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Care and Social Services Inspectorate Wales
Care Standards Act 2000
Inspection Report
Marie Curie Cancer Care (Nursing Agency)
Mamhilad House
Block C
Mamhilad Park Estate
Pontypool
NP4 0HZ
Type of Inspection – Baseline
Date(s) of inspection – Monday, 9 February 2015
Date of publication – Wednesday, 29 April 2015
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Summary
About the service
The Marie Curie Cancer Care (Nursing Agency) is registered with the Care and Social
Services Inspectorate Wales (CSSIW) to provide registered nurses to cancer and noncancer patients and their families with the aim of enabling people to be cared for and
remain in their homes at the end of life.
The provider is a charitable organisation and runs throughout Wales. The agency is
commissioned by all seven Health Boards in Wales and the Velindre NHS trust to provide
nursing through a variety of services. Individual assessments of people who use the
service are undertaken by the board that commissions the services.
There is a nominated person who represents the agency. The Registered Manager post is
currently vacant but an application is pending with CSSIW.
What type of inspection was carried out?
We (CSSIW) visited the agency's office on an unannounced basis on the 9 February 2015
and on an announced basis on the 25 February 2015. An analysis of information held by
CSSIW, about the service, led us to conduct a baseline inspection which considered the
quality of staffing and leadership and management themes. To inform our report we
considered the following:
A review of information held by CSSIW about the service
Care documentation of a person using the service
Representatives of people using the service.
Examination of two staff files.
Information from the quality of care report 2013 to 2014.
Information relating to POVA and complaints.
Discussion with lead nurses from commissioning services.
Discussion with a manager and staff.
Discussion with representatives of the NHS
What does the service do well?
The agency runs additional services alongside providing nursing staff that is of benefit to
both patients and their family representatives. These include the "helper service" which
provides companionship, practical help and respite. Also the “caring for carers” that aims
to support carers who are caring for those who are coming to the end of their lives.
Marie Curie are currently running a pilot in Wales which offers bereavement support for
families and carers of patients who have received care from the Marie Curie nursing
service.
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What has improved since the last inspection?
There were no non-compliance notices issued at the last inspection and no areas for
improvement identified.
What needs to be done to improve the service?
There were no non-compliance notices issued at this inspection. However, the service will
improve with the implementation of the following:
The service need to ensure that NHS district nurses are familiar with the process of
communication so that they may have updated information from the agencies nurses. This
is because a district nurse informed us that she was unable to obtain a next day update
following an overnight shift by Marie Curie staff.
The service need to ensure that all agency staff can contact the Referral Centre when they
need to. This is because we were informed that it was sometimes difficult to be able to
speak with the referral centre via the telephone when requiring urgent information.
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Quality Of Life
This theme is not considered in Nursing agency inspections.
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Quality Of Staffing
People can feel confident in the care that they receive because the service employs
people following a robust recruitment procedure. This includes appropriate checks made
and references sought in relation to staff skills abilities and qualifications. Their suitability
in relation to the Disclosure and Barring Service (DBS) and a check made to the Nursing
and Midwifery Council (NMC), where nurse’s current registration number is obtained.
Staff files examined demonstrated that staff undertook an appropriate interview and that
any gaps in employment history are robustly monitored and, if required, answers are
sought.
We saw evidence of ongoing reviews of DBS and NMC registration compliance.
The service has a practice educator who is responsible for the induction and ongoing
training of staff. We saw evidence of the induction staff undertake which includes a
welcome to the charity, principles and practice of palliative care and
Marie Curie Cancer Care guidelines. We saw evidence of the ongoing training
programme which included a more in-depth training on palliative care, online training for
the mandatory subjects and topics such as dementia care and challenging behaviour.
We saw the overall training plan and monthly update reports from the practice educator
detailing progress towards the plan. We spoke with staff who said they were able to
undertake specialist training and one informed us that all she has to do is contact her
manager should she require any specific training related to the people she cares for.
People can be assured that staff are supported and motivated to provide the appropriate
care. This is because the service will provide staff with supervision, and staff have a
good level of contact with the agency and their line manager.
