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Inspection Summary


Overall summary & rating

Outstanding

Updated 1 July 2016

Hospiscare is a charity which was founded in 1982 as a community service which expanded to include the building of a purpose built inpatient unit in 1992. Hospiscare serves the people of Exeter, Mid and East Devon. In 1995 Hospiscare appointed a specialist nurse to work at the Royal Devon and Exeter Hospital to visit patients and provide education and this has grown to a small specialist team. Hospiscare provide palliative and end of life care, advice and clinical support for people with progressive, life limiting illnesses and their families and carers. They deliver physical, emotional and holistic care including counselling and bereavement support, outpatient clinics, occupational and creative therapy, complementary therapy, chaplaincy and volunteer services. The hospice inpatient unit at Searle House Hospice is registered to provide care for up to 12 adults who require complex symptom control or end of life care. The average length of stay is two weeks. The service provides acute care for people and does not provide a respite service or have longer stay beds. In 2006 a new visitor accommodation was opened allowing families to stay close to the ward. The majority of people are cared for in the community, currently around 770 people. Last year Hospiscare cared for 2,225 people, their families and loved ones. The service also has sister charities which provide community care for people in Exmouth, Budleigh Salterton and Sidmouth and three day centres, a Wellbeing Suite in Exeter and day centres in Tiverton and Honiton.

The service continuously looked at the local community to see how best they could provide the service. This had resulted in the expansion of day service provision and the Hospice at Home service in Seaton, East Devon. This comprised of a team of registered nurses, community nurse specialists and health care assistants working closely with local GPs. This meant that people in Seaton benefitted from a holistic service from the Hospiscare Hospice at Home team who could also provide district nursing support in people’s homes therefore maintaining consistency and reducing the number of professionals visiting their homes. The Hospiscare Hospice at Home service started in July 2015 and provides responsive end of life care and support to patients and their families in their own home or a care home. The service operates 24 hours a day, 7 days a week with access to doctors, registered nurses and health care assistants as well as ancillary staff and therapists.

The Hospice at Home staff were all employed by Hospiscare and worked with other health care professionals in the community. Services were free to people and Hospiscare was largely dependent on a large team of volunteers, donations and fund-raising. A comprehensive training centre in Exeter also offered advice and support to Hospiscare staff and external health professionals such as those in nursing and residential care settings in the community. The service had also recognised a need to provide specialist training and end of life care for people living with dementia and their carers, recently employing a specialist dementia care nurse, and had established links with the local prison service. The service was outstanding in the way they explored and maintained close partnerships with a wide range of external services providing end of life care such as other charities, community health professionals, hospitals and on-call out of hours services, agencies and care providers. The service worked in partnership with other organisations to drive improvements at national level for the benefit of people who used hospice services as a whole .

This inspection was carried out on 21, 22, 24 March and 11 April 2016 as it was a large service covering Exeter, East and Mid Devon. It was carried out by a lead inspector, a bank inspector, a pharmacist inspector, an expert by experience and a specialist advisor in palliative care. It was an unannounced inspection. There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. They oversaw the running of the service and were supported by a leadership team that included the chief executive and directors, assistant directors and department managers. The service was last inspected in November 2013 and found to be compliant in all areas inspected.

The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death in the place of their choice as much as possible.

Staff were trained appropriately and had excellent knowledge of each person and of how to meet their specific support needs. Staff went that extra mile to ensure people’s needs were met in a holistic way including support for people’s loved ones. Hospiscare were pro-active in providing support and training for external services and health professionals in the community and had a culture of sharing knowledge and education. Staff had received essential training including end of life care and were scheduled for regular refresher courses. Staff had received further training specific to the needs of the people they supported. All members of care and support service staff received regular one to one or group supervision and support with clinical supervision and professional validation. This ensured they were supported to work to the expected standards and career progression and knowledge was encouraged.

People’s feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was kind and compassionate. Relatives told us staff were very supportive and kind and nothing was too much trouble for them. People’s feedback about the caring approach of the service and staff was overwhelmingly positive and described it as “amazing.” Clear information about the service, the facilities, and how to complain or comment was provided to people and visitors and there was opportunity for people to be directly involved in providing comment and feedback linked to formal audits.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of past conduct and suitability from previous employment to ensure staff were suitable to work with vulnerable people.

