North Devon Hospice

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed safe systems; safe environments; safe and effective staffing and medicines optimisation quality statements for the safe key question. The service managed safety well. The inpatient unit used a tool that measured the acuity of its service users to ensure that the unit was adequately staffed and only admitted patients when it was safe to do so. There was continuity of care provided by the community nursing team. The design of the environment followed national safety guidance. The inpatient unit had been recently refurbished and was designed with input from both patient and staff groups and provided an outstanding environment for its service users. It had all the necessary clinical equipment but the rooms were designed so that these did not impact on the feel of the room which was comfortable and calming. The service had safe staffing levels and skill mix, however the service was working to improve its compliance with mandatory training. The service provided support and supervision to its staff base. Medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happened.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service worked well with partners such as the local trust, GP’s, the ICB and district nursing teams. For example, there were daily capacity meetings which included representation from both the provider and the hospital palliative care service. This meeting discussed new referrals, out of hours messages, discharges and deaths as well as requests for admissions to the in-patient unit. There was also a weekly Multidisciplinary Team Meeting which looked at complex community cases in more detail and discussed care plans for patients.

Patients and their families we spoke with confirmed they saw the same people for their care and they were reliable, knowledgeable and caring. The views of people who used the service, partners and staff are listened to and taken into account. This was evident in the re-design of the inpatient unit.

The service managed safety well. The inpatient unit used a tool that measured the acuity of its service users to ensure that the unit was adequately staffed and only admitted patients when it was safe to do so.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

The design of the environment followed national guidance for safety. The in-patient unit had been recently refurbished and was designed with input from both patient and staff groups and provided an outstanding environment for its service users. It had all the necessary clinical equipment but the rooms were designed so that this did not impact on the feel of the room which was comfortable and calming. All equipment we checked for safety was appropriately tested and within the timescale for the next checks. The majority of the in-patient rooms had balconies overlooking the garden which provided the service users and their friends and family with the opportunity to get some fresh air.

Staff and patients and family members we spoke with said they were able to obtain appropriate equipment for patients both at home and in the in-patient setting. The service had recently purchased a 'cuddle bed' which staff said were fantastic for when family members such as husbands and children wished to spend time being close to their loved ones. These were normal size beds which could extend to accommodate an additional person. Staff members said that this was really important for the emotional well-being of their patients.

There was enough qualified, skilled and experienced staff however the service was trying to improve its compliance with mandatory training in order to reach its organisational target of 80%. As at October 2023 there were 20 mandatory training subjects and for its registered professional staff the service was above 80% for 9 of these subjects. The service had an action plan in place since January 2023 to improve its compliance with completion of work books for mandatory training, in particular dysphagia management and human rights in end of life care. There were robust and safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their roles. Staff received the support they needed to deliver safe care which included supervision, appraisals and support to develop their skills. There was a clear performance management system. The service was actively recruiting to its care-side vacancies and was in the process of increasing its staffing establishment numbers which will result in an additional staff member on each night shift and on each weekday early or middle shift.

Staff said they worked together to ensure they provided safe care that met people's individual needs. The service was actively recruiting to its care-side vacancies to meet its establishment levels. The in-patient unit was in also in the process of increasing its staffing establishment which will result in an additional member of staff on each night shift as well as an additional member of staff on each weekday early or mid-afternoon shift.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were regular audits and monitoring of clinical incidents.

The service had clear processes for medicine management. Oxygen cylinders were stored safely.

Medicines and treatments were safe and met people’s needs, capacities and preferences. Patients and family members said they were involved with their treatment plans and were kept informed about any changes in medication.