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Inspection Summary


Overall summary & rating

Good

Updated 3 February 2015

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Our inspection was unannounced which meant the service and staff did not know we were visiting.

The Douglas Macmillan Hospice provides care and treatment to people using the 28 bedded inpatient unit, three community led beds, the hospice at home service, the domiciliary care service and outpatient clinics. People may also receive support from the hospice's ambulance transport service and a telephone advice line. All these services provide specialist palliative and end of life care to people with progressive, advanced disease and a limited life expectancy. The hospice also runs a day therapy unit that provides a service for up to 25 people per day. This service falls outside of our regulatory role, therefore we did not include this in our inspection.

At the beginning of our inspection there were 26 people using the inpatient unit, three people were using the community beds, 708 people were using community and outpatient services and 37 people were using the domiciliary care services. There were 75 people using the hospice’s transport service to access the day therapy unit, and in the two weeks prior to our inspection 175 calls had been made to the telephone advice line.

Care and support was provided within the hospice environment and within people’s own homes dependent upon their care preferences and needs.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were very happy with the care. We saw that people were treated with dignity, respect and compassion. People were involved in the planning of their care which meant their care preferences and choices were identified so they could be met by the staff.

People were safe because there were effective systems in place to help manage the risks posed to people. For example procedures were in place to protect people from the risks associated with medicines and the risk of falling.

There were sufficient numbers of staff to meet people’s individual needs and keep people safe. Volunteers were innovatively used to help manage the risks posed to people and to improve the effectiveness of the care.

The staff and volunteers were trained to provide the specialist care people required. A holistic approach to care was used which meant the staff treated the whole person and their family rather than only treating the person’s medical condition. People’s health and wellbeing were closely monitored so they could receive the right care at the right time.

The staff worked closely with other professionals and services so that people received consistent care. The staff responded positively and inclusively to people’s changing needs and the diverse needs of the local population.

The staff worked with people on an individual basis to plan their end of life care. When people required end of life care, it was provided with the aim of achieving a private, dignified and pain free death.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Managers regularly assessed and monitored the quality of care by completeing audits and seeking feedback from people who used the service and the local community. The service actively engaged in project work and research to identify best practice and make improvements in care.

Inspection areas

Safe

Good

Updated 3 February 2015

The service was safe. Staff knew how to keep people safe and how to report any safety concerns. The staff had a positive approach to risk and people who used the service were involved in risk assessment and management in conjunction with the multidisciplinary team.

When people did not have the ability to make decisions about their own care the staff followed the legal requirements that ensured decisions were made in people’s best interests.

There were sufficient numbers of staff to keep people safe and the innovative use of volunteers complemented complemented the work of the staff.

Medicines were managed safely and the premises and equipment were monitored and maintained to keep people safe. Effective systems were in place to prevent and manage potential infections.

Effective

Good

Updated 3 February 2015

The service was effective. Staff and volunteers received specialist training that enabled them to provide effective care and support. The service had worked innovatively to develop and integrate the various roles of the volunteer to maximise the quality of care.

A holistic approach was used to provide effective care that met people’s needs. Staff worked closely with other professionals and services in a manner that ensured people received the right care at the right time.

The staff encouraged and supported people to eat and drink a balanced diet that met their individual needs and professional advice was sought if people’s eating and drinking deteriorated. The hospice environment met the specialist needs of the people who used the service.

Caring

Good

Updated 3 February 2015

The service was caring. People were treated with care and compassion. The staff respected people and their choices and they promoted people’s privacy and dignity.

People were involved in making decisions about their care which meant care and support was individualised.

The staff were suitably skilled to identify when people required end of life care. People were supported to receive individualised, comfortable and pain free end of life care and support. Support was also offered to the families of people who used the service both during and after end of life care.

Responsive

Outstanding

Updated 3 February 2015

The service was responsive. People were assisted to devise advanced care plans that recorded their end of life care preferences and choices. These care plans provided the staff with the information that enabled them to provide care in a manner that was responsive to people’s individual needs.

People and professionals acting on their behalf could access advice and support from the service’s twenty four hours a day.

Effective communication systems were in place that enabled information about people’s needs to be shared with the staff and other professionals that provided care and support.

The service sought feedback from the people who used the service, their families and the community to monitor and improve the quality of care.

Well-led

Good

Updated 3 February 2015

The service was well led. Effective induction and training ensured staff were suitably skilled to provide care and support in accordance with the service’s positive and inclusive values.

The staff understood their roles and responsibilities and the roles of the management team. The staff and people who used the service were empowered to share concerns about the care.

An effective management team regularly assessed and monitored quality and drove improvements. Staff worked with other agencies and used national and best practice guidance to implement improvements in care and innovative practice.