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Inspection Summary


Overall summary & rating

Good

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.

Inspection areas

Safe

Good

Updated 20 May 2016

The service was safe.

People received care from staff who were trained in safeguarding and would act to protect people from being harmed. Recruitment procedures for new employees were safe and ensured suitable staff were employed.

Any risks to people’s health and welfare were well managed. People were not on the whole assisted with medicines but qualified nurses supported them when necessary.

The service had a flexible workforce. There were always sufficient numbers of staff with the required skills and experience to meet people’s needs safely.

Effective

Good

Updated 20 May 2016

The service was effective.

People were looked after by staff who were well trained and well supported to carry out their jobs. Staff had the qualities and skills to provide compassionate care and support

Staff understood the importance of obtaining consent from people before helping them. The service was aware of the principles of the Mental Capacity Act (2005).

People were provided with support to eat and drink where this was needed and supported to see their GP and other healthcare professionals as required.

Caring

Outstanding

Updated 20 May 2016

The service was caring.

People were treated with respect and kindness and were at ease with the staff who were looking after them. The staff not only cared for the ‘service user’ but also other family members who were affected by the imminent death of a loved one.

The staff team had good relationships with people and talked respectfully about the people they looked after. They were compassionate about their role and getting the care and support right for the person and their families.

Responsive

Good

Updated 20 May 2016

The service was responsive.

People and their families received the care and support that met their specific needs. The service was adjusted to take account of any changes in people’s needs.

People were listened too and staff supported them if they had any concerns or were unhappy.

Well-led

Good

Updated 20 May 2016

The service was well led.

Feedback from people who used the service and their families was regularly gathered and used to make improvements to make the service better.

There was a good management structure in place. Staff were provided with good leadership and supported to provide the best quality care.

There was a programme of checks and audits in place to ensure that the quality of the service was measured. Any accidents, incidents or complaints were analysed to see if there was any lessons to be learnt.