Hospice in The Weald is a local charity covering a catchment area in West Kent and East Sussex that provide palliative and end of life care, advice and clinical support for adults with life limiting illness and their families and carers. They deliver physical, emotional and holistic care through teams of nurses, doctors, counsellors, chaplains and other professionals including therapists. The service cares for people in three types of settings: at the hospice in a 15 beds ‘In-Patient Unit’ plus up to two people in the day procedures room, or in their ‘Hospice Day Service’ that welcomes approximately 120 persons per week, and in people’s own homes through their ‘Hospice in the Home’ service that supports approximately 700 people. The service provides specialist advice and input, symptom control and liaison with healthcare professionals. This includes a training centre and offering advice and support to staff in nursing and residential care settings in the community, receiving up to 130 palliative care referrals per month. Services are free to people and the Hospice in the Weald is largely dependent on donations and fund-raising by volunteers in the community.
The services provided include counselling and bereavement support; a Lymphoedema service (for people who experience swellings and inflammations); an outpatient clinic; occupational and creative therapy, physiotherapy, chaplaincy and volunteer services that include approximately a thousand volunteers.
This inspection was carried out on 12 and 13 October 2015 by two inspectors, a 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. The registered manager was also the Nursing Director for the service. They oversaw the running of the service and were supported by a leadership team that included a chief executive officer (the provider) and five directors.
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.
Some practices regarding the administration of medicines were not in line with current controlled drug legislation. We have made recommendations about this.
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 communication needs.
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 and support service staff received regular one to one or group supervision. 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. Staff communicated effectively with people, responded to their needs promptly, and treated them with genuine kindness and respect.
People’s feedback was actively sought, encouraged and acted on. People and relatives were overwhelmingly positive about the service they received. They told us they were extremely satisfied about the staff approach and about how their care and treatment was delivered. Staff approach was kind, compassionate and pro-active. Relatives told us, “All the staff here are extraordinary, nothing is too much trouble, they have great empathy and genuinely care for people” and, “I trust them with my life and I trust them with my death; they understand how I feel, they know what I need, they truly care about what they do.”
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.
Staff pre-empted and responded to people’s individual needs and requirements. People and their relatives told us that the way staff responded to their needs was “Outstanding” and “So personalised”. They said, “The nurses, doctors, and indeed all the staff are marked by kindness, compassion, and a deep sensitivity to your needs; nothing is too much trouble”.
People were involved in the planning of activities that responded to their individual needs. A broad range of activities was available that included creative ways to keep people occupied, engaged and stimulated. Varied outings were available and attention was paid to people’s individual social and psychological needs.
The registered manager was open and transparent in their approach. They held a vision for the service that included “Providing the best care possible ‘with and not to’ patients, families and carers.” Staff told us they felt valued and inspired by the registered manager to provide a high quality service. They described him as “Passionate about care”. The management team had launched a pioneering project to provide ‘cottage hospice care’ to people in the community.
Relatives’ comments about the management of the service were extremely complimentary. A comment included, “The Hospice in the Weald has an unsurpassed reputation for excellence; it is extremely well managed by managers who care.”
Emphasis was placed on continuous improvement of the service. 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 at national level.