Archived: The Martlets Hospice

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 their meal times. Staff knew about and provided for people’s dietary preferences, restrictions and reduced appetite.

People’s feedback was actively sought and acted on. People and relatives were very positive about the quality of service they received. They told us they were very satisfied about the staff approach and about how their care and treatment was delivered.

Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people’s individual communication needs and treated them with genuine kindness and respect.

Staff approach was kind, compassionate and pro-active. They often went beyond the scope of their duties to meet people and their families’ needs. People’s testimonies included, “Anything big or small they will do it for you” and, “Being here has been an enjoyable experience for me even in these circumstances because the staff are so fantastic”. A relative said, “There are no adequate words to describe how wonderful all the staff are in this place, they have become our friends in times of great need.”

Clear information about the service, the facilities, and how to complain was provided to people and visitors. People’s privacy was respected and people were assisted in a way that respected their dignity. Staff sought and respected people’s consent or refusal before they supported them.

The registered manager was open and transparent in their approach. They held a vision for the service that included, “Helping our patients make the most of whatever time they have left; providing person-centred care.” They told us, “We are all very passionate about ensuring everyone has a dignified death, has their wishes respected and their families are well supported through the process.”

Comprehensive audits were carried out about every aspect of the service to identify how it could improve. When needs for improvement were identified, remedial action was taken to improve the quality of the service and care. The service worked in partnership with other organisations to drive improvements.

We found that patients were supported to have adequate nutrition and hydration. Patients said that there was a good choice of food available and if they wanted something individual it was provided for them quickly and with the minimal of fuss. When we asked patients to describe the meals they told us they found the choice and quality to a good standard. One patient told us "The food is good and I can ask if I want a small, medium or large portion which is really good.'

We found that patients received treatment and care that met their individual needs from polite, knowledgeable and professional staff. We spoke with six patients who were very positive about their experiences of care and treatment at the hospice. The comments we received included 'The staff are very efficient here and you couldn't wish for anything better" and 'They are wonderful and explain everything to me very gently.'

The provider had systems in place to gain and review consent from patients. Patients told us that they were involved in their treatment and care and asked for their consent. They said that staff took time to ensure that they were fully aware of their treatment and care options.

There were procedures for receiving, handling, considering and responding to comments and complaints. Patients told us that they knew how to raise concerns and were confident that these would be listened to and acted upon.

People were very complimentary about how staff cared for them and the services provided at the hospice. When we asked people what they thought of the food they told us that the comprehensive menu suited most people's taste, and that if someone wanted or fancied something different it was never a problem. One patient told us how staff had produced a cake and scones for her to celebrate her birthday with visiting friends, and how special they had made her day.

We took the opportunity to talk with visiting relatives who were keen to tell us they found staff kind, knowledgeable and supportive. They told us how staff treated their mother with 'dignity, compassion and tenderness'. One relative said that she found the standard of care 'absolutely outstanding' and was 'overwhelmed at how staff were so dedicated in looking after her mum'. We asked people if they had felt involved in the care of their relative and they told us that staff always went the extra mile to explain what was happening.