St Michael's Hospice Hastings and Rother

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.

Staff told us that they worked closely as team, and that all decisions made about care were fully discussed with the patient, family and multi-agency team. One staff member said 'It's a really great place to work.' Another said 'We have a really good team of staff and the volunteers are a valuable support to our patients.'

We found that patients felt fully involved in their care and treatment, that all aspects of care, both medical and therapeutic were documented and agreed to.

We saw that patients were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Improvements made to patients' personal records including medical records had ensured they were accurate and fit for purpose.

Staff told us that they work closely as team, and that all decisions made about care were fully discussed with the patient, family and multi-agency team. One staff member said 'It's a rewarding job.' Another said 'We have a really good team of staff and our volunteers are brilliant.'

We found that patients felt fully involved in their care and treatment and that all aspects of care, both medical and therapeutic were discussed and agreed to. Care and treatment was delivered in a way that ensured patients safety and welfare. The care plans however did not have a person centred approach and did not fully reflect patients individual needs.

The hospice was clean, hygienic and comfortable. We saw that staff used gloves and aprons appropriately to promote infection control practices.

Patients who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Patients were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.