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Harrogate District Hospice Care Limited Good

Inspection Summary

Overall summary & rating


Updated 20 October 2015

The inspection took place on 2 July 2015 and was unannounced.

At our last inspection on 15 October 2013 the provider was meeting all the regulations that were assessed.

Harrogate District Hospice Care Limited provided care and support to more than 2,000 people every year through its hospice and community based services. Services included specialised support at home, hospice care including day therapy and inpatient care, lymphoedema management, support for families and carers, and bereavement support. They are made available to people living in the Harrogate area who are at least 18 years old and there is no charge to people using the services.

This report follows an inspection visit to the 10 bedded inpatient unit known as Saint Michael’s Hospice, which was carried out on 2 July 2015. People are referred to the hospice in agreement with their consultant or GP and may be admitted for care during the last weeks and days of their life, symptom control, assessment and / or respite care. The hospice is located in a large adapted building overlooking Crimple Valley in Harrogate. During their stay people have access to a team of health and social care professionals as well as bereavement counsellors, complementary therapists and chaplains.

There is 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 that Harrogate District Hospice Care Limited provided outstanding care. Effective leadership, management and governance systems were used along with clear strategic planning to critically assess their performance and create a culture of continual improvement, to meet the changing needs of the population.

There was a visible management presence throughout the service, which promoted the hospice vision and values and ensured consistent best practice. Feedback from people using the service, health and social care professionals and visitors was wholly positive. Everyone spoke highly of the care that they or their relative received and people said that staff were highly sensitive to their needs and were compassionate. Hospice staff were extremely proactive in finding out and meeting people’s emotional, spiritual and social needs as well as their physical needs. This meant people approaching end of life or with a life limiting conditions were actively supported to lead a full, active life. People were provided with as much information as they wanted and were encouraged to make their own decisions based on the best therapeutic options.

People spoke positively about all the staff and the catering team was singled out for particular mention. People who used the service and staff said that catering staff were always willing to make special efforts, to tempt people’s appetites with food that they might like or that had been requested. Everyone told us that the food was of an excellent quality and that mealtimes were a social occasion that everyone enjoyed.

There were examples of excellent partnership working and joint planning with commissioners and other providers, to ensure people received the best care. A joint initiative with the Harrogate Hospital Foundation Trust meant that people had the support of specialist care and advice whether they were in the hospice, in residential or nursing care, in hospital or at home. Staff were currently engaging with another care provider to review and better understand palliative care needs for people with a learning disability. This offered staff the opportunity to exchange professional ideas and promote best practice.

Volunteers were used extensively throughout the hospice and in the counselling and befriending services. Those services provided substantial practical care and emotional support during people’s illness and during bereavement. People experiencing emotional distress or poor mental health could also access counselling and support services, which operated alongside the bereavement support service. The award of a social action end of life project grant meant that the home care service was set to expand still further and thus enable people living with any terminal illness to benefit.

An extensive range of educational development programmes, meetings and support was provided to external organisations. This benefitted people living in the Harrogate district area through the dissemination of best practice and enhanced communication between partner agencies. Health and social care professionals endorsed the training they had undertaken and were positive about the benefits to their own work.

Effective management arrangements were in place to safeguard people and to promote their wellbeing. Safe recruitment practice was followed for both paid staff and volunteers, which minimised the risk of appointing someone unsuitable. All staff and volunteers received training appropriate to their role within the hospice. Staff were knowledgeable and had the right skills, knowledge and experience to provide people with safe, consistent care. Clinical supervision and counselling promoted staff self-awareness, professional accountability and emotional wellbeing, which further enhanced patient care.

There was a high level of expertise in the way people’s symptoms were managed and clinical care was delivered. Prescription charts were clear and the times medicines were administered conscientiously recorded and medicines due outside of normal medicine rounds were flagged to ensure they were not forgotten. Whilst practice issues regarding medicines management were discussed immediate action was taken once these matters were brought to the manager’s attention. The governance arrangement around the management of medicines including controlled drugs was good. Incidents including medicines errors were logged and reviewed by the manager quarterly to look for trends and to learn from what had happened.

