We inspected Nottinghamshire Hospice on 28 November 2016. The inspection was unannounced.
The hospice provides care and support for people with life limiting conditions and those who are nearing the end of their lives. The provider operates a day therapy centre which can support up to 35 people each day and a hospice at home service. The hospice at home service can provide support from nurses and healthcare assistants across a 24 hour period within the county of Nottinghamshire. The hospice also provides a range of therapies and counselling and bereavement services. These services are available to people who use other hospice services and their family members and loved ones.
There was an experienced registered manager in post at the time of the inspection. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People and their family members spoke highly of the compassionate and personalised nature of the hospice services. They praised staff for their warm and attentive approaches to care and support. They told us staff were knowledgeable and skilled and this inspired confidence in the services.
The emotional and social impact of life limiting conditions and palliative care was fully recognised by service managers and taken into account when planning and developing hospice services. The commitment to providing a holistic service for people and their family members was central to the organisation’s vision.
People were at the heart of the service. They were fully involved in developing and reviewing their own care packages. Family members and those who were important to them were also consulted. Care plans were personalised and took account of people’s preferences and wishes, including those related to the end of their lives.
People’s consent was sought before any part of their care package was delivered by staff. Staff were aware of how to provide support for those people who were not able to give their consent, either by following the wishes and decisions they had set out in advanced care planning discussions or by following the guidance of the Mental Capacity Act, 2005 (MCA). This meant that people’s rights were protected.
People were protected by robust systems to manage their health, safety and welfare. Staff followed detailed risk management plans when providing care and support. They demonstrated a clear understanding of how to recognise and report any situation that may put people at risk, including those situations which may be abusive in nature. Medicines were managed in a safe way and people received all of the healthcare and nutritional support they needed.
There were effective systems in place to recruit, train and support staff. This included volunteers. This meant that there were enough suitably skilled staff to provide the support and care people wanted and needed.
Strong leadership and effective management systems promoted a culture of continuous improvement, openness and inclusiveness. Learning from mistakes and listening and responding to people’s views was embedded in this culture. A programme of audits designed to monitor the quality of services supported this approach. This meant that people would benefit from services that were flexible, responsive and could be tailored to their needs.