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Inspection carried out on 11 August, 4 and 7 September 2015

During a routine inspection

This inspection took place on 11 August and 4 and 7 September 2015 and was unannounced.

We last inspected this service during December 2013. At that inspection we found the service was meeting all the legal requirements in force at the time.

St Oswald’s Hospice provides specialist care for people with life limiting illnesses, including day and inpatient services for children, young adults and adults. It provides nursing care. It has 19 beds and had 13 adults and six children living there at the time of this inspection.

The service had a registered manager who had been in post for five years. 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 their relatives told us they received an exceptional quality of care from all the staff at the hospice. They said staff were wholly and genuinely committed to meeting all their physical, social and emotional needs, in highly person-centred, imaginative and flexible ways. They described a culture that was positive and life-affirming. Typical comments received from relatives included, “This is a marvellous place, even if you were a multi-millionaire you couldn’t pay for the care you get here”; “They’re like a second family, they wrap themselves around you to support you”; and, “They go above and beyond what you get in the community.”

There were very good staffing levels which allowed staff to meet people’s needs in a safe, timely and personalised manner. Extensive use was made of a large team of trained, experienced and dedicated volunteers (many of them qualified) in all areas of the service. This gave hospice staff the space to work with people in a particularly individualised way, and added considerably to the well-being of people and their families. People felt they were fully involved in all aspects of their care and treatment, and that their views were paramount in how their care was given.

The service had a well-defined, dynamic management structure that provided strong, effective and innovative leadership. There was a well-articulated vision for the next ten years’ development of the service. This focussed on breaking away from the traditional model of the hospice, as there was a recognition that many people were not currently receiving the support and care they needed in their own homes. By taking services out into the community and working in partnership with other hospices, hospitals and agencies, the service was developing new ways of supporting a much wider range of people with their end of life care needs.

End of life care was given in sensitive and appropriate ways that acknowledged people’s rights and preferences. The service promoted a ‘focus on living’ approach to care, which supported people and their families to appreciate and enjoy the time they had together and enhance their feelings of well-being. People were given a wide range of social stimulation and activities, supported by trained activities specialists in well-equipped on-site facilities, and could access complimentary therapies. As part of the ‘focus on living’ approach people were encouraged to develop skills and enjoy new experiences. A relative told us, “My perception of places like this was that it was a place you came to die. I’ve changed my perception, it’s far from that.”

There was a shared commitment by all staff to the service’s values of ‘care, compassion, dignity and love’. We found these values to be clearly demonstrated in the approach of staff and in the care given to people and their families. Staff morale was high and they told us that all the management team actively listened to their views, gave them the support they needed and made them feel valued and respected.

The staff team were highly qualified and very experienced. The service had its own training team and ensured staff were kept up to date with all training needs and supported in keeping the knowledge and skills updated. New staff were given structured induction and close mentoring. Regular supervision and annual appraisal were used to support clinical and non-clinical staff.

People using the service and their relatives told us they felt safe and well protected whilst in the service. Staff had been trained to recognise and report any possible issues of abuse. No safeguarding incidents had occurred in the unit since the last inspection.

The service carefully assessed all risks to people using the service and took appropriate measures to control risks. However, people were able to take risks necessary for them to maintain their independence.

All accidents and incidents were recorded and analysed, to allow for lessons to be learned and appropriate steps taken to prevent recurrence.

Regular checks were made regarding the safety of the building and equipment. Staff were given training in safe working practices and were provided with any necessary personal protective equipment to keep them safe. Effective systems were in place to monitor the control of infection.

Robust staff recruitment systems were in place which ensured that only applicants who met the service’s high specifications regarding qualifications, experience, character and caring abilities were employed. This included the recruitment of volunteers who were subject to the same processes as staff employed by the service.

The safe management of people’s medicines was given a high priority. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff had been trained in this important area and were aware of their responsibilities regarding protecting people’s rights. The registered manager submitted appropriate applications to the local authority for authorisation to place restrictions on certain people’s movement, in their best interests.

