We carried out a review of the data available to us about Rowcroft Hospice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Rowcroft Hospice, you can give feedback on this service.
Our rating of this service went down. We rated it as good because:
However:
We rated this service as good because it was safe, effective, caring and responsive, with good leadership.
The service continuously looked at the local community to see how best they could provide the service. This had resulted in the provision of the Hospice at Home service. Rowcroft's Hospice at Home service provides responsive end of life care and support to patients and their families in their own home or a care home in the last two weeks of life. The service operates 24 hours a day, 7 days a week with access to doctors, registered nurses and care assistants as well as ancillary staff and therapists. The Hospice at Home staff are all employed by Rowcroft and work with other health care professionals in the community. Services are free to people and Rowcroft Hospice is largely dependent on donations and fund-raising. A training centre also offers advice and support to staff in nursing and residential care settings in the community. The service had also recognised a need to provide specialist training and end of life care for people living with dementia and their carers and had established links with homeless communities.
This inspection was carried out on 11 and 14 January 2016 by one inspector, a pharmacist inspector, an expert by experience and a specialist advisor in palliative care. It was an unannounced inspection. There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run. They oversaw the running of the service and were supported by a leadership team that included the chief executive and directors and department managers.
Information about the needs of the local population had been used to develop specialist support such as the expansion of the hospice at home service. The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death.
Staff were trained appropriately and had a good knowledge of each person and of how to meet their specific support needs. Staff went that extra mile to ensure people’s needs were met in a holistic way including support for people’s loved ones.
People’s feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was kind and compassionate. Relatives told us, “The care was first class, the staff were all so considerate and helpful no matter the problem and what a wonderful place.” People’s feedback about the caring approach of the service and staff was overwhelmingly positive and described it as “Fantastic” and “A1”. Clear information about the service, the facilities, and how to complain or comment was provided to people and visitors.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.
There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of past conduct and suitability from previous employment to ensure staff were suitable to work with vulnerable people.
Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people’s communication needs. 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 according to their individual plans and provided outstanding care.
The environment was an older style building and had been well utilised for ease of access for people. It was welcoming, well maintained and suited people’s needs. The clinics, therapies and support groups were held in a new purpose built building across the grounds. There was a beautiful outlook and well maintained grounds which were also accessible for people to enjoy.
Staff had received essential training including end of life care and were scheduled for refresher courses. Staff had received further training specific to the needs of the people they supported. All members of care and support service staff received regular one to one or group supervision and support with clinical supervision and professional validation. This ensured they were supported to work to the expected standards.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered the requirements of the Mental Capacity Act 2005.
The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences, restrictions and reduced appetite.
Staff communicated effectively with people, responded to their needs promptly, and treated them with genuine kindness and respect.
People’s privacy was respected and people were assisted in a way that respected their dignity. Staff sought and respected people’s consent or refusal before they supported them. Staff pre-empted and responded to people’s individual needs and requirements. People and their relatives told us, “From our first contact with staff, my husband and I were helped in every possible way with kindness and efficiency. We could not have had better treatment”.
People were involved in the planning of activities that responded to their individual needs. The hospice mainly cared for people with acute needs meaning they were unwell or at the end of their lives. Therefore, activities were more based on therapeutic methods such as therapies and spending time with people. Attention was paid to people’s individual social and psychological needs.
The registered manager was open and transparent in their approach. They held a vision for the service that included “Let's make every day the best day possible.” Staff demonstrated this vision in their practice and gave person centred, individualised care. Staff told us they felt valued and inspired by the registered manager to provide a high quality service. They described the registered manager as welcoming and friendly, someone who made people feel valued.
Patients were able to consent to their care and treatment but also said 'They are the experts and know what is best for me'. We were told that patients were provided with enough information about their care and appreciated the staff being at the end of the call bell or telephone.
The hospice was clean and had systems in place to reduce the spread of infection.
There were sufficient numbers of skilled staff available who were popular with patients. Comments included 'Everyone here is amazing, all the staff and doctors,' and, 'everyone is brilliant here from the cleaners right up to the top people'. Relatives told us 'There was always someone around to ask and sometimes they knew they were needed before we knew it ourselves.'
Records were well maintained, kept under constant review and reflected the care that was provided.
Relatives told us people had been able to choose where to spend their final days of life. One relative said "It was his wish to stay at home in his own bed. Without the hospice at home team we could not have made this happen. Another relative said "Mum had never been in hospital. Hospice at home meant she never had to be." A thank you card read "Her request was to be at home and you made that possible, for which I am eternally grateful."
Feedback about the service patients and their families received was also very good. Relatives described staff and the care as "Brilliant", "Amazing" and "Faultless". One relative told us "The help and kindness they showed was incredible, and the care they provided in the last few hours made a difficult time more bearable for us all."
Relatives said that they appreciated the seamless approach offered when more than one healthcare professional was caring for the person. One person said "At one stage we had several staff in the house at the same time. However, this did not matter. They all worked so well together so he received the best care. The Rowcroft staff just blended into the team and just knew what needed to be done."
We spoke to three health care professionals who we also very complimentary about the service. A district nurse said "They are all so very professional and knowledgeable.
District nurses told us the care records kept were their responsibility but that any entries made by hospice at home staff were written to a very high standard. We saw that the nursing staff also entered a summary of the care they had provided on the computerised system used by the hospice. However we saw that information regarding a person's culture, faith or sexual orientation was not always recorded.
Relatives said they felt safe when Rowcroft Hospice at Home staff were in their home. One relative said "I just felt reassured by their presence." Another relative said "They (staff) were dignified, respectful and caring. They never left her bedside, making sure she was comfortable. They supported us through the hardest time of our life."
Relatives knew there were formal ways of making complaints or sharing concerns but all of those asked said they could not envisage the occasion arising such was the high level of genuine and good care from the staff.
All comments received from bereaved relatives and healthcare professionals were positive and reflected an opinion that the staff were knowledgeable, professional and kind. Staff had access to mandatory and additional training programmes, and received formal and informal supervision and support in their roles.
There were recruitment processes in place which meant that only staff who have had robust pre employment checks undertaken before they were able to work with vulnerable people.
Patients and relatives knew how to complain and were given opportunities to provide feedback about the care they had received. Effective systems, audits and checks were also in place to continually monitor the quality of the service provided.
All patients and relatives we spoke with were all very complimentary about the staff and the care they received. Staff and volunteers said it was a supportive and good place to work.
General comments from patients and visitors included, ' Tip Top', 'Can't fault it', 'Beautiful setting, 'Rowcroft is just brilliant ' invaluable to us', 'The volunteers are lovely and like all the staff so respectful'.
Patients appreciated the care given to them and their families and were complimentary about how respectful the care was provided. One relative told us that the staff had been 'fantastic' when their partner had been cared for. They went on to say 'Staff really listened to us both and treated the whole family with great care.'
Staff were good at recognising the different needs each person had, which included spiritual, emotional and social care needs. Patients and relatives appreciated the complimentary therapies offered.
Without exception patients were full of praise for the choice, flavour, quality and presentation of the food. Some said that if choices on the daily menu were not to their liking they could choose something else. Patients also appreciated the pre lunch drinks trolley with a wide variety of alcoholic beverages and non-alcoholic items.
Patients knew what to do if they were unhappy about any aspect of the care they received. Patients thought the Hospice was well maintained and very clean.
Patients and their families were encouraged to give feedback either informally or formally using the survey left at the patients' bedside.