Background to this inspection
Updated
15 September 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 was planned to check 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.
The provider was given 48 hours’ notice because we did not wish to impact on the day to day running of the service and wanted to enable nursing staff to be available to speak with us.
On the day of the inspection there were three adult social care inspectors and a specialist advisor in end of life and palliative care who was a registered nurse.
Before the inspection we reviewed all the information we held about the service, this included notifications of significant changes or events. The registered provider had completed a provider information return [PIR] prior to the inspection in April 2016 and we updated this information with them during the course of the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
At the time of our inspection visit there were four people who used the in-patient service and there were 16 people using the day hospice facility. We spoke with two people using the in-patient service, two relatives and five people using the day hospice facility.
During the visits we spoke with nine staff, this included the head of care, human resources manager, the clinical governance and quality assurance advisor, the operations manager, the catering and housekeeping manager, three nurses and health care assistants.
Before the inspection we reviewed any information from people who had contacted us about the service since the last inspection. For example, people who wished to compliment or had information that they thought would be useful.
Before the inspection we reviewed information from the local safeguarding teams, local authority and health services commissioners in which the provider operated. Prior to the inspection we also contacted the local Healthwatch. Healthwatch is the local consumer champion for health and social care services. They give consumers a voice by collecting their views, concerns and compliments through their engagement work. Information given by these public bodies were used to inform the inspection process.
During the inspection we reviewed a range of records. This included four people’s care records who used the hospice, including care planning documentation and medication records in both the in-patient and day hospice facility. We also looked at staff files, including staff recruitment and training records, records relating to the management of the hospice and a variety of policies and procedures developed and implemented by the registered provider.
Updated
15 September 2016
Willow Burn Hospice provides a range of services focusing on relieving and preventing the suffering of people with life limiting illnesses. These include specialist day care services, palliative care and an outreach service. There were four people using the inpatient service on the day of our visit and approximately nine people attending the day hospice facility.
There was not a registered manager employed for this service. 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. The service had appointed a very experienced manager [head of care] who had joined the service six weeks previously with a background in hospice care. During the inspection the provider clarified the position of the responsible individual [who also has legal responsibilities with CQC] in the temporary absence of the previous appointee.
Some of the systems and processes to ensure the hospice was well led had lapsed following the absence of a registered manager at the home. Work to review and implement improvements to the governance of the service had only been recently introduced by the present manager [head of care] and included joint work with staff, senior colleagues and an externally appointed consultant.
People and their families told us that staff were kind and compassionate. People told us that staff were caring and listened to them. People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support package met their needs not just in terms of physical care but also in relation to their emotional support. People using the day hospice spoke very highly of the complementary therapies that were available to both people who used the service and relatives. The hospice provided family support, counselling and bereavement support which people told us made a massive impact to their lives.
The staff undertook the management of medicines safely and in line with people’s care plans. The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with delivering the person’s care and their environment. The hospice environment was maintained and there were regular checks on safety and equipment.
People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.
Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs and the service had a team of volunteers who provided additional support. The hospice had a bank of staff who they could contact if they needed additional staff.
The service had a care planning system that we saw recorded people’s admission assessment and on-going plan of care. Care plans were personalised to include people’s wishes and views. Care plans were regularly reviewed in a multi-disciplinary framework. We observed staff caring for patients in a way that respected their individual choices and beliefs. There was evidence of advance care planning and specific guidance ‘Deciding Right’ [a good practice initiative] was used to capture people’s choices and planning for future anticipated emergencies. Staff knew peoples’ preferences about treatment as they approached the end of life stages and these were recorded. However the service did not follow best practice because there was not a specific care plan for caring for patients in the last days of life. CQC recommended that the provider considers best practice in advanced care planning.
Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care. However, although staff told us they felt supported, arrangements for one to one supervision, appraisal and clinical supervision for qualified staff [nurses] had only recently been introduced by the manager [head of care].
Staff told us they were very supported by their management and could get help and support if they needed it at any time. Staff members told us they felt part of a team and were proud to work for the hospice.
People had choices about their care and their consent was sought by staff and their rights were being protected whilst at the hospice. However records of the assessment of people’s mental capacity was insufficiently detailed in relation to the Mental Capacity Act 2005 [MCA]. CQC recommended that the registered provider improve the capacity assessment documentation so that judgements in line with the MCA could be demonstrated.
People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking to them which led to the chefs being able to give the person the type and amount of food they would be able to eat. There was a choice of menu on the day we inspected and drinks and snacks were available at any time.
People were confident expressing any concerns to staff at the service and knew who to approach if they were not satisfied with the response.