2 March 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was carried out to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection was carried out on 13 January 2017 by three inspectors, one pharmacist inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert-by-experience who took part in the inspection had specific knowledge of caring for older people who approached the end of their lives.
Before our inspection we looked at records that were sent to us by the registered manager and the local authority to inform us of significant changes and events. We also received a Provider Information Return (PIR) which the registered manager had completed prior to our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.
We looked at the premises and equipment. We looked at 12 sets of records that related to people’s care and examined three people’s medicines charts. We looked at people’s assessments of needs and care plans and checked that their care and treatment was delivered consistently with these records. We consulted documentation that related to staff recruitment, training and management, and records relevant to the storage, ordering and administration of medicines. We observed the administration of medicines. We looked at checks that were carried out in relation to the safety and quality of the service. We sampled the services’ policies and procedures.
We spoke with four people who stayed in the In-Patient Unit (IPU), six of their relatives, two visitors and three volunteers. We also spoke with relatives of four people who received support from the community palliative care service and the hospice at home service in the community.
We spoke with the provider's chief executive officer, the registered manager (who is also the community services manager), the head of clinical services, a hospice at home team leader, the day services manager, the education manager, the human resources manager, the counselling services manager, a matron who oversaw the IPU, three nurses, and five care workers.
We also spoke with two district nurses who oversaw people’s care in the community, and a home manager whose service was supported by the hospice at home team. We obtained their feedback about their experience of the service.
2 March 2017
St Michael’s Hospice Hastings and Rother is a local registered charity that provides palliative care to adults with advanced progressive life-limiting illnesses, both within the hospice and in the comfort of their homes. It aims to meet people’s physical, emotional, social and spiritual needs. Services are free to people and St Michael’s Hospice is largely dependent on donations and fund-raising by volunteers in the community to fund its operations.
The service includes a 26 bed In-Patient Unit (IPU) across three wards with 26 rooms with en-suite, a hospice at home service and clinical nurse specialist team, day services, a re-enablement and fitness service, chaplaincy and bereavement services. At the time of our inspection, there were 16 people staying in the IPU, and 61 people receiving regular support in their own homes. Another 118 people in the community were consulting the hospice’s ‘out of hours’ service for advice and guidance.
This inspection was carried out on 13 January 2017 by three inspectors, one pharmacist inspector and an expert by experience. 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.
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.
There were sufficient care staff on duty, to support and care for people in the IPU, the day services and the hospice at home service. People and staff told us there were enough staff to care in the way people needed and at times they preferred. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place to ensure suitable staff were employed to care for people.
We have made a recommendation about improving some aspects of the arrangements for managing medicines. Although remedial action has been taken on the day of our inspection, the required improvements need to be embedded in practice and sustained over time.
There was an effective system in place to ensure people remained as safe as possible from the risk of acquiring an infection. Throughout the service, fittings and equipment were regularly checked and serviced. There was a system in place to identify any repairs needed and action was taken to complete these promptly.
Staff understood how they should respond to a range of different emergencies. The hospice had worked closely with the East Sussex Fire and Rescue Service to ensure that robust fire risk assessments were in place and these were fully embedded in day to day practice.
People said they were very satisfied about the way staff gave them the care they needed. They told us, “I have never had such wonderful treatment; I get lots of attentive care and they have really good equipment.”
Staff had appropriate training and experience to support people with their individual needs. Staff were well supported in their personal developmental. They received a thorough induction, one to one supervision, an annual appraisal and training suitable for their role.
Staff knew how to communicate with each person and understood their individual needs.
Consent was sought, obtained and recorded before any aspect of people’s care and treatment was carried out.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Staff were trained in the principles of the MCA and the DoLS and were scheduled to attend further training. An appropriate template for mental capacity assessments was in use and staff knew how to consult the Local Authority if they were in any doubt about people’s mental capacity, in the service and in the community.
Staff protected people effectively from the risks of poor nutrition, dehydration, swallowing problems and other medical conditions that affected their health. People told us, “The food is marvellous.”
People were referred and signposted to appropriate services without delay in order to respond quickly to their healthcare needs. When necessary they were referred to healthcare professionals whose recommendations were acted on.
The premises had been rebuilt in part, renovated and adapted to meet people’s needs effectively. They were well designed, welcoming, well maintained and suited people’s needs.
People were proactively supported to express their views and staff were skilled at giving people face to face information and explanations they needed and the time to make decisions. Clear and comprehensive information about the service and its facilities was provided to people, relatives and visitors. The service provided emotional support for families that was continual, beyond the provision of care for people.
People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People’s care and support was planned in partnership with them. People took part in discussions with staff to express their views, preferences and wishes in regard to their care, support and treatment, and were invited to take part in ‘advance care plans’. Their views, wishes and plans were respected.
A wide range of activities was provided to stimulate people’s interests and creativity.
People were actively encouraged to give their views and raise concerns or complaints. Complaints were addressed promptly and followed up with an action plan when necessary in order to drive improvement. There was an open and positive culture which focussed on people.
There was a system in place to maintain and monitor the quality of the service across all departments, which was effective in driving continuous improvement. When needs for improvement were identified, remedial action was taken to improve the quality of the service and care. The audit system was not fully effective in identifying shortfalls and this was intended to be improved. Several policies needed to be reviewed and updated, and a need had been identified for the introduction of additional policies and procedures; the head of clinical services told us this was intended to be remedied and showed us their improvement plan which was underway.