We saw evidence in staff files of regular clinical supervision. This includes individual and
group supervision. Clinical forum meetings are held monthly and staff are invited to
attend. The staff members informed us that she receives regular supervision and that the
Nurse Manager is always available to contact. She also said that should she have any
issues during the course of her shifts then an on-call duty manager is also always
available.
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Quality Of Leadership and Management
People that are working or linked to the service are clear about what it sets out to
provide. This is because staff, people using the service and their representatives and
those commissioning the services are involved in the planning, reviewing and quality
assurance processes.
The level of communication, in general, is robust and there is a good quality assurance
process in place which ensures that the provider will respond positively to feedback and
complaints. However, we were informed by a NHS district nurse that it was sometimes
difficult getting updated information from agency staff following a night shift. We were
informed by the Manager that there are processes in place and that all commissioners of
services would be reminded of these lines of communication. The service needs to
review the way the "referral contact centre" works as we were informed by a Marie Curie
agency nurse that it was difficult to get through by telephone.
Senior nurses and the Clinical Nurse Managers from the provider will attend monthly
District Nurse meetings to discuss any issues that arise and, once a referral has been
received, they will discuss the plan of care and the nature of the service required.
All the information required by the agency nurses is normally at the service user's home.
We saw evidence of one care file, where information included was person centred and
included relevant risk assessments, levels of medication and service users’ (or family)
preferences. Patient information is provided by the District Nursing Service for the
relevant health board and any updates required identified by agency nurses is forwarded
to the District Nursing Service by either the agency nurse visiting or the Marie Curie
nurse managers.
We were informed of and saw evidence of the agency's action plan for the development
of services for 2014/15 and examined a report assessing the standards of practice with
regards to record management. This evidences the commitment of the service to
ongoing development based on a partnership agreement with local health boards.
People can be assured that any complaints or incidents of safeguarding are promptly and
robustly dealt with as we saw evidence of incidents relating to both. Patients and their
representatives can be assured that whichever service staff are attending, they
understand their role with regards to safeguarding people. We saw evidence of the latter
where the provider’s staff prompted a safeguarding referral as a result of practice they
had observed.
We spoke with patients representatives, District Nursing staff and District Nursing
managers who were all extremely complimentary of the service provided by the Marie
Curie agency nurses. A patient's representative told us that the nurses are “wonderful
and I'm always confident of leaving my relative with them”. Another told us that the
nurses "are excellent timekeepers".
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A manager from Continuing Healthcare for a local health board said that the "level of
competency of staff is good and there is excellent communications with the agency".
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Quality Of The Environment
This theme is not considered in Nursing agency inspections.
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How we inspect and report on services
We conduct two types of inspection; baseline and focussed. Both consider the experience
of people using services.
Baseline inspections assess whether the registration of a service is justified and
whether the conditions of registration are appropriate. For most services, we carry out
these inspections every three years. Exceptions are registered child minders, out of
school care, sessional care, crèches and open access provision, which are every four
years.
At these inspections we check whether the service has a clear, effective Statement of
Purpose and whether the service delivers on the commitments set out in its Statement
of Purpose. In assessing whether registration is justified inspectors check that the
service can demonstrate a history of compliance with regulations.
Focused inspections consider the experience of people using services and we will
look at compliance with regulations when poor outcomes for people using services are
identified. We carry out these inspections in between baseline inspections. Focussed
inspections will always consider the quality of life of people using services and may look
at other areas.
Baseline and focused inspections may be scheduled or carried out in response to concerns.
Inspectors use a variety of methods to gather information during inspections. These may
include;
Talking with people who use services and their representatives
Talking to staff and the manager
Looking at documentation
Observation of staff interactions with people and of the environment
Comments made within questionnaires returned from people who use services, staff
and health and social care professionals
We inspect and report our findings under ‘Quality Themes’. Those relevant to each type of
service are referred to within our inspection reports.
Further information about what we do can be found in our leaflet ‘Improving Care and
Social Services in Wales’. You can download this from our website, Improving Care and
Social Services in Wales or ask us to send you a copy by telephoning your local CSSIW
regional office.
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