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Inspection carried out on 8 March 2016

During a routine inspection

This inspection took place on 8 and 9 March 2016 and was unannounced. We previously inspected the service on 11 March 2014 and found no breaches of regulations in the standards we looked at.

The inspection team included two inspectors, a pharmacy inspector, a nurse specialist in palliative care and an expert by experience. An expert by experience a person who has personal experience of using or caring for someone who uses this type of care service.

Weldmar Hospicecare Trust is a registered charity. All services to patients are provided free of charge. Some funding is provided by the NHS but most is provided through fundraising and charitable donations. The service is for adults with life-limiting illnesses or advanced progressive conditions, their families and others close to them.

Joseph Weld hospice is in Dorchester and the inpatient unit is registered for 18 beds, although a maximum of 14 beds are used at any one time.It cares for about 300 people a year. The hospice accepts people with a diagnosis or medical condition that significantly limits their life to less than two years or where they have complex symptom management problems. Also, if the person or other family member has psychosocial, emotional or spiritual needs. Admissions to the inpatient unit were usually for symptom control, and for end of life care.

The hospice is purpose built over two floors. The inpatient unit has four single rooms and a family room, all with ensuite facilities. There are four single sex bays, each with its own bathroom, which can accommodate a maximum of four beds, but are only ever used to accommodate three people. The rooms have lovely views of the landscaped grounds and surrounding countryside. There are ample car parking facilities including disabled access spaces near the main entrance. More recently Joseph Weld has benefitted from the addition of an orangery which provides a bright and welcoming space, with quiet areas for people and relatives to relax in. This includes a café opened to the public at lunchtime each day and a play area for children.

People can access the service in a variety of ways, via referrals from local GP's and consultants in the NHS, or from people and/or family members/carers (with the person’s permission). Services are provided up to and at the time of death, and after death, for the bereaved.

The hospice has three specialist teams of community specialist palliative care nurse teams across central, south and north Dorset, known as Weldmar community nurses (WCN’s). These nurses are skilled and experienced in supporting people with the management of their pain and symptom control. They provide physical, emotional and social support for about 650 people and families each year. It is a five day a week service, with emergency cover at the weekend. The WCN’s visited people at home, in nursing or care homes and in community hospitals. They also worked closely with 45 GP surgeries, district nurses and other community based staff providing advice about managing people’s symptoms and prescribing.

The hospice provides day services to about 350 people each year, which include social respite, social groups and wellbeing services. These services were held on various days of the week, at Joseph Weld hospice in Dorchester, Trimar in Weymouth, and at community hospitals in Blandford, Shaftesbury and Sherborne. Some people we met at these services shared their experiences of being admitted to Joseph Weld hospice for pain management and symptom control.

The hospice has a large team of volunteers, who work in the inpatient unit, day hospice and wellbeing services, and as volunteer drivers. They offered befriending services to people and provided respite for carers. Some volunteers had professional qualifications and offered counselling and complementary therapies.

The service has a registered manager who is the Director of Nursing and Patient Services. 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 families received outstanding care from exceptional staff and volunteers who developed positive, caring and compassionate relationships with them. The service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide seamless care for people.

People received excellent care, based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. The hospice education department was a regional centre of excellence for staff training in end of life care. They worked with staff in the NHS, in care and nursing homes and domiciliary care agencies to improve their skills and knowledge in end of life care. This meant more people could have end of life care in their preferred place of home, or in the hospice, which helped reduce admissions to hospital.

People were partners in their care, and were consulted and involved in decisions about their care and treatment. They were asked about where and how they would like to be cared for when they reached the end of their life. Staff treated them with the utmost sensitivity, dignity and respect.

The hospice offered an array of bereavement services. In particular, a child support worker was doing innovative work, to provide individual support for children and young people facing bereavement. They worked with schools, district nurses and with child and adolescent mental health services to ensure more children received bereavement support.

People received exceptionally personalised care which responded to their individual needs and preferences. Staff used a range of creative ways to help people to manage some of their symptoms and to promote as good a quality of life as possible. Staff supported people with practical needs, such as any equipment so they could remain at home, this included electric beds, moving and handling and pressure relieving equipment.

People had access to high quality food and drink, for as long as they were able and wished to. Excellent catering services met people's individual nutrition and hydration needs.

People said staff made them feel safe and cared for. Staff knew how to recognise and report signs of potential abuse, and any concerns reported were investigated. People received care at a time and pace convenient for them because there were enough skilled and experienced staff. Staff could spend time with each person offering them assistance, support, comfort and reassurance.

People’s human and legal rights were respected because staff understood their responsibilities in relation to the Mental Capacity Act (MCA) (2005) and Deprivation of Liberty Safeguards (DoLS). People knew how to complain and any complaints received were thoroughly investigated with lessons learned. Staff were open and honest when things went wrong and were committed to learning from people’s feedback and experiences.

People received their medicines on time and in a safe way. All appropriate recruitment checks were completed to ensure fit and proper staff were employed. They were cared for in a clean and hygienic environment. Staff reduced the risks of cross infection for people through good hand hygiene, and regular cleaning.

People received consistently high quality care because senior staff led by example and set high expectations for staff about standards of care. The provider had a range of robust systems to monitor the quality of care provided, which included feedback surveys, audits and quality monitoring checks. They continuously made changes and improvements in response in response to their findings.

Inspection carried out on 6 November 2013

During a routine inspection

We looked at comments from people who used the service and saw that they were happy with the care and treatment that they had received. There were comments such as "Excellent care" and "Five star food". We saw that staff protected people's privacy and maintained their dignity.

Care and attention was paid to people's individual needs so that they received effective and appropriate treatment. Staff were trained to understand the specific needs of people requiring end-of-life care. There were facilities in place to deal with emergencies and any adverse incidents were dealt with effectively and recorded appropriately.

Staff were supported and managed effectively and were encouraged to up-date their skills and knowledge. Professional and organisational skills were regularly assessed and further development encouraged.

Inspection carried out on 15 June 2012

During a routine inspection

We visited the hospice unannounced on 15 June 2012. There were 14 people in the hospice on the day of our visit. We spoke with five people, three relatives and five staff.

One person told us that staff "were angels" and their treatment plan was explained at a pace and way they could understand.

We spoke with one person who told us " The Dr was very good, he discussed treatment and I felt more involved in my care."

We spoke with one person who told us how staff supported their independence. There were tasks they could do themselves such as eating. There were other tasks such as help with personal care they could not. Staff respected this.

One person told us that staff were very kind and supportive and this made them feel safe.

Another person told us that when being hoisted they were not worried as staff knew what they were doing.

Relatives we spoke with told us staff were informative and welcoming. They also told us that they were kept up to date with information about the care and treatment their relative had received.

People told us they were given leaflets on how to reflect and comment on the care and treatment they received during their stay in the hospice. This enabled them to consider the service and care and take time to respond.

Reports under our old system of regulation (including those from before CQC was created)