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The Mary Stevens Hospice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 24 April 2020

The Mary Stevens Hospice provides specialist palliative care to adults aged 18 years and older.

The inpatient unit could provide services for up to ten patients at a time, with 24 hour nursing and medical support. Patients could be referred to the inpatient facility for symptom control, terminal care, respite care and crisis intervention.

The day services unit offered a full range of care, therapy and support services for those with life-limiting illnesses which includes medical advice and support, physiotherapy and occupational therapy, complementary therapies, recreation activities and social activities. The day service unit has capacity to accommodate up to 25 patients a day, Monday to Friday.

This was the second inspection of this service. It was previously inspected in 2016 and rated Good overall. We inspected this service using our comprehensive inspection methodology. This was an unannounced inspection (they did not know that we were coming). We carried out our inspection on the 25 and 26 February 2020.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patient’s needs were constantly assessed and identified with treatments and opportunities aligned to their needs and wishes. Patients nearing the end of their life were encouraged to think about wish lists to allow the staff and those close to fulfil those that were possible.
  • People’s individual needs and preferences were central to the delivery of tailored services. The service had innovative ways to provide integrated person-centred pathways. Services were flexible to meet patient’s needs.
  • The service took a proactive approach in understanding the needs and preferences of different groups of people and delivered care which met these needs. Staff made reasonable adjustments to meet the needs of patients, including those with protected characteristics.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and fully aligned to local plans within the wider health economy.
  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Midlands)

Inspection areas

Safe

Good

Updated 24 April 2020

Our rating of safe stayed the same. We rated it as Good because:

The service provided mandatory training in key skills to all staff and made sure everyone completed it.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.

The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank staff a full induction.

The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

The service used systems and processes to safely prescribe, administer, record and store medicines.

The service managed patient safety incidents well. Staff recognised and reported incidents and near misses.

Effective

Good

Updated 24 April 2020

Our rating of effective stayed the same.We rated it as Good because:

The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.

Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.

Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way.

Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.

The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

Staff gave patients practical support to help them live well until they died.

Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions.

Caring

Outstanding

Updated 24 April 2020

Our rating of caring improved. We rated it as Outstanding because:

Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Patients needs were constantly assessed and identified with treatments and opportunities aligned to their needs and wishes. Patients nearing the end of their life were encouraged to think about wish lists to allow the staff and those close to them to fulfil those that were possible.

Staff gave patients and those close to them help, emotional support and advice when they needed it to minimise their distress. Staff understood the emotional and social impact that a person’s care, treatment or condition had on their wellbeing and on those close to them.

Staff supported patients and those close to them to be fully involved in making decisions about their care and treatment and understanding their condition.

Responsive

Outstanding

Updated 24 April 2020

Our rating of responsive improved.We rated it as Outstanding because:

People’s individual needs and preferences were central to the delivery of tailored services. The service had innovative ways to provide integrated person-centred pathways. Services were flexible to meet patient’s needs.

The service took a proactive approach in understanding the needs and preferences of different groups of people and delivered care which met these needs. Staff made reasonable adjustments to meet the needs of patients, including those with protected characteristics.

People could access the service when they needed it in a way to suit them and received the right care promptly.

It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

Well-led

Good

Updated 24 April 2020

Our rating of well-led stayed the same.We rated it as Good because:

Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and fully aligned to local plans within the wider health economy.

Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work, and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them.

Checks on specific services

Hospice services for adults

Outstanding

Updated 24 April 2020

Services were provided from one location. We rated the service as outstanding overall as it was rated outstanding for caring and responsive and good for safe, effective and well led.