• Hospice service

North Devon Hospice

Overall: Good read more about inspection ratings

Deer Park, Newport, Barnstaple, Devon, EX32 0HU (01271) 344248

Provided and run by:
North Devon Hospice

Important: We are carrying out a review of quality at North Devon Hospice. We will publish a report when our review is complete. Find out more about our inspection reports.

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Background to this inspection

Updated 13 October 2017

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 was 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 inspection was announced and undertaken by two adult social care inspectors and an expert by experience. An expert by experience is a person who has been involved in this type of service in the past. The previous inspection of North Devon Hospice was completed in January 2016. There were no breaches of the legal requirements at that time; however, there were two areas where improvements were required to be made. These were in respect of some aspects to do with the management of medicines and the consistency of the catering arrangements.

Prior to the inspection we looked at the information we had about the service. This included notifications that had been submitted by the service. Notifications are information about specific important events the service is legally required to report to us. We reviewed the Provider Information Record (PIR). The PIR was information given to us by the provider. This is a form that asks the provider to give some key information about the service, tells us what the service does well and the improvements they planned to make.

During our inspection we spoke with six people who were using hospice services and five relatives. We spoke with 18 members of staff including the chief executive officer, the director of care and registered manager, medical staff, qualified nurses, health care assistants, heads of departments and one volunteer.

We looked at paper and electronic care records for three of the five people in the bedded unit, policies and procedures, quality audits, quality assurance reports and minutes of meetings.

Overall inspection

Good

Updated 13 October 2017

This inspection took place on 17and 18 July 2017 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available.

The North Devon Hospice at Deer Park in Barnstaple provides a seven bed in-patient unit (called the bedded unit), a team of community nurse specialists (CNS), a range of day services and support groups and a hospice to home team. Deer Park is situated on the hillside above Barnstaple, has beautiful views and is surrounded by well-kept landscaped gardens. The area of North Devon covers 1000 squares miles of mainly rural countryside. They work closely with community hospital facilities and the local NHS Trust.

The hospice has an outreach centre in Holsworthy, known as The Long House. This opened in September 2015 and was a specially designed building in order to aid people’s sense of well-being. From here people can see their CNS, complementary therapist and attend therapeutic support groups. This addition of this outreach centre meant that people from the lower half of the North Devon area did not have to make long journeys up to Barnstable for their care, treatment and support.

Hospice services were provided for adults over the age of 18, with life-limiting illnesses and advanced progressive conditions. At the time of this inspection 80% of services were provided to people with a cancer diagnosis and 20% were to people with non cancer illnesses. Non cancer illnesses include motor neurone disease and other degenerative neurological conditions, pulmonary and cardiac disease.

Where people’s preferred place of care was their own home they were supported by the hospice to home team, the CNS and the local community district nurses. The hospice to home team helped people to stay at home longer or to die in their own home. The service also offered respite for family carers.

The staff team included the following: doctors, nurses, health care assistants, physiotherapist, occupational and complementary therapists, counsellors and volunteers. The various services provided by the hospice worked in conjunction with people’s own GP’s, 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. The director of care was the registered manager.

At the time of the inspection the bedded unit were looking after five people and the hospice to home team were providing support to about 20 people living in their own homes.

Both parts of the service provided end of life care in the last couple of weeks or during a time when they needed care and treatment for symptom control or help during an emotional or physical crisis. The service looked after people with a cancer diagnosis (80%) and non-cancer patients (20%) but the service aimed to increase the numbers of people they were able to support with non cancer conditions. From the bedded unit 20% of people were able to go home after a short stay and may return at a later date and 80% would die in the hospice. The hospice to home service was mainly provided for people nearing the very end of their life, however they may also support people and their families during a crisis.

The service was safe. All staff received safeguarding adults 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. Recruitment procedures were robust and ensured that only suitable staff were employed.

Training was undertaken by all staff who assisted people to move from one place to another including the use of equipment. Staff were trained how to use equipment correctly. Any risks to people’s health and welfare were identified during the assessment of care needs and were then well managed. The service had the appropriate procedures in place to protect people from being harmed.

Staffing numbers in the bedded unit were determined by the number of people who were receiving care and support and the complexity of their needs. The hospice to 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.

The service was effective. There was a programme of mandatory training for all staff to complete and this prepared them for their job role. New staff had a comprehensive induction training programme to complete at the start of their employment and all other staff had a programme of refresher training. Additional training was arranged regarding clinical skills. This ensured the staff team had the required skills and qualities to provide a compassionate and caring service to people and their families.

People’s capacity to make decisions was continually 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 the Deprivation of Liberty Safeguards (DoLS). Staff ensured consent was given prior to providing any care and support but worked within best interest principles where people could not provide this. 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 bedded unit were provided with a well-balanced and nutritious diet. They were able to choose what they wanted to eat. There was a guide menu however alternatives were always prepared to meet people’s individual needs and preferences. Significant improvements had been made to the catering services since the last inspection. People were also given the choice of when they wanted to eat their meals; there was no set meal time. 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. The hospice to home service received referrals from the district nurses, GPs or clinical nurse specialists. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

The service was very caring. All the staff teams had the necessary qualities and skills to provide sensitive and compassionate care and support to the people they were looking after. This care and support also extended to the person’s family and friends. It was evident the staff developed close working relationships with the people they looked after and their families. The staff went out of their way to meet people’s dying wishes and told us about several examples of how they had made a difference to the last few days/weeks of people’s lives. For example, they had arranged a third birthday party for a child whose mother was at the very end of their life and had arranged a Jamaican ‘sights and sounds’ experience for a Jamaican person who was dying. There were many examples of the staff going the extra mile and providing a person-centred service to each person and their family.

People received person centred care and as they moved between the different hospice services, the hospital and their GP, communication was coordinated. The hospice service provided ongoing bereavement support to families, adults and children for as long as was necessary. The service also referred families on to other relevant services where needed. All staff who worked for the hospice were emotionally well supported by their colleagues and the managers, evidencing this is a very caring service.

The service was responsive. The care and support needs for each person whether they were being looked after in the bedded unit, in their own home or attending for a treatment/counselling were provided with person-centred care. Regular reviews of people’s needs ensured their care plans were revised as often as necessary. People were always involved in making decisions about their care. The hospice to home team ensured that family carers were always supported in a way that was most beneficial to them.

The service was well led. There was a robust leadership and management structure in place and all the teams of different staff were passionate about providing a high quality service that was safe, effective, caring and met people’s needs. The measures in place to assess the quality and safety of the service ensured that when shortfalls were identified, that improvement actions were taken. Analysis of any events such as accidents, incidents and complaints meant any trends were identified and enabled the service to make changes and prevent a reoccurrence. There was a continual programme of audits in place to drive forward any service improvements needed.

Feedback from people and their families was used to measure how people felt about the care and support they received. This feedback was used to drive forward any improvements or to make changes to the service provided. One example was the provision of various support groups rather day hospice services.