12 May 2016
During a routine inspection
Rennie House is registered to provide specialist palliative care, advice and support for adults and children with life limiting illness and their families in their own homes. They deliver physical, emotional and holistic care through teams of nurses, counsellors and other professionals including therapists.
At the time of the inspection there were 180 adults and 52 children using this service. The service provided specialist advice with regards to symptom control and worked in partnership with health care professionals to ensure that people received the best possible support in their own homes. There was a counselling, pre- bereavement and bereavement support offered to families and relatives.
Rennie House had 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.
Staff were trained in how to protect people and children from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Staff assessed the risks involved in delivering a service in people and children`s own homes. Staff communicated any risks to people and children`s health and well-being to health and social care professionals. They followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.
People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences. The children services team from the hospice worked closely with children`s parents and social and health care professionals to ensure the best possible outcome for children with a life limiting illness.
Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.
Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. There were sufficient numbers of staff to ensure people received support when they needed it.
The service operated a 24 hour service and on-call system to ensure people received the same support and advice during the day as during the night. This gave people great confidence and comfort. People told us they valued this service and they felt reassured to know they could talk to a member of staff any time during day and night. The children services team was not providing a 24 hour on-call service, however when a child`s condition deteriorated the staff worked on a rota system and provided support to the children, parents and families over a 24 hour period.
People told us that staff understood their individual care needs and were compassionate and understanding and that their cheerful and friendly approach gave them reassurance and made them feel safe. Parents of the children who used the service were appreciative of the support they received had confidence and trust in the staff. They all felt the service was very safe. Staff told us they undertook training which enabled them to provide good quality care to people and children in their own homes.
People’s medicines were administered by trained and qualified staff who had their competency assessed regularly by their manager. Any changes in people`s medication were discussed with health care professionals to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs. Staff from the children services developed a close relationship with the team of paediatricians and specialists looking after the children`s health.
The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.
People and relatives were very positive about the caring and compassionate attitude of the staff delivering the service. They told us they were completely satisfied with their care and thought highly about staff and management. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected.
Parents of the children using the service valued the service they received and praised staff for the long standing support they gave to them and their children often for years until children reached adulthood. Staff from the hospice supported children and parents in the transition from children services to adult services liaising with social and health care professionals to ensure a smooth transition.
The management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. The registered manager was committed to improve and broaden the services the hospice offered.
The management and staff team actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.
There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.