Effective systems of communication were in place to enable people to express their needs and wishes clearly. People were asked to give their formal consent to their care. Where they were deemed to lack capacity to do this, appropriate ‘best interest’ decisions were made on their behalf, in conjunction with family and professionals.

People were given appropriate support to take a nutritious diet.

People’s general and specific health needs were kept under constant assessment and met, by treatment within the service or by referral to other professionals.

People said their right to privacy was fully protected, and told us they were always treated with dignity and great respect by all staff and volunteers. Staff demonstrated a commitment to maintaining confidentiality of people’s personal information.

Every effort was made to enhance people’s independence whilst at the service. Appropriate mobility and communication aids were available. People were given choice in all aspects of their daily living and were encouraged to express their individuality.

People were fully involved in assessing their care and treatment needs and their wishes and preferences were incorporated in planning how those needs were to be met. Regular reviews of people’s care were held and people were encouraged to take full part in discussing how their needs were being met.

Systems were in place for responding to concerns and complaints, but we found no complaints had been received about in-patient services.

The service worked closely with other professionals and agencies to ensure people’s holistic needs were fully met.

Robust systems were in place to continually monitor the quality of the service being provided and to identify and implement areas for further development. Staff at all levels were genuinely committed to a culture of excellence and demonstrated this in their day-to-day work.

There was clear evidence of close and effective partnership working between families and carers, and between the service and external professionals.

Inspection carried out on 11 December 2013

During a routine inspection

Patients had their needs assessed and the assessment was used to develop personalised care plans. Patients commented: �They (staff) could not do more for you�; �I have only to mention something and something is done about it�; �If you don�t feel like a full meal and just want a sandwich that was what you got�, and, �If I feel unwell and want to stay in bed all day, that is fine.�

We found that patients received their care and treatment in premises that were well maintained, clean and free from unpleasant odours.

Patients were happy with the staff providing their care and treatment. One patient said, �How could we not be happy to be here when we are being looked after by such caring professionals.� The provider had systems in place to ensure that prospective employees were suitable to work with vulnerable people.

Patients and their relative's were asked for their views about the service. One patient said, �I could not fault the care.�

We found staff had access to accurate and up to date information about each person. Information was stored securely and could be accessed easily when required.

Inspection carried out on 8 January 2013

During a routine inspection

People using the day hospice told us they make their own choices about how to spend their time. One person commented, �The staff are fantastic and nothing is too much trouble. You can do as much or as little as you want, the patient is very much in control.�

People told us how they maintained or developed their life skills such as spending time out of the hospice and accessing the day hospice to undertake a range of activities such as arts and crafts, music and trips out, for example to the cinema. One relative described how staff supported the whole family and commented, �Staff look after me, listen to me and ask how I am.�

Medicines were handled appropriately. We saw the provider had comprehensive systems for monitoring medication which people brought into the hospice with them and managing medication administered to people. All staff had completed safe handling of medicines training and had their competency assessed annually.

Staff told us they felt well supported by managers and each other. Staff told us the provider was very supportive about them working towards further qualifications and attending additional training such as blood transfusion and bereavement training.

People told us they were aware of the complaints system and understood how to complain if they were unhappy with their care or treatment. No-one we talked with had any concerns and one person commented, �I have nothing to complain about, the staff and volunteers are amazing.�

Inspection carried out on 11 January 2012

During a routine inspection

We met with people who were inpatients on the adult and young person units.

People we spoke with were very happy with the services provided by St Oswald�s Hospice. One person told us "There is such good atmosphere when you walk in the door". Another person told us "I visit here regularly and I always enjoy my stay".

Everybody told us they were fully consulted about their care and treatment. People who had previously attended day services and who now received inpatient treatment told us continuity of care was very good and they felt supported.

People spoke highly of the meals provided and told us they were always given choices. They said that meals were well presented and appetising.

People knew how to raise any concerns and were given the opportunity to provide feedback on the level of service received. Everyone we spoke with told us the staff were very helpful, kind and knowledgeable about their needs. They said "they are just so thoughtful".

They said the environment was pleasant, restful and clean.

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