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Inspection Summary


Overall summary & rating

Good

Updated 19 February 2016

The Martlets Hospice is a local charity that provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families in the Brighton, Hove and Havens area.

They deliver physical, emotional and holistic care through teams of doctors, nurses, counsellors, chaplains and other professionals including therapists and social workers. The service cares for people in two types of settings: at the hospice in an 18 beds ‘In-Patient Unit’, or in their ‘Hospice at Home’ service where a team of nurses and nursing auxiliaries offer specialist, short term end of life nursing care for people in the comfort of their own home. In addition, The Martlets Day Services provide therapeutic support for patients and their carers who are living at home, and aim to maximise their independence and quality of life. Services are free to people and the Martlets Hospice is largely dependent on donations and fund-raising by volunteers in the community.

This inspection was carried out on 21 and 22 December 2015 by three inspectors and two pharmacist inspectors. 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. The registered manager was also the director of clinical services and oversaw the running of the service. They were part of a leadership team that included a chief executive officer, a medical director, a director of human resources, a finance director and an income generation director.

The services provided include counselling and bereavement support; outpatient clinics; occupational therapy, physiotherapy, chaplaincy and volunteer services that include approximately 500 volunteers.

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.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people according to their individual plans.

The environment was well designed, welcoming, well maintained and suited people’s needs.

Staff had received essential training including end of life care and were scheduled for refresher courses. Staff had received further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and an annual appraisal. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed th

Inspection areas

Safe

Good

Updated 19 February 2016

The service was safe.

Staff were trained to protect people from abuse and harm and knew how to refer to the local authority if they had any concerns.

Risk assessments were centred on the needs of the individuals and there were sufficient staff on duty to meet people’s needs safely.

Practices regarding the storage and administration of medicines were in line with current controlled drug legislation.

Robust and safe recruitment procedures were followed in practice.

The environment was secure and well maintained.

Effective

Good

Updated 19 February 2016

The service was effective.

Staff were trained appropriately and had a good knowledge of each person and of how to meet their specific support needs.

The registered manager understood when an application for DoLS should be made and how to submit one. Staff were trained in the principles of the MCA and the DoLS and were knowledgeable about the requirements of the legislation.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of suitable food and drink.

People were referred to healthcare professionals promptly when needed.

Caring

Outstanding

Updated 19 February 2016

The service was very caring. People’s feedback about the caring approach of the service and staff was overwhelmingly positive . They told us, “This is an outstanding place to be, absolutely exceptional staff” and, “The care is second to none, the staff go the extra mile as a matter of course”.

Staff showed kindness and knew how to convey their empathy when people faced challenging situations. People valued their relationship with the staff team who often performed beyond the scope of their duties and pre-empted people’s emotional needs.

The service was very flexible and responded quickly to people’s changing needs or wishes. Staff communicated effectively with people and treated them with utmost kindness, compassion and respect.

People were consulted about and fully involved in their care and treatment. The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death.

Responsive

Good

Updated 19 February 2016

The service was responsive to people’s individual needs.

People’s care was personalised to reflect their wishes and what was important to them. Care plans and risk assessments were reviewed and updated when needs changed. The delivery of care was in line with people’s care plans.

The service sought feedback from people and their representatives about the overall quality of the service. People’s views were listened to and acted on.

Well-led

Good

Updated 19 February 2016

The service was well-led by a management team who placed people and staff at the heart of the service. There was an open and positive culture which focussed on people.

The staff told us they felt supported and valued under the registered manager’s leadership.

There was a robust system of quality assurance in place. Comprehensive audits were carried out to identify where improvements could be made and action was taken promptly as a result.