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Inspection Summary


Overall summary & rating

Good

Updated 26 January 2016

This inspection took place on 11 August and 4 and 7 September 2015 and was unannounced.

We last inspected this service during December 2013. At that inspection we found the service was meeting all the legal requirements in force at the time.

St Oswald’s Hospice provides specialist care for people with life limiting illnesses, including day and inpatient services for children, young adults and adults. It provides nursing care. It has 19 beds and had 13 adults and six children living there at the time of this inspection.

The service had a registered manager who had been in post for five years. 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.

People and their relatives told us they received an exceptional quality of care from all the staff at the hospice. They said staff were wholly and genuinely committed to meeting all their physical, social and emotional needs, in highly person-centred, imaginative and flexible ways. They described a culture that was positive and life-affirming. Typical comments received from relatives included, “This is a marvellous place, even if you were a multi-millionaire you couldn’t pay for the care you get here”; “They’re like a second family, they wrap themselves around you to support you”; and, “They go above and beyond what you get in the community.”

There were very good staffing levels which allowed staff to meet people’s needs in a safe, timely and personalised manner. Extensive use was made of a large team of trained, experienced and dedicated volunteers (many of them qualified) in all areas of the service. This gave hospice staff the space to work with people in a particularly individualised way, and added considerably to the well-being of people and their families. People felt they were fully involved in all aspects of their care and treatment, and that their views were paramount in how their care was given.

The service had a well-defined, dynamic management structure that provided strong, effective and innovative leadership. There was a well-articulated vision for the next ten years’ development of the service. This focussed on breaking away from the traditional model of the hospice, as there was a recognition that many people were not currently receiving the support and care they needed in their own homes. By taking services out into the community and working in partnership with other hospices, hospitals and agencies, the service was developing new ways of supporting a much wider range of people with their end of life care needs.

End of life care was given in sensitive and appropriate ways that acknowledged people’s rights and preferences. The service promoted a ‘focus on living’ approach to care, which supported people and their families to appreciate and enjoy the time they had together and enhance their feelings of well-being. People were given a wide range of social stimulation and activities, supported by trained activities specialists in well-equipped on-site facilities, and could access complimentary therapies. As part of the ‘focus on living’ approach people were encouraged to develop skills and enjoy new experiences. A relative told us, “My perception of places like this was that it was a place you came to die. I’ve changed my perception, it’s far from that.”

There was a shared commitment by all staff to the service’s values of ‘care, compassion, dignity and love’. We found these values to be clearly demonstrated in the approach of staff and in the care given to people and their families. Staff morale was high and they told us that all the management team actively listened to their views, gave them the support they needed and made them feel valued and respected.

The staff team were highly qualified and very experienced. The service had its own training team and ensured staff were kept up to date with all training needs and supported in keeping the knowledge and skills updated. New staff were given structured induction and close mentoring. Regular supervision and annual appraisal were used to support clinical and non-clinical staff.

People using the service and their relatives told us they felt safe and well protected whilst in the service. Staff had been trained to recognise and report any possible issues of abuse. No safeguarding incidents had occurred in the unit since the last inspection.

The service carefully assessed all risks to people using the service and took appropriate measures to control risks. However, people were able to take risks necessary for them to maintain their independence.

All accidents and incidents were recorded and analysed, to allow for lessons to be learned and appropriate steps taken to prevent recurrence.

Regular checks were made regarding the safety of the building and equipment. Staff were given training in safe working practices and were provided with any necessary personal protective equipment to keep them safe. Effective systems were in place to monitor the control of infection.

Robust staff recruitment systems were in place which ensured that only applicants who met the service’s high specifications regarding qualifications, experience, character and caring abilities were employed. This included the recruitment of volunteers who were subject to the same processes as staff employed by the service.

The safe management of people’s medicines was given a high priority. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff had been trained in this important area and were aware of their responsibilities regarding protecting people’s rights. The registered manager submitted appropriate applications to the local authority for authorisation to place restrictions on certain people’s movement, in their best interests.