People’s care plans gave a good overview of people’s individual needs and the assistance they required. They contained detailed information to instruct staff what action they should take to make sure people received appropriate care, treatment and specialist support. People were supported to attend healthcare appointments and hospice staff liaised with other healthcare professionals, to meet people’s holistic care needs.

A high value was placed on dignity and respect and the wishes of the person who was ill. Staff were aware of the requirements of the Mental Capacity Act (MCA) 2005 and Deprivations of Liberty safeguards (DoLS) and had applied their knowledge appropriately to ensure people’s rights and freedoms were upheld. Where people were unable to make complex decisions for themselves the service had considered the person’s capacity under the MCA and had taken action to arrange meetings to make a decision within their best interests.

Inspection areas



Updated 20 October 2015

The service was safe. Processes were in place to protect people from the risk of abuse. Staff were aware of safeguarding adults procedures.

Risks were assessed and well managed. Safe recruitment practice was followed, which minimised the risk of appointing anyone unsuitable. Volunteers who worked with people also underwent stringent interview processes and Disclosure and Barring System checks.

Staff handled people’s medicines safely and focused on effective symptom control. Issues around medicines management were dealt with promptly and efficiently.



Updated 20 October 2015

The service was effective. People received high quality, compassionate care from a dedicated, committed staff team.

Staff continually developed their skills, and focused on clinical practice and professional development, to enhance people’s care and treatment. The provision of clinical supervision counselling promoted reflective practice and emotional wellbeing in the staff team and further enhanced the provision of high quality care.

Extensive training, professional meetings and ongoing advice and support was provided to staff working in the service, volunteers and external organisations, to ensure people received excellent care based on national guidance and best practice.

People commended the catering team and the quality of the food provided. Both staff and the people who used the service told us that the catering team made special efforts and went the extra mile to tempt people with food that they might like or that they had requested. They said mealtimes were a social occasion, which everyone enjoyed.

The hospice staff liaised closely with other health and social care professionals to ensure that people received high quality care and the healthcare treatment they required.



Updated 20 October 2015

The service was caring. The feedback we received from a range of sources was entirely positive. People spoke highly about their care and they said staff were highly sensitive to their needs and were compassionate.

People’s experiences were enriched by volunteers who offered a wide range of practical support and companionship. People using the service and their families had access to bereavement counselling and befriending services, to promote their emotional and psychological wellbeing.

People living in the community could also access bereavement counselling independently of other hospice services. This service operated alongside a counselling and support service, which offered counselling, befriending, support and social groups, to support people’s emotional and psychological wellbeing in the community.

The hospice was proactive in addressing health inequalities and improving access to people living with life limiting or end of life conditions, in line with national directives. For example, the service was actively working with another provider to look at improved outcomes and access to hospice services for people with a learning disability living with palliative care needs.

People were involved in end of life planning, and their wishes were recorded and carried out. People were supported to access information through leaflets, in the supporter’s magazine and on the website. Translators were made available to people whose first language was not English to make sure they were involved in decisions about their care.

People’s privacy and dignity were respected. Visitors could visit at any time and could stay for as long as they wanted. People had access to counselling services, quiet spaces for reflection and visiting chaplains offered solace and support.



Updated 20 October 2015

The service was responsive. People’s care records were personalised to reflect their individual preferences and the support they required to meet their care needs. Care plans were used as a basis for quality, continuity of care and risk management.

People spoke positively about the service and were confident that their views and opinions would be listened to and acted upon.

People received consistent and coordinated care. Staff worked collaboratively with other palliative care providers to promote a responsive and effective delivery of services.



Updated 20 October 2015

The service was well led.

There was an experienced leadership team who communicated a clear vision and purpose about the strategic development of the service. Management systems were used to critically assess the service’s performance both regionally and nationally and drive a culture of continual improvement.

People described a confident, innovative culture with a strong focus on best practice. There was a dedicated, committed staff team that ably demonstrated the vision and values of the organisation to put local people at the heart of how care was delivered and improve the lives of people affected by terminal illness.

Effective management systems were in place to promote people’s safety and welfare. The hospice fostered good working relationships with partner organisations in order to give people access to high quality, person centred end of life care. Staff and volunteers were encouraged and supported to develop their practice to ensure people received flexible care that effectively met their care needs.