Longfield

Updated 20 May 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.

The inspection was announced and was undertaken by two inspectors and an expert by experience. An expert by experience is a person who has used this type of service in the past. The previous inspection of Longfields was in December 2013. There were no breaches of the legal requirements at that time.

Prior to the inspection we looked at the information we had about the service. This included notifications that had been submitted by the service. Notifications are information about specific important events the service is legally required to report to us. We reviewed the Provider Information Record (PIR). The PIR was information given to us by the provider. This is a form that asks the provider to give some key information about the service, tells us what the service does well and the improvements they plan to make.

We contacted four health or social care professionals and asked them to tell us about their views of the service. Their comments have been included in the body of the report.

During our inspection we spoke with 17 people who were using the day therapy service and five relatives who had previously been supported by the Hospice at Home team. We spoke with 18 members of staff plus the registered manager and the Chief Executive.

We looked at four people’s electronic care records. We looked at six staff employment records, training records, policies and procedures, audits, quality assurance reports and minutes of meetings.

Updated 20 May 2016

This inspection took place on 10 and 11 March 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available. The Hospice at Home service provided short-term care for people with a rapidly deteriorating condition in the last three months of life. The service supports people in their own homes, or the place where they live and works in conjunction with GPs and community based nurses.

The service also runs a day therapy service, an outpatient service and a counselling service for people who have life limiting or life threatening conditions. These services do not come within the scope of registration with the Care Quality Commission. We have however spoken with some people using the day therapy service in order to gain a broad view of “people’s experience of using Longfield”. Longfield is a purpose built facility, has a pleasant and relaxing atmosphere and surrounded by beautifully maintained gardens.

There was 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.

At the time of the inspection the hospice at home team were supporting seven people. They have at times helped up to 25 people at the same time. The criteria for receiving this service was the person was in the last three months of their life. The average length of time people received support from the hospice at home team was seven days in 2014/15. Health and social care professionals referred people to the service for support and the district nurses were the key workers. Hospice at home staff worked in partnership with the district nurses.

People who used the service were safe. This was because the nurses and healthcare assistants were trained on how to safely use any moving and handling equipment and had received safeguarding adults and children training. Risks to people’s health and welfare were well managed. Safe recruitment procedures were followed to ensure that only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.

People were safe because the staffing levels were sufficient. The service offered to support people at the end of their lives only when there was sufficient staff available to meet their needs. The service had a flexible workforce in order to be able to accommodate demand for the service.

All staff completed a programme of essential training to enable them to carry out their roles and responsibilities. New staff completed an induction training programme and there was a programme of refresher training for the rest of the staff. Staff received palliative and end of life training and had the necessary skills and qualities to provide compassionate and caring support to people and their families. Bereavement follow-up is an opt-out service. They automatically follow up all families and carers of people who have died and been supported by Longfield .

People were supported to make their own choices and decisions where possible. Staff understood the principles of the Mental Capacity Act (2005). Where people lacked the capacity to make decisions because of their condition or were unconscious they worked within assumed consent but checked with healthcare professionals and family members before providing care and support.

Where identified as a care need people were provided with the assistance they needed to eat and drink. Staff liaised with the district nurses and the person’s GP when needed. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

Because of the nature of the work the hospice at home team undertook the staff team developed good working relationships with the people they were looking after and their families. These working relationships were short but intense. Staff were well supported emotionally by their colleagues and managers.

People were provided with a personalised service that met their own individual needs. People were included in decision making about the support they, and their family needed. The hospice at home staff worked in partnership with the district nurses and ensured important records they kept about peoples care was shared between all agencies. Communication between nurses, healthcare assistants and the office ensured that significant information was reported and changes in people’s health was reported.

The service was well led with dedicated, compassionate and experienced good leaders and managers. All staff had a passion for providing a quality service and ensuring people had a good death. Where things did not go as well as expected, they looked at the reasons why and made adjustments accordingly. There was a continual programme of review to drive forward improvements.

People’s views and opinions were at the heart of the service provision. There was a variety of means of gathering feedback from people who used the service about how they felt about the service. All feedback that the service received was used to drive improvements. The service used a “You said….We did” approach to any critical comments made.

Longfield (the whole hospice service) worked in partnership with other care providers and also helped other care services attain the Gold Standards Framework in End of Life Care. This partnership arrangement enabled the service to share good practice with other care providers and improve standards for people who were at the end of their lives.

The service had a regular programme of audits in place but this was being expanded to align to the fundamental standards, the five key question areas and the key lines of enquiry.