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Inspection Summary


Overall summary & rating

Good

Updated 17 January 2017

This inspection took place on 19 and 21 October 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available.

The hospice at Leckhampton Court has a 16-bed in-patient unit, a day service and a hospice at home team. It provides support for people over the age of 18 who have life limiting conditions such as cancer, heart failure, lung disease and degenerative neurological illnesses. The hospice at home team helps people to stay at home longer or to die at home if this is their preferred place of death. The service also offered respite for carers. The expert care team included doctors, nurses, health care assistants, physiotherapist, occupational and complementary therapist, social workers, bereavement support workers, volunteer befrienders and spiritual care workers. The various services provided by the hospice worked in conjunction with people’s own GP, community district nurses, and other health and social care professionals.

There was a registered manager in post. 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.

A hospice service was provided for end of life care in the last couple of weeks, symptom control, emotional and physical crisis. From the in-patient unit 50 percent of people would go home after a short stay and may return at a later date and 50 percent would die in the hospice. The hospice at home service was mainly provided for people in the last two months of life, however this service had helped people with degenerative neurological conditions for longer periods.

All staff including volunteers received safeguarding adults training and nurses and care staff received safeguarding children training. This meant they would be able to recognise if people and children they came into contact with were being harmed and would know what to do to report those concerns.

The nurses and health care assistants were trained on how to use equipment correctly to safely move and transfer people from one place to another. Any risks were identified and management plans put in place. Any other risks to people’s health and welfare were identified during the assessment of care needs and were then well managed. Safe recruitment procedures were followed to ensure that only suitable staff were employed. The service had the appropriate procedures in place to protect people from being harmed.

The numbers of staff on duty in the in-patient unit were determined by the number of people who were receiving care and support and the complexity of their needs. The hospice at home team had a flexible workforce (bank staff) in order to be able to increase capacity and accommodate the demand for their service. The team endeavoured to always meet any referrals for a service and would pull out all the stops to support those in need.

All staff had a programme of mandatory training to complete. This enabled them to carry out their roles and responsibilities effectively. Volunteers also had to complete some of these training sessions. There was a comprehensive induction training programme for all new staff plus a programme of refresher training for all other staff. This ensured they had the required skills and qualities to provide a compassionate and caring service to people and their families. .

On admission to the in-patient unit people’s capacity to make decisions was assessed and where possible they were supported to make their own choices and decisions. Staff received training regarding the principles of the Mental Capacity Act (2005) and these were understood. They ensured consent was given prior to providing any care and support. Where people lacked the capacity to make decisions because of their condition or were unconscious they worked within assumed consent but checked with healthcare professionals and family members before providing care and support.

People in the in-patient unit were provided with a well-balanced and nutritious diet. Alternatives were always available in order to meet people’s specific needs and an out of hours menu was available for those who needed to eat, outside of planned meal times. People in their own homes were assisted to eat and drink where this was required.

Health and social care professionals referred people to the hospice service when they needed in- patient care, and provided an overview of their medical and nursing care needs. Hospice at home staff received referrals for their service from the district nurses and the person’s GP and liaised with them as and when needed whilst they were providing a service. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

All staff who worked for the hospice had the qualities and skills required to provide sensitive and compassionate care and support to the people they were looking after. The staff developed close working relationships with the people they looked after and their families. The hospice received glowing feedback from families post bereavement and examples of these are detailed in the main body of the report. The hospice service not only cared for the people they looked after but also looked after the staff. Staff were emotionally well supported by their colleagues and the managers.

People’s care and support needs were assessed and they were provided with person-centred care. Regular reviews of people’s needs ensured their care plans were revised as often as necessary. People were involved in making decisions about how they were looked after and in the case of the hospice at home service, the support their family would find beneficial. There were secure communication systems in place for the hospice at home staff so that changes in people’s health status was reported back to the team and to the district nursing services.

The service was well led. There was a team of experienced managers and heads of department in post, all committed to providing a high quality service that was safe, effective, caring and met people’s needs. The prevalence of any events such as accidents, incidents and complaints were monitored and analysed to identify trends and enable the service to prevent a reoccurrence. Where things had not gone as expected by families and an individual experienced contentious or complex issues at end of life, the staff looked at the reasons why and looked for lessons they could learn for the future. There was a continual programme of audits in place to drive forward any service improvements needed.

Feedback from people who used the in- patient service, the day therapy service and the hospice at home service was gathered and used to measure how people felt about the care and support they received. All feedback was used to drive forward any improvements. A service user group was set up 18 months ago and feedback gathered from this group had led to a number of changes being implemented. These are listed in the main body of the report,

The service worked in partnership with other hospice care providers, took part and led on research projects. The partnership arrangements enabled the service to share good practice with other care providers and improve medical and nursing standards of care for people who were at the end of their lives or living with a life limiting condition.

Inspection areas

Safe

Good

Updated 17 January 2017

The service was safe.

All staff received safeguarding adults and children training and protected the peoples they were supporting from harm. Any risks to people’s health and welfare were well managed. Recruitment procedures for new employees were safe and ensured only suitable staff were employed.

People were assisted with and administered their medicines safely. Qualified nurses had the appropriate skills to enable them to administer end of life medicines.

Sufficient staff were employed at all times to meet people’s needs. The hospice at home service had a flexible workforce and was generally able to meet all referrals for a service. The staffing levels on the in-patient unit varied depending upon the number of people and their care and support needs.

Effective

Good

Updated 17 January 2017

The service was effective.

People were looked after by staff who were well trained and well supported to carry out their roles effectively. Staff had the qualities and skills to provide compassionate care and support.

Staff understood the importance of obtaining consent from people before helping them. They were aware of the principles of the Mental Capacity Act (2005).

People were supported to eat and drink where this was needed and supported to see their GP and other healthcare professionals as required. There was good collaborative working in place between the different health care services.

Caring

Good

Updated 17 January 2017

The service was caring.

People were treated with the utmost respect and kindness and their dignity was maintained until the end. The staff teams were highly motivated to provide a kind and loving service and ensured when people were at the end of their life they had a good death.

Families were also provided with a very caring and supportive service, at a difficult time in their lives.

The service looked after its staff and provided them with emotional support and guidance.

Responsive

Good

Updated 17 January 2017

The service was responsive.

People and their families received the care and support that met their specific needs. The care and support was adjusted as and when required in response to people’s changing needs.

People were listened too and staff were all committed to supporting them if they had any concerns or were unhappy.

Well-led

Good

Updated 17 January 2017

The service was well-led.

People were highly complimentary about the hospice service. External health care professionals said the service was well organised, well managed and provided service to an extremely high standard.

The service worked in conjunction with other hospice services and educational establishments to influence and improve best practice in palliative and end of life care.

Feedback from people using the services and the families of people who had used the service was gathered and used to drive forward any improvements. People were listened to and all staff, including volunteers, were involved and consulted by the management team.