This inspection took place on 15 March 2016 and was unannounced. Garden House Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional, spiritual and social holistic care through teams of nurses, doctors, counsellors, spiritual care team and other professionals including therapists. The service provides care for people through an ‘In-Patient Unit’, Day Service, `Out- Patient Care`, `Drop-in Service`, and `Hospice at Home`. The hospice also offered a 24hour telephone advice line for people and their family carers to request help if there was a need for it.
The inpatient facility catered for up to 12 people, accommodated within a ward or individual rooms. At the time of the inspection there were six people using this service, beds being gradually reduced for refurbishment work. Approximately 10 people received support from the ‘Hospice at Home’. The service provided specialist advice with regards to symptom control and worked in partnership with health and social care professionals to ensure that people received the best possible support.
The services provided included counselling and bereavement support, family support, chaplaincy, out-patient clinics, patient clinics, physiotherapy, complementary therapies and a lymphedema outpatient clinic (for people who experience swellings and inflammation usually to their limbs post cancer treatments).
Garden House Hospice had 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.
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 to make sure people were protected from harm.
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 respecting their wishes and preferences.
Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.
People’s physical, psychological, emotional and spiritual needs were met as the service employed sufficient staff with the appropriate skills to support those needs. People’s needs were regularly reviewed and the service responded to their changing needs. Staff provided spiritual support and complementary therapies as well as caring for people`s physical needs.
The service supported people within the community providing psychological and practical support. People from the community accessed the various clinics held in the day care facilities where staff could review their health. People told us that the day care facility enabled them to meet with people in similar circumstances and was a welcome part of the community support.
People told us that staff understood their individual care needs and were compassionate and understanding and that their cheerful and friendly approach created a welcoming and relaxed atmosphere. Staff told us they undertook training which enabled them to provide good quality care, which supported a holistic approach to care.
The staff provided meals that were in sufficient quantity and met people’s needs and choices. People and their relatives praised the food they received and they enjoyed their meal times. Staff communicated effectively with people, responded to their needs promptly, and treated them with genuine kindness and respect.
People’s medication needs both within the hospice and the community were discussed by health professionals to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.
The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.
People, their friends and relatives were consistently very positive about the caring and compassionate attitude of the staff working at the hospice. They told us they were completely satisfied with their care and thought highly about staff, volunteers and management. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected.
Staff respected people’s cultural and spiritual needs and people told us they received the religious and spiritual support they wanted and needed. Relatives told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member.
The management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. The Board of Trustees and the management team demonstrated a strong commitment to providing people and those closest to them with a safe, high quality and caring service and promoted high standards. The registered manager was committed to improve and broaden the services the hospice offered. They told us, “We need to keep up with the changing needs of our community. We are adapting our services to ensure we reach out to more people in need.”
The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.
There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.