end of life care.

The community team works with primary healthcare professionals to manage people’s symptoms particularly around pain management. They provide an advice line over a 24 hour period, practical financial support, bereavement/counselling and support for people through their illness and death.

The service had a registered manager in post who was the Director of Clinical Services. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People were very positive about the support they received and told us staff were kind and compassionate. They told us staff listened to them, were respectful and tried to ensure they received care in line with their needs and wishes. The team works as part of Haringey partnership to offer an all-inclusive approach to people and their families.

New staff initially received an extensive induction programme and were consequently well trained. There was a focus on continuous professional development and learning. Staff told us they were well supported by their peers and managers. There were a number of forums where staff could raise issues and be supported to undertake their roles.

People received care that was personalised to their needs. They were supported to take as much control as they wanted of their lives and of their death. Care plans reflected their choices about specific needs and preferences; this included any cultural and spiritual needs. Care plans were continually revised so they were up to date and reflected the person’s current needs.

Staff knew how to safeguard people at risk. They knew what action they should take if they considered people were at risk of harm or abuse. People received their medicines as prescribed and staff knew how to manage medicines safely. Risks to people’s health and well-being were regularly assessed and action taken to minimise those risks.

The provider showed a commitment to providing high quality care and was continually striving for improvements. The trustees and managers of the service learnt from incidents and accidents. They actively sought feedback from people who used the service and their families. People felt able to raise any issues or complaints and the provider took any issues seriously. There was a rolling programme of audits so the provider could monitor the quality of the service provided and make improvements where required.

People’s needs were carefully assessed and reviewed frequently. People told us they felt involved in care that was provided and that staff always carefully explained the treatment options available to them.

People told us that staff always sought their consent prior to care being given. Staff were trained and aware of the issues relating to the Mental Capacity Act 2005. If people were not able to give their informed consent, then best interests meetings were held and decisions were made with the involvement of the person’s relatives and other healthcare professionals as required.

People told us they felt the service was safe. We checked the recruitment records for staff and saw that checks prior to employment were undertaken to ensure only suitable staff were recruited.