Treetops Hospice

Updated 9 June 2016

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 is 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.

This inspection took place on 6 and 7 April 2016 and was unannounced.

The inspection was carried out by one inspector, a member of the CQC pharmacy team and a specialist professional advisor. The specialist advisor had experience working as a nurse within the community and within the field of palliative care.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR was completed and returned to the Care Quality Commission. We found the information in the PIR was an accurate assessment of how the service operated.

We sent out questionnaires to people who use the service, their relatives and community professionals and staff seeking their views about the service.

We also reviewed the information the provider had sent to us which included notifications of significant events that affect the health and safety of people who used the service.

We spoke with two people who were accessing the day care facility who used or had used the hospice at home service. The registered manager arranged for us to speak with people who used the hospice at home service or their relatives by telephone. We spoke with one person who used the service and 9 relatives on the 8 and 11 April 2016.

We spoke with the registered manager; six nurses, the director of clinical services, the hospice at home manager, the community complementary therapy nurse and the chief executive.

We viewed twelve people’s records to see how their support was provided and recorded. We looked at a selection of medication records to check medicines were managed safely.

We also looked at the recruitment files of four members of staff, a range of policies and procedures, quality assurance and clinical audits and the minutes of meetings.

Updated 9 June 2016

This inspection took place on 6 and 7 April 2016 and was unannounced.

Treetops Hospice is registered to provide palliative care and support to people within their own home that have a life limiting illness, and includes providing a respite service for people’s relatives and carers. The aim of the hospice at home service is to enable people to remain at home as their preferred choice, to be cared for and to die at home, thus reducing unnecessary admissions to hospital. The services offered by Treetops Hospice supplement and complement existing service provision. At the time of the inspection there were 109 people using the hospice at home service. Treetops Hospice as part of its service provides counselling to people with life limiting conditions and those bereaved. And in addition provides complementary therapy and day care.

Treetops 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.

People who used the service and their relatives or carers told us they felt they received safe care from the staff employed by Treetops Hospice; which was confirmed by information gathered from questionnaires we had sent to those using the service.

The provider and staff were committed to promoting people’s safety across all levels of staff within the organisation and included, the meeting of a health and safety committee to review incidents. Policies and procedures were in place to promote the safety of its staff when working alone within the community.

Staff within the hospice at home service followed the risk assessments developed by health care professionals with primary responsibility for the provision of the persons care. Staff when visiting a person at home observed for potential risks. Where these were identified these were shared with the health care professionals who were responsible for assessing and minimising risk. So that people’s plans of care and risk assessments could be reviewed and updated.

Staff spoke positively about their induction and on-going training, which enabled them to meet people’s needs; this was confirmed by the completed questionnaires we had sent to staff. Staff had the opportunity to develop their skills through reflective practice when they met to discuss people’s care. This enabled them to further develop their understanding and awareness to improve the quality of the care they provided.

People’s physical, psychological and emotional needs were met as the provider employed sufficient staff from a range of disciplines to provide holistic care, which included the provision of the hospice at home service, day care and complementary therapies. People’s needs were regularly discussed and changes to people’s health and welfare were raised with health care professionals who had overall responsibility for managing people’s care. People we spoke with told us this was managed effectively so that information was shared amongst all those involved in their care.

The frequency of people’s support was planned by the hospice at home co-ordination team and led by a nurse with the involvement of people using the service and their relatives. The support provided was based upon people’s individual needs and took into account changes to people’s health in order that the service provided was effective.

The service supported people within the community providing psychological and practical support. People in some instances accessed the day care facility, which included complementary therapies, art therapy and social activities. People told us the day care facility enabled them to meet with people in similar circumstances and was a welcome part of their support.

People told us staff understood their individual care needs and were compassionate and understanding. Their cheerful and friendly approach meant that they viewed staff in many instances as an extension of their family or friend network. Staff told us that they undertook training which enabled them to provide good quality care, which supported a holistic approach to care.

People’s medication needs within the hospice at home service and day care were met by nurses or health care assistants employed by Treetops Hospice, who administered or supported people with the taking of their medicine where required. The support provided was consistent with their training and role within the service.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They worked collaboratively with people and other health care providers in supporting people to make informed decisions about their care.

The hospice at home service supported people with their nutritional needs where required, following the person’s care plan as written by health care professionals with the primary role of assessing and planning the person’s care.

People, friends and relatives were consistently very positive about the caring and compassionate attitude of the staff. They told us they were completely satisfied with their care. They spoke of excellent relationships with staff who understood their needs and preferences. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way.

People using the service, their relatives and carers told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. Bereavement support was available to people and their families and friends. This provided emotional and practical support to those who required it. People who used the service, their relatives and carers shared with us what the service meant to them and the very positive impact it had on their day to day lives.

People we spoke with told us that information about the services offered had been made available to them and had been useful in informing them of the range of services offered. Information about the service is made available within the wider community and the service has a presence through its shops and fundraising work.

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 provider encouraged people who used the service and their relatives to provide feedback and comment about the service in order that they could influence the service and continue to drive improvement.

The provider is open and transparent providing a range of information within the service and on its website. This included the outcome of surveys and audits undertaken and their response to improving the service. There were systems in place to enable people to make comments and ask questions about Treetops Hospice, which include completing questionnaires.

The provider, registered manager and other staff worked collaboratively with the wider health care community to review its commitment and effectiveness in providing good quality palliative and end of life care to people in their own homes.