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Inspection carried out on 7 and 8 April 2015

During a routine inspection

We undertook this unannounced inspection on the 7 and 8 April 2015. The last full inspection took place on 10 January 2014 and the registered provider was compliant in all the areas we inspected.

Dove House Hospice is situated in a residential part of Hull and provides supportive and palliative care services. The service can provide in-patient care to a maximum of 21 adults and has a day care unit providing therapy for up to 25 people, three times a week; there is also an outpatient clinic. The inpatient unit has five single bedrooms and four bays each of which accommodate four beds and would reflect single sex occupancy. All the bedrooms and bays have doors leading directly into the gardens and patios. There is a range of bathrooms, communal rooms and therapy facilities to meet the needs of people who use the service. On the first day of the inspection there were 12 people using the service as inpatients. Other people were admitted over the two days of the inspection.

The service has recently undergone a building extension. This included the addition of two family suites, outdoor weatherproof spaces, enhanced therapy assessment and treatment areas, new rehabilitation and gym facilities and a new and improved day therapy unit. Beds were increased on the inpatient side to accommodate an additional 14 people. Two of these new bedrooms were for people living with dementia who also had need of palliative care and support. These 14 bedrooms had not been registered with the Care Quality Commission yet and were not in use at present.

The service has a registered manager. 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.

We found staff mostly managed medicines safely and encouraged people to take their medicines independently when this was possible and safe. We found some staff had not always followed the hospice’s policy for recording medicines.

Risk assessments were completed and staff knew what to do to minimise risk in order to protect people and maintain their wellbeing. Some risk assessments had not been updated when people’s needs changed.

We found the environment was safe and had been designed to meet the specific needs of people who used the service. Systems were in place to enhance security of the building.

Staff were recruited in a safe way and full employment checks were completed before they started work in the service. There were sufficient staff on duty to meet the range of care, support and treatment needs of people who used the service. Staff were well trained and had supervision and support systems in place to ensure their practice was monitored and they were able to develop skills and knowledge. We saw staff had completed safeguarding training and knew what to do to keep people safe from abuse or harm. There were policies and procedures for additional information and guidance.

We found people’s health care and nutritional needs were met. There were plenty of choices for meals and fluids and dietetic advice was obtained when required. The service had creative ways to alert staff when people required additional monitoring regarding their nutritional intake.

When people were assessed as lacking capacity to make decisions about their care and treatment, best interest meetings were held with relevant people to discuss options. Assessments and care plans were produced to provide staff with guidance in how to provide care and treatment which met their preferences.

We observed staff provided care and treatment to people who used the service in a kind, compassionate and professional way. People told us staff couldn’t be better, were empathetic and were caring towards them. There was a range of complementary therapies and activities to stimulate people and promote their wellbeing. There were support systems in place for bereaved relatives.

We observed the culture of the organisation was one of openness and sound values based on putting the people who used the service at the centre of what they provided. There was a quality monitoring system to enable checks of the service provided to people and to ensure they were able to express their views so improvements could be made.

Inspection carried out on 10 January 2014

During a routine inspection

Patients� views and opinions were taken into account about the care they received. The provider sought the views of the patients, their relatives and staff about how the service was run. A relative we spoke with was positive about the staff. They told us, �The staff are really kind and caring, they attend quickly if we press the buzzer and they are always happy to help� and �I really don�t know what we would have done without them.�

A varied and nutritious diet was provided for patients and visitors. A relative we spoke with told us, �My wife is really enjoying the food and it�s making her feel a bit better�, �We can eat in the room or we can go to the canteen, it�s all really nice, it�s just like home cooking.� And �You really can�t fault it there�s always plenty of choice.�

The location was clean warm and free from any offensive odours. All areas were well maintained. One relative told us, �This place is a God send, much better than being in hospital; I can spend time with my wife� and �Our children stayed as well over Christmas and we all had Christmas day together.�

The provider�s recruitment and selection procedures ensured patients were not exposed to staff who should not be working with vulnerable people. These also ensured correctly trained were employed to meet the needs of the patients.

Inspection carried out on 5 February 2013

During a routine inspection

We saw that the provider had held best interest meetings for their patients. Best interest meetings were held when a patient lacked the capacity to make an informed decision. We saw evidence that the meetings were attended by the patient�s Independent Mental Capacity Advocate.

The hospice employed a team of healthcare professionals, including consultants and social workers. A second year registrar told us that �Everyone�s opinion is heard, it�s fantastic how many professionals are involved with every patients care.�

The hospice had a number of policies in place to safeguard the patients who used the service from abuse. Amongst others, reporting of serious malpractice and abuse, safeguarding children, prevention of bullying and protection of vulnerable adults.

Appropriate arrangements were in place for the safe ordering, dispensing and disposal of medication.

We noted the hospice had a complaints procedure and an anonymous complaints policy. Two formal complaints were received in 2012; we saw that the complaints had been investigated and the findings had been shared in the clinical forum meeting, using each complaint as a learning opportunity.

We spoke with the Caldicott Guardian who explained there role in relation to record keeping �I am the conscience of the organisation, to protect patients confidential information�, �I work in partnership with the Senior Information and Records Officer whose role is the security of information.�

Inspection carried out on 16 November 2011

During a routine inspection

During our visit to the service we spent our time in the In-Patient unit. We spoke with two people being cared for. We did not speak with as many people as we would have liked because of the circumstances of the people being cared for there, on the day we visited.

Those people we spoke with only provided positive comments about the service. These included �The care is absolutely brilliant. The staff, can�t do enough. Nothing is too much trouble.� And �They (the staff) are always smiling�.

Another person explained that they had quite complex care needs when they first arrived and �The care staff coped with me really well.� They added �Staff are vey kind and attentive. And the standard of care day and night is the same too. It�s a fantastic place.�

One person commented �Staff absolutely treat you with respect and dignity. �They knock on your door before they come in and make sure you are covered when helping you.�

People also spoke positively about other aspects of the service. One person said they had expected lots of people to be dying, when they came in, but it wasn�t like that at all. They said there was �A really happy atmosphere.� People commented about the lovely meals and the different places they could go with their visitors, like the lounges, gardens and caf�.

They also commented on the �Fantastic support� provided by the hospice. One person told us of the craft therapy, music therapy and aromatherapy. They added �There�s always things going on.� These support systems have a positive impact on people�s emotional wellbeing and provide distraction and relaxation.

Reports under our old system of regulation (including those from before CQC was created)