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Inspection report

Date of Inspection: 7 July 2011
Date of Publication: 30 September 2011
Inspection Report published 30 September 2011 PDF | 39.75 KB

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Meeting this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 07/07/2011, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services.

Our judgement

Arrangements in place ensure that people benefit from safe quality care, treatment and support.

User experience

People told us that staff consult them about their needs. They told us they have a weekly meeting to talk about their care and health needs.

Other evidence

When we visited the manager was on a day’s annual leave. We were assisted by the senior nurse who facilitated our visit with competence. We were impressed by the professionalism of all the staff we came into contact with.

Staff told us “This is the best place I have ever worked” and “The door of X is always open if you need to talk something through”.

Weekly meetings take place with each individual to review their care and ensure the hospice is meeting their needs.

There is an infection control committee and regular audits are done to ensure any risks to people are minimised. The hospice was clean when we visited and there were hand washing facilities well sited and accessible to staff to ensure that they practice good standards of hygiene.

There is a complaints policy and procedure in place and we were told that the hospice have not received any complaints.

There is an information booklet that is given to people and their relatives. This was in the process of being updated and we were told CQC contact details were to be amended so people would know how to contact us if they need to.

Meetings are held at board level, with the senior management team and regular staff meetings take place. This ensures good communication systems are in place.

We saw that health and safety audits are completed and we looked at some of these for water, wheelchairs and fire. We saw that an emergency plan was under development. This ensures a safe and well kept environment is maintained to ensure people’s safety.