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Inspection carried out on 18 February 2016

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 18 August 2015 and a breach of legal requirements was found. After the comprehensive inspection the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Lindsey Lodge Hospice on our website at www.cqc.org.uk

We undertook this inspection on 18 February 2016. The inspection was announced. When we had previously inspected this service on 18 August 2015 it was rated requires improvement overall, with a requires improvement rating in two domains; 'safe and well-led.' We had issued a requirement notice for shortfalls found in the medicine management at the service, which was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found that the registered manager had made improvements to the auditing and medicine management within the service which ensured that the shortfalls we had previously found had been addressed.

Lindsey Lodge is a purpose built hospice that provides inpatient care and treatment for a maximum of 10 people who have a life limiting condition. The service can also provide day care support for up to 14 people each day. Accommodation is provided on the ground floor with all rooms having good access to gardens and patio areas. En-suite and communal bathrooms with shower and assisted bathing facilities are provided, some with overhead hoist facilities to help meet people's mobility needs. There are two shared occupancy rooms which can be opened up to create a four bedded unit. This area can be changed to make two large bedrooms where family can stay close to their relative. There is a separate out-patient suite with craft rooms, communal areas and therapy rooms. Separate family accommodation has been recently built which is available for use; these facilities include are en-suites with televisions and tea making equipment. During our inspection there were people being cared for on

the in-patient unit and the out-patient clinic was open for people to use. Car parking facilities are provided with disabled parking by all entrances.There are local amenities, shops, a pub and garage nearby.

The service has a registered manager in place. 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 hospice director is the registered manager of this service.

We found improvements had been made in regard to the ordering of medicines, storage and monitoring of the temperature of the medicine storage room and fridge. Stock levels of medicines were monitored by staff and the management team. The medicine policy and procedure had been reviewed and had been rewritten to ensure it provided robust guidance for all staff in all areas of medicine management. We did not speak with people using the service directly about their medicines because the issues relating to medicine management that we had found at our last inspection on 18 August 2015 did not directly affect patient care or their symptom control.

We found that the registered provider and registered manager had been proactive and developed improvements to the quality monitoring systems within the service which were effective at highlighting any issues. Action plans were put in place which helped to monitor, maintain or improve the service which was provided to people.

Inspection carried out on 18 August 2015

During a routine inspection

We undertook this unannounced inspection on 18 August 2015. At our last inspection which took place on 2 January 2014 we found the service was compliant with the regulations that we inspected.

Lindsey Lodge is a purpose built hospice that provides inpatient care and treatment for a maximum of 10 people who have a life limiting condition. The service can also provide day care support for up to 14 people each day. Accommodation is provided on the ground floor with all rooms having good access to gardens and patio areas. En suite and communal bathrooms with shower and assisted bathing facilities are provided, some with overhead hoist facilities to help meet people needs. There are two shared occupancy rooms which can be opened up to create a four bedded unit this area can be changed to make two large bedrooms where family can stay close to their relative. There is a separate outpatient suite with craft rooms, communal areas and therapy rooms. Separate family accommodation has been built recently which is available for use; these facilities are en suite with televisions and tea making equipment. During our inspection there were three people being cared for on the in-patient unit and the out-patient clinic was supporting up to fourteen people. Car parking facilities are provided with disabled parking by the entrances to the in-patient and out-patient facilities. There are local amenities, shops, a pub and garage nearby.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The hospice director was also the registered manager of this service.

People were looked after by staff who understood they had a duty to protect people from harm and abuse. Staff knew how to report abuse and said they would raise issues with the registered manager who would report these to the local authority.

Staff knew people’s needs well and were aware of risks to their health and wellbeing. This ensured staff were able to support people effectively. People were encouraged to make decisions about their care. Where people were not able to do this, staff worked within the guidance of the Mental Capacity Act 2005 to ensure decisions were made in the people’s best interests and that the least restrictive options were in place. Family representatives were involved in this process to make sure people’s rights were protected.