Effective systems of communication were in place to enable people to express their needs and wishes clearly. People were asked to give their formal consent to their care. Where they were deemed to lack capacity to do this, appropriate ‘best interest’ decisions were made on their behalf, in conjunction with family and professionals.

People were given appropriate support to take a nutritious diet.

People’s general and specific health needs were kept under constant assessment and met, by treatment within the service or by referral to other professionals.

People said their right to privacy was fully protected, and told us they were always treated with dignity and great respect by all staff and volunteers. Staff demonstrated a commitment to maintaining confidentiality of people’s personal information.

Every effort was made to enhance people’s independence whilst at the service. Appropriate mobility and communication aids were available. People were given choice in all aspects of their daily living and were encouraged to express their individuality.

People were fully involved in assessing their care and treatment needs and their wishes and preferences were incorporated in planning how those needs were to be met. Regular reviews of people’s care were held and people were encouraged to take full part in discussing how their needs were being met.

Systems were in place for responding to concerns and complaints, but we found no complaints had been received about in-patient services.

The service worked closely with other professionals and agencies to ensure people’s holistic needs were fully met.

Robust systems were in place to continually monitor the quality of the service being provided and to identify and implement areas for further development. Staff at all levels were genuinely committed to a culture of excellence and demonstrated this in their day-to-day work.

There was clear evidence of close and effective partnership working between families and carers, and between the service and external professionals.

Inspection areas

Safe

Good

Updated 26 January 2016

The service was safe. Risks to people were assessed and appropriate steps taken to minimise harm to people, without restricting their independence.

There were high staffing levels and good support from trained volunteers which allowed staff to give people safe and timely care.

Staff had been trained to recognise and respond to any actual or potential abuse. No incidents of abuse had occurred.

People’s prescribed medicines were safely managed.

Effective

Good

Updated 26 January 2016

The service was effective. There was a highly trained staff group which had the necessary skills and experience to meet people’s needs effectively.

Staff were given the support and supervision they needed to carry out their roles.

People’s rights were protected under the Mental Capacity Act 2005 and no one was being deprived of their liberty unlawfully.

People’s health needs were carefully monitored and appropriate referrals made to other professionals, where required. People’s nutritional needs were understood and met.

Caring

Outstanding

Updated 26 January 2016

The service was particularly caring. People and their relatives told us that staff treated them with exceptional kindness, care, dignity and respect at all times.

Staff were highly pro-active in their approach to care. They demonstrated compassion in every aspect of their work and ‘went the extra mile’ to make people feel valued and supported.

An extensive range of imaginative activities and social stimulation was offered, including on-site access to many complementary therapies. People were given information about a wide variety of support services.

There was an emphasis on genuinely holistic care that valued every aspect of the person and gave opportunities to develop and enjoy their time with their families. People’s spiritual needs were recognised and if appropriate met by a chaplaincy team with multi-faith links.

People were encouraged to be as independent as possible, make their own decisions and maintain control of their lives.

Responsive

Good

Updated 26 January 2016

The service was responsive. People and their families were fully involved in assessing their needs and planning how their care should be given.

Staff delivered people’s care in a person-centred way, treating them as individuals and encouraging them to make choices about their daily lives.

No complaints had been received regarding the service.

Well-led

Good

Updated 26 January 2016

The service was particularly well led. The management team gave strong, effective and innovative leadership and provided a clear strategy for the long term development of the service. The management team was dynamic and pro-active in introducing new ways to meet the needs of people in the wider community.

There were clear management structures and lines of accountability. Staff told us the service was very well managed, that they were treated with respect and were actively involved in decision-making.

Robust systems were in place to monitor the quality of the service being provided. The views of people who used the service, their families, staff and other professionals were regularly canvassed and used to identify where improvements were necessary.

All staff shared an outstanding commitment to excellence in every aspect of their work.