Hospice of St. Mary of Furness

Updated 9 August 2016

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 planned 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.

The inspection took place on 31 May and 2 June 2016 and was unannounced. This meant the provider or staff did not know about our inspection visit. It was carried out by an adult social care inspector and a pharmacy inspector. The last inspection for this service had been in February 2014 and there had been no concerns.

We spent time during the two days speaking with people who used the services, their relatives and the staff in various parts of the hospice service. We spoke with four people using the hospice in patient services, one using the hospice at home and three relatives. We looked in detail at the care records and plans for four people. We looked in detail at the medication management and administration records and the risk assessments in place to see how care was being planned with people and delivered. We looked at records relating to the ordering, management, use and storage of medicines. We looked at the staff rotas, recruitment files, staff training and supervision records and records relating to the maintenance and the management of the premises and the equipment in use. We looked at records that related to how the home was being managed and how service quality and effectiveness was being monitored. We attended an inpatient unit staff meeting and also the clinical leads meeting that was focusing on risk registers.

On the days we inspected we spoke with four members of nursing staff, the inpatient/hospice at home sister, the hospice at home coordinator, four health care assistants, a nurse practitioner, the hospice chaplain, the Deputy Chairperson of the Trustees who was a retired senior nurse, the senior speciality doctor and the Head of Clinical Services (who was the accountable officer) and the Head of Administration and Finance. The accountable officer is the person who has a legal responsibility to ensure that controlled drugs (drugs liable to misuse) are properly managed. During the inspection we contacted external health care professionals by email to seek their views on the care and service received. We also received email comments from three people who had used or come into contact with the hospice services who wanted to share their views and experiences with CQC.

Before the inspection, the provider returned a Provider Information Return (PIR). This form asks the provider to give us key information about the service, what the service does well and any improvements they planned. The registered manager had completed this in considerable detail.

We reviewed information we held about the service including statutory notifications sent by the registered manager about incidents and events that the service must send to us by law. No concerns about the service had been raised with CQC. We used this information to decide which areas to focus on and to help plan the inspection.

Updated 9 August 2016

The inspection took place on 31 May and 2 June 2016 and was unannounced. At our last inspection the registered provider was meeting all the regulations that were assessed.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run.

The Hospice of St Mary of Furness is registered to provide specialist palliative care, advice and clinical support for adults with palliative care needs, life limiting illness and also their families. The hospice delivers physical, emotional, spiritual and social holistic care through teams of nurses, doctors, counsellors, a chaplaincy/ spiritual care team and complimentary therapists. The hospice worked with the palliative care consultant for the local NHS Trust to try to make sure the team provided seamless holistic care. The service provides care for people through an In-Patient Unit, a Day Service, and Hospice at Home. The hospice also offered a 24 hour telephone advice line for people and their carers to request help if there was a need for it.

The inpatient facility accommodated up to nine people and they were all within individual rooms. At the time of the inspection there were seven people using this service. The hospice at home service provided specialist advice with regards to symptom control and worked in partnership with health and social care professionals to ensure that people and carers received the best possible support whilst the person remained at home.

The Hospice of St Mary of Furness is located in a residential area of the market town of Ulverston. It is an older detached stone building with modern extensions to accommodate patients in individual rooms. The hospice has undergone substantial external and internal refurbishment to extend and improve facilities. The addition of an orangery has provided a place where patients and their carers and family can spend time together; staff can also use the orangery as a place to relax. Although built on a hillside, the hospice has level access for those with impaired mobility. The internal refurbishment has provided improved assisted bathing and showering facilities for patients and facilities for carers and family have also been improved.

People told us they felt safe while receiving services from the staff team and that “I have total confidence in the staff; they’re all highly skilled and know their jobs". We found during the inspection that the people using the hospice services were placed at its centre and were treated very much as individuals and with respect and compassion. People and their relatives told us that staff understood their specific needs. A person who had used the service told us “I certainly felt well rested after my stay and would recommend the Hospice to anyone”. We were also told "I am so at ease here" and how coming into the hospice was like "Being amongst friends".

Care plans in regard to all aspects of people’s medical, emotional and spiritual needs were personalised and written in partnership with people so their preferences were made clear. Staff delivered support to people respecting these wishes and preferences about their care and life choices. The catering team spent time with people to make sure the food and drink provided to people was of a high standard and that people could choose what to eat and drink whenever they wished to. We were told, “The food is absolutely excellent, better than a five star hotel and beautifully presented".

We saw staffing numbers and skills mix were planned to respond to changing needs and provide a high standard of care and to keep people safe. There were experienced palliative care nurses, health care assistants and nurse practitioners working on the inpatient unit to provide appropriate palliative and end of life care and support to people. There was a high level of expertise in the way people’s symptoms were managed and clinical care was delivered. People told us that their pain was well managed and also that they received the support and understanding to deal with the emotional impact of their illness. We saw people who used the service were protected by the provider’s thorough recruitment policy and practices.

A wide range of educational development programmes, meetings and educational support was provided to staff and management at the hospice and to external organisations to help develop their end of life care. All staff had access to person and professional development and training courses relevant to their different roles. Training and education programme was also available to all managers and those in leadership roles working in the hospice . We were told that the focus the training programmes for the coming year was upon developing and maintaining a positive culture and promoting leadership in services in order to “shine a light on forward progression”. The overall goal for the year being of having an “outstanding place of work as well as an outstanding place of care”.

The management and staff team undertook work in the local community to raise awareness and understanding of end of life care and to encourage health awareness. Strong relationships had been developed with local healthcare services and community groups so people received any specialist or individual support they required. This included care and treatment planning to make sure it was inclusive to meet the diverse and changing care needs of the local population. This also helped people to receive seamless care and treatment through shared working and knowledge.

Great emphasis was placed on promoting and ensuring dignity, respect and supporting the aspirations and wishes of the person who was receiving care. Staff and volunteers working for the hospice had been 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 to make sure people were protected from harm.

A pharmacist inspector looked at the way medicines were prescribed and managed at the hospice. We found that patients were protected from the risks associated with medicines because medicines were used safely and were thoroughly monitored for safe use and effectiveness. The governance arrangements around the management of medicines including controlled drugs was thorough and consistently good..

The registered manager and staff we spoke with understood and were clear about their responsibilities to people around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care. 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 sure any decisions taken were in their best interests.

The management team were highly visible and demonstrated strong shared values and a desire to learn about, develop and implement best practice throughout the service. There was a strong organisational and governance structure and all the people we spoke with who worked for or volunteered in the hospice were clear about their roles and their responsibilities toward the people using the service.

Feedback from people using the service, health and social care professionals and visitors was entirely positive. Staff took pride in their work, job satisfaction was high and continuous learning and development for all staff was addressed comprehensively by the registered provider, leading to positive outcomes for people using the service.