Training was provided to staff in a variety of subjects which included the specific needs of people with life limiting conditions and the care people needed to receive at the end of their life. This ensured effective care was delivered and helped to maintain and develop the staff’s skills.

Recruitment processes in place were thorough. Staffing levels provided were flexible and were increased if the service was busy with multiple people who needed end of life care. Skilled and knowledgeable staff were available to support people and their relations and friends at this time.

Medication systems in place required improving in some areas. The issues we found did not directly affect patient care or their symptom control. We found the registered provider was in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the registered provider to take at the end of this report.

People’s food and fluid intake was monitored to make sure their nutritional needs were met. They were provided with home cooked food. Those who required prompting or support to eat and drink were assisted by patient and attentive staff. Advice was gained from relevant health care professionals to maintain people’s dietary needs and hydration.

Health care professionals supporting the service were available to give staff help and advice at any time. Staff followed medical instructions and used their professional skills to support people and keep them comfortable.

People were supported by kind, caring and empathetic staff. People’s privacy and dignity was respected. Staff supported people effectively and were able to give them information about their care and condition. Staff were skilled at supporting people, their family and visitors; they saw this as essential to ensure holistic care was provided to each person who used the service.

People’s wishes for their end of life care were documented and were followed by the staff. Family members were offered a place on a bereavement support course which staff from the service provided over a period of a few weeks. This helped people to express their grief and feelings and gain professional help and support at this time.

The service was clean and infection control policies and procedures were in place. There was a member of staff who took the lead for infection control to ensure staff maintained a high standard of cleanliness. The building was well maintained, door wedges in use in none patient areas were removed on the day of our inspection to help maintain fire safety at the service.

There was a complaints procedure in place which was displayed in reception. Complaints received were investigated and people were informed of the outcome of the complaint. Issues raised were dealt with in a timely way.

People and their relatives were asked for their opinions about the service provided. The quality of the service was audited and the registered manager and head of departments took on board any feedback they received to improve it. A new clinical lead was about to commence work at the hospice. The registered manager told us this was an exciting time because they would then be able to develop the service further once this person was in post.

Inspection carried out on 2 January 2014

During a routine inspection

Patients told us staff asked for their consent prior to delivering care and treatment. Comments included, “They ask if it’s ok for me to have a shower” and “They always ask if it’s alright to take bloods.” We found staff completed assessments of capacity and held best interest meetings when people were assessed as unable to make their own decisions.

Patients told us they enjoyed the meals provided and were offered choices and alternatives. Comments included, “I think the food is alright; I can’t think of any improvements” and “They are brilliant in the kitchen and patients get whatever they fancy.” We found patient’s nutritional needs were met.

Medicines were managed safely and staff ensured patients received their medicines on time and as prescribed.

We found staff had access to a range of training relevant to their role. They were supported by senior staff and had annual appraisals. Comment included, “Management support is good. You can go to them with anything and they will take time out to sort out the problem.”

We found the service had a complaints policy and procedure, which was available in each bedroom. Patients told us they would feel able to make complaints if required.

Inspection carried out on 19 November 2012

During a routine inspection

People told us they were treated with respect and with dignity by the staff team. They said treatment options were explained to them and they were provided with relevant information. People told us they were able to make choices about meals, therapies and their care and treatment. Comments included, “I look forward to coming every week”, “They treat you as a person and you are accepted” and “They explained all the options before admission.”

People told us their health care needs were met within the service. They said they had access to a range of therapies. We found that assessments and care plans were produced to guide staff in how to support people. We found that the care plans could be more personalised.

We found that staff had completed training and were knowledgeable about how to safeguard people from the risk of harm and abuse.

People told us the service was always kept clean and tidy. We found the service was spacious, warm, clean and suitable for its intended purpose.

People told us the staff team were friendly and caring. They told us they answered call bells quickly and had time to sit and talk to them. Comments included, “All the staff came and introduced themselves and they keep coming in for a chat. It’s so completely different to what I expected” and “The staff are really good."

We found that people were asked their views about the service and results of audits had led to changes in practice.

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