Staff communicated effectively with people, responded to their needs promptly, and treated them with genuine kindness and respect. Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people’s communication needs. People and/or their families were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. One relative confirmed, “I am always informed if there’s any problem or change in the care plan.” Plans in regard to all aspects of peoples’ medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people according to their individual plans and provided outstanding care.

The environment of the inpatient unit was purpose built and had been well utilised for ease of access for people. It was welcoming, well maintained and suited people’s needs. The clinics, therapies, day centre and support groups were held in the same building in Exeter surrounded by well maintained, accessible and beautiful grounds. The building was opposite the Royal Devon and Exeter Hospital with whom they had a close relationship and the Palliative Care Hospital Team was based in Searle House.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered the requirements of the Mental Capacity Act 2005. People’s privacy was respected and people were assisted in a way that respected their dignity. Staff sought and respected people’s consent or refusal before they supported them.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences, restrictions and reduced appetite.

People were involved in the planning of activities that responded to their individual needs. The hospice mainly cared for people with acute needs meaning they were unwell or at the end of their lives. Therefore, activities in the inpatient unit were more based on therapeutic methods such as therapies and spending time with people. Day centres provided more varied and creative activities based on people’s needs such as a specialist day centre for people living with dementia. Attention was paid to people’s individual social and psychological needs.

The registered manager was open and transpa

Inspection areas

Safe

Good

Updated 1 July 2016

The service was safe.

Staff were trained to protect people from abuse and harm and knew how to refer to the local authority if they had any concerns.

Risk assessments were centred on the needs of the individuals and there were sufficient staff on duty to meet people�s needs safely.

Robust and safe recruitment procedures were followed in practice.

The environment was fit for purpose and well maintained.

Medicines were safely managed.

Effective

Outstanding

Updated 1 July 2016

The service was exceptionally effective.

Staff went that extra mile to ensure people�s needs were met in a holistic way including support for people�s loved ones.

The service took a vital and key role in the local community, for example providing training and support with a care home initiative and reaching out to minority groups such as people living with dementia and prisons to enable them to access good quality end of life care.

Staff were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation putting it into practice in a sensitive way.

People benefitted from a service which provided food and drink in an individualised way depending on people�s end of life needs.

People were referred to healthcare professionals promptly when needed. Staff worked in partnership with external health professionals, sharing end of life care expertise, to ensure processes benefitted people and supported their choices in a timely way.

Caring

Outstanding

Updated 1 July 2016

The service was very exceptionally caring.

People�s feedback about the caring approach of the service and staff was overwhelmingly positive. The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death in the place of their choice as much as possible.

Staff showed kindness and knew how to convey their empathy when people faced challenging situations. People valued their relationship with the staff

team who often performed beyond the scope of their duties to meet people�s needs.

The service was very flexible and responded quickly to people�s changing needs or wishes. Staff communicated effectively with people and treated them with utmost kindness, compassion and respect.

People were consulted about and fully involved in their care and treatment.

Responsive

Outstanding

Updated 1 July 2016

The service was exceptionally responsive.

The hospice used knowledge of the local community to continue to develop a service which best met local needs.

People told us staff had outstanding skills and knowledge. They told us that staff understood and anticipated their needs which enhanced the quality of their support.

The service provided person-centred care based on best practice and focused on continuous improvement. People�s care and support was planned and reviewed in partnership with them to reflect their individual wishes and what was important to them.

Well-led

Outstanding

Updated 1 July 2016

The service was exceptionally well led.

The provider and registered manager provided outstanding and compassionate leadership and support to ensure people needs were met.

There was an open and collaborative culture within the team who worked effectively with people, relatives, volunteers and other professionals to shape the service on offer and ensure people�s health social and wellbeing needs were met.

A committed and stable staff team showed willingness to learn from mistakes and improve because they felt supported and were well trained.

Information about the needs of the local population had been used to develop specialist support.

Strong emphasis was placed on continuous improvement of the service and best practice. Ideas from staff had been encouraged and implemented to drive service improvements and ensure best practice.

The service worked closely in partnership with other organisations and spoke nationally. It conducted research and projects to ensure best practice and to promote the future of hospice services to provide a high quality service.