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Inspection Summary


Overall summary & rating

Outstanding

Updated 30 July 2016

We carried out an unannounced comprehensive inspection of this service on 12 and 13 October 2015, at which a breach of legal requirements was found. Although we identified shortfalls in respect of medicines, people had not experienced any negative outcomes as a result and some remedial action was taken on the day of our inspection. However we found that some aspects of monitoring processes with regard to medicines needed to be consistently embedded to ensure that improvements were sustained over time.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 11 July 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to medicines as part of the question ‘Is the service safe?’ You can read the report from our last comprehensive inspection on our website at www.cqc.org.uk.

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; an outpatient clinic; occupational and creative therapy, physiotherapy, chaplaincy and volunteer services that include approximately a thousand volunteers.

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.

At our focused inspection on 11 July 2016, we found that the provider had followed their action plan. New monitoring processes with regard to medicines had been consistently embedded in practice since October 2015 and legal requirements were met.

Inspection areas

Safe

Good

Updated 30 July 2016

The service was safe.

Practices regarding the administration of medicines were in line with current controlled drug legislation to reduce risks for people.

Improved monitoring processes in regard to medicines were consistently embedded and sustained over time. People could be confident that staff followed robust monitoring processes in regard to all aspects of their medicines to ensure their safety.

Effective

Good

Updated 27 January 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 27 January 2016

The service was very caring. People’s feedback about the caring approach of the service and staff was overwhelmingly positive and described it as, “Outstanding”, “Exceptional” and “Truly remarkable”.

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

Outstanding

Updated 27 January 2016

The service was very responsive. People’s feedback described the service as, “Outstanding” and “So personalised”.

People told us staff had outstanding skills and knowledge; they told us that staff understood and anticipated their needs which enhanced the quality of their support.

The service provided person-centred care based on best practice and focussed on continuous improvement. People’s care and support was planned and reviewed in partnership with them to reflect their individual wishes and what was important to them.

The service had creative ways to involve people and their families and stimulate their engagement through personal projects and individual activities. People’s families were encouraged to remain involved with the service for as long as they wished after their loved ones had reached the end of their life.

The service took a vital and key role in the local community. People, their families and friends were actively encouraged, enabled and supported to engage with events outside of the service.

Well-led

Good

Updated 27 January 2016

The service was consistently well-led by the leadership and management team. People described the leadership of the service as, “Truly exceptional” and, “Second to none.” The service was described as a role model for other services.

The management team promoted an open and positive culture that placed people and staff at the heart of the service. Person-centred principles were put into practice by staff. The provider and registered manager promoted strong values based on person-centred care and inspired staff to work in partnership with people.

Staff felt supported, valued and inspired under the registered manager’s leadership.

Strong emphasis was placed on continuous improvement of the service and best practice. Inventive ideas from staff had been encouraged and implemented to drive service improvements and ensure best practice.

The service worked in partnership with other organisations to ensure they followed best practice and provided a high quality service.