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Inspection Summary


Overall summary & rating

Good

Updated 16 August 2017

Pilgrim Hospice Thanet is one of three hospice locations for the provider, Pilgrim Hospices in East Kent. The hospice offers specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional and holistic care through a multi-disciplinary team of doctors, nurses, occupational therapists, physiotherapist, social workers, counsellors, spiritual leaders and a range of volunteers. The location has a day centre and capacity for 18 persons in their In-patient unit (IPU). At the time of our inspection, nine people were using the service as in-patients. The community team provides services for people in their own homes and at an outreach clinic in Deal. There is a rapid response service that provides personal care to people in the community and is available the same day it is needed. The Hospice at Home service supported people in the last days when they approached end of their life. Support groups for carers are available and advice is available 24hours a day. The service was providing services to approximately 400 people in the community and in the hospice at the time of our inspection.

There was a manager 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 nursing and care services.

At our last inspection on June 2016, we found that medicines were not properly and safely managed; staff had not received the appropriate supervision to enable them to carry out their roles; we issued two requirement notices in relation to these two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the service was not always effective in protecting staff from rude and bullying behaviour. The registered provider sent an action plan to us detailing the improvements they would make. They confirmed they would be meeting the requirements of the regulations by October 2016 and that new systems would be embedded and sustained over time. They kept us informed of their progress.

This inspection was carried out on 15 and 16 June 2017 to follow up on compliance with these notices and check whether new systems were embedded in practice. At this inspection we found that the registered provider had met the requirements detailed in the requirement notices and had made significant improvements to medicines management, the support provided to staff and the culture of the service.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns in regard to people’s safety. 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.

Improvements had been made in regard to the management of medicines. People received medicines that were stored, documented, administered and disposed of appropriately by competent staff.

People received care from staff who were appropriately supported, skilled and appropriately trained. All staff received regular one to one supervision sessions to support them in their role. There were members of staff who took the lead in a speciality, offering guidance to other staff so people could be confident about staff particular expertise. There were sufficient staff on duty to meet people’s needs across the service. Robust recruitment systems ensured staff were suitable to work with people.

People were fully involved in the planning and review of their care, treatment and support while in the Inpatient Unit (IPU) and while receiving support in the communi

Inspection areas

Safe

Good

Updated 16 August 2017

The service was safe.

Practices regarding the storage, administration and management of medicines were in accordance with current legal requirements.

Consistent and robust recruitment procedures were followed in practice.

Staff knew how to recognise signs of abuse and how to raise an alert with the local authority if they had any concerns in regard to people’s safety.

Risk assessments were centred on the needs of the individuals and there were sufficient staff on duty to meet people’s needs safely.

Effective

Good

Updated 16 August 2017

The service was effective.

The system for the monitoring of staff training was effective. Essential mandatory training was provided consistently. All staff received one to one supervision to be supported in their role and were provided with opportunities to discuss issues and make suggestions about the service.

The service used a multi-disciplinary approach to meet people’s health and psycho-social needs. Staff had a good knowledge of each person and of how to meet their specific support needs.

Staff were trained in the principles of the Mental Capacity Act (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 complimentary about the quality of the food.

Caring

Good

Updated 16 August 2017

The service continued to be caring.

Staff showed kindness, compassion and knew how to convey their empathy when people faced challenging situations. They were skilled at giving people the information and explanations they needed in a sensitive manner.

Staff communicated effectively with people and treated them with respect.

People and their families when appropriate were consulted about and fully involved in their care and treatment. People were enabled to experience a comfortable, dignified and pain-free death.

Responsive

Good

Updated 16 August 2017

The service continued to be responsive to people’s individual needs.

People were fully involved in the planning of their care, treatment and support, which reflected their choices and preferences.

People‘s needs were assessed before support was provided in the community and as soon as they came into the In-patient Unit (IPU). Care plans and risk assessments were reviewed and updated when needs changed. The delivery of care was in accordance with people’s care plans and was very responsive to people's individual needs.

People’s views were listened to, valued and acted on. People and relatives' comments were very positive about how staff responded to their needs.

Well-led

Good

Updated 16 August 2017

The service was well-led.

New systems and projects had been implemented and embedded in practice to improve staff support and consultation. There was a culture that focused on people and people were placed at the heart of the service.

The staff told us they had confidence in the current management team and were very complimentary about the management team.

There were systems to maintain and monitor the quality of the service to ensure continuous improvement.