• Hospice service

Eden Valley Hospice

Overall: Good read more about inspection ratings

Durdar Road, Carlisle, Cumbria, CA2 4SD (01228) 810801

Provided and run by:
Eden Valley Hospice, Carlisle

Latest inspection summary

On this page

Background to this inspection

Updated 15 July 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 uannounced inspection took place on 16 May 2016 with follow up telephone calls on 19 May 2016. The inspection was unannounced and the inspection team consisted of a lead adult social care (ASC) inspector, a pharmacist specialist advisor and a specialist paediatric nursing advisor. These advisors provided specialist knowledge to inform the inspection.

During our inspection we spoke with two people who were using the adult inpatient services and one young person on Jigsaw. We spoke with two relatives and the parent of a young person using Jigsaw. We spoke with a volunteer supporting the ‘Sunflower Group’.

We spoke with the Chief Executive of the service, the Head of Care, the Head of Hospice Facilities and support services, senior nurses on the adult and children’s units one of the senior clinicians and a GP who was one of four clinicians providing medical cover. We spoke with two registered nurses on the adult in patient unit and two registered nurses on the Jigsaw unit. We spoke with two health care assistants and with the hospice chaplain who led the chaplaincy team. We also spent time talking with the two catering staff on duty.

We attended a meeting of the ‘Sunflower Group’ that provided support for people who were caring for people with terminal or life limiting illnesses. We were able to speak with those attending and the palliative care social worker, based at the hospice, who facilitated the group. We attended a staff handover on the adult unit involving nursing, support and medical staff.

We reviewed four care records of children of different ages who used the Jigsaw unit and case tracked two of them. We reviewed the care plans for four people on the adult unit and case tracked two. This meant we spoke with staff and read people’s care records to see how the people were supported.

We looked at records, medicines and care plans relating to the use of medicines in detail for people being cared for on the adult inpatient part of the hospice and also the children’s hospice, called Jigsaw. We observed medicine rounds and how medicines were being handled and we discussed medicines handling with nursing staff.

Before our inspection we reviewed the information we held about the service. We looked at the information we held about notifications sent to us about incidents that affected the service and people attending the hospice. A notification is information about important events which the service is required to send us by law. We looked at the information we held on safeguarding referrals and any applications made under deprivation of liberty safeguards.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. This was completed promptly and in detail.

Overall inspection

Good

Updated 15 July 2016

The inspection took place on 16 May 2016 and was unannounced. At our last inspection the registered provider was meeting all the regulations that were assessed.

Eden Valley Hospice is located in the outskirts of Carlisle. It is registered to provide palliative and end of life care for up to12 adults and five children. The hospice has a 12 bed adult in-patient unit with eight single ensuite rooms and one four bed room. Care and support services for children and young adults with life limiting conditions are provided within a separate unit on the site called Jigsaw. Adults and children may be admitted for care during the last weeks and days of their life, symptom control, and assessment and / or respite care. There is a Day Hospice that provides care and support for up to 15 people a day, four days a week. The hospice provides bereavement support, complimentary therapies, counselling and carer support services and wellbeing programmes. There is a multidisciplinary team who are all experienced and trained in palliative care. Medical cover is provided by dedicated doctors who are supported by a Palliative Care Consultant.

At the time of our inspection there were 10 people using the adult inpatient unit and two children in Jigsaw.

There was a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The management team demonstrated a desire to learn about and implement best practice throughout the service. There was a clear organisational structure and a visible management presence throughout the service. Feedback from people and families using the service, health and social care professionals and visitors was very positive and people praised the care and compassion of the staff and volunteers.

The hospice environment was calm and it was open to families to visit and stay 24 hours a day. Hospice staff facilitated pre and post bereavement support for children, young people and adults through the hospice’s family support team. Those offering bereavement support and counselling had specific training for this role in line with ethical practice.

We saw people had been able to discuss with staff their spiritual and cultural beliefs and how they wanted these to be met. There was a well established chaplaincy team to offer pastoral and spiritual support whatever a person’s individual beliefs.

Hospice nursing and medical staff spent time with people and planned ahead to find out what people’s needs and goals were. A holistic approach was used to help make sure people’s emotional, spiritual and social needs were met as well as their physical needs. This meant people approaching end of life or with life limiting conditions were supported to lead a full and meaningful life. People told us they could speak openly about what they wanted and how they felt about their illnesses and were given the information needed to help them make their own treatment decisions.

Records we looked at demonstrated that staff took a lot of time working with people and giving them the time and information they needed to make decisions about their care and treatment. We saw that this process was led by the adult or child’s family.

There was a safeguarding policy in place that included information about the protection of adults and children. The safeguarding policy covered both adult services and Jigsaw and referred to relevant policies and national guidelines.

There were policies and procedures in place covering all aspects of the management of medicines within the adult inpatient unit and the Jigsaw unit. Medicines were stored in appropriate cabinets and fridges and were administered in accordance with the prescriber’s instructions. Controlled Drugs were handled appropriately.

We made some recommendations regarding medication good practice that we discussed with the management team. We made a recommendation in regard to areas that required review to incorporate current best practice and to include this in policies and procedures being used. Also we made recommendations about assessment in aspects of security and action planning following audit findings. We agreed the actions that would be taken and some were addressed on the day..

Records demonstrated that people were being well supported physically and emotionally and had been consulted throughout their care and treatments. There was evidence of risk assessments for people before and on admission that stated the actions staff were to take to reduce the possibility of harm without applying any unnecessary restrictions on people’s freedom. The records in people’s care files indicated that consent to support, care and treatment was being sought in line with legislation and guidance.

People's care plans included clear planning with regard to the control of distressing symptom and pain management that were being updated on a continual basis. The updates included changes in people's health and what was agreed when people experienced changes in their conditions, symptoms or pain levels

Care plans in use in the hospice included risk assessments using accredited measuring and monitoring tools. Records demonstrated that incidents, accidents and near misses were reported, recorded and reviewed through the management reporting process and action taken where any trends were identified.

There was a high ratio of staff to people/children using the service of suitably experienced and skilled staff to keep people safe and meet their needs and expectations. Safe recruitment practices were followed when new staff were employed or volunteers taken on. The hospice has its own bank staff to cover for holidays, for training and sickness and they had been recruited using the same process as permanent staff.

The hospice had a training and development strategy in place and there was a comprehensive mandatory and statutory training programme for all those working or volunteering in the hospice. All staff received supervision and support and an annual appraisal of their work.

Nutrition risk assessments were carried out and used to identify specific risks associated with people and these were subject to continuous review. People and their relatives were very complimentary about the food provided which was cooked daily from fresh ingredients. We were told “The food is lovely”.

There were clear strategic plans in place for the continual development of hospice services and a business plan which clearly summarised the organisation's aims and objectives, with forward planning strategies being implemented.