25 April 2017
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 carried out 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.
This inspection was carried out on 20 and 21 February 2017 and was unannounced. The inspection team consisted of three inspectors, one pharmacist inspectors and an expert by experience. The expert by experience who supported this inspection had experience in palliative care.
The registered manager had completed a Provider Information Return (PIR) at the time of our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. Before our inspection we looked at the information provided in the PIR; records that were sent to us by the provider, the registered manager and the local authority to inform us of significant changes and events; the provider’s action plan; and our previous inspection reports.
We made a tour of the premises and equipment. We looked at ten sets of records that related to people’s care and examined people’s medicines charts. This included people’s assessments of needs and care plans and observations to check that their care and treatment was delivered consistently with these records. We consulted documentation that related to staff recruitment, training and management, maintenance and safety of the premises, and records relevant to the storage, ordering and administration of medicines. We looked at checks that were carried out concerning the monitoring of the safety and quality of the service. We observed a multi-disciplinary meeting and the administration of medicines. We sampled the services’ policies and procedures.
We spoke with the chief executive officer (CEO), the registered manager, the head of the Inpatient Unit (IPU), the palliative care consultant, the human resource manager, the head of the Outpatient Centre, the head of Community Outreach Team, the family support manager, and the head of retail. We spoke with a dementia nurse specialist, three nurses, three healthcare assistants (HCAs), the maintenance manager, the chef, and a member of the housekeeping team.
We consulted three people who stayed in the IPU, four of their relatives, two visitors including a member of the ‘patient and carer engagement group’ and five volunteers. We also spoke with three people who attended Outpatient Centre, and three people who received support in their own home from the community team. We contacted two GPs who referred people to the service, three external specialist nurses, and a lead specialist who visited the service regularly to help staff manage acute and chronic conditions associated with Cancer. We obtained their feedback.
25 April 2017
The Heart of Kent Hospice is a local charity that provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families in the Maidstone, Aylesford, Tonbridge and Malling area. They deliver physical, emotional and holistic care through a multi-disciplinary team that includes doctors, nurses, physiotherapist, occupational therapist, volunteer complementary therapist, counsellors, a welfare advisor and administrative, catering and housekeeping staff. The service is supported by approximately 600 volunteers. Services are free to people and the Heart of Kent Hospice is largely dependent on donations and fund-raising by volunteers in the community.
The service cares for people in two types of settings: at the hospice in a 10 beds ‘Inpatient Unit’, or in their own home with the support of a community palliative care team. In addition, the Heart of Kent Hospice provides an Outpatient Centre, ‘Magnolia Place’, which is open three days a week, where people can access advice, support, and take part in individual and group therapeutic activities. A weekly Drop-in Centre and a dementia café provide an environment where people and their families can receive support from the team as well as talk to others facing a similar situation.
At our last inspection on February 2016, we issued three requirement notices in relation to three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that care and treatment was not provided in a safe way for people; medicines were not properly and safely managed; documentation regarding staff training, advance care planning, people's individual likes and dislikes, complaints logs and recruitment was not appropriately completed; systems and processes were not established and operating effectively to ensure compliance; there was a lack of staff competency checks; and staff did not receive appropriate support, training, supervision as is necessary to enable them to carry out their duties. 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 February 2017 and that new systems would be embedded and sustained over time. They kept us informed of their progress.
This inspection was carried out on 20 and 21 February 2017 to follow up on compliance with these notices. At this inspection we found that the registered provider had met the requirements detailed in the requirement notices and had made significant improvements to the culture of the service and the care people received. At the time of our inspection, six people resided in the Inpatient Unit and 575 people were open to the community palliative care team, 170 of whom lived with dementia.
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.
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.
There were sufficient staff on duty to meet people’s needs across the service. New recruitment systems were embedded in practice and ensured relevant checks and records were appropriately completed.
Improvements had been made in regard to the secure storage of medicine, competency checks for nursing staff and records of administration of medicine. People received medicines that were appropriately stored, documented and administered by competent staff.
People could be confident that staff had been appropriately trained. Essential mandatory training was provided and the monitoring of staff training had been improved. A new system to monitor all staff training had been implemented and embedded in practice. All members of care 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.
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 community. Staff delivered care and support to people according to their individual plans.
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 in accordance with 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 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 individual communication needs and treated them with genuine kindness and respect.
Staff were outstandingly caring. Staff approach was kind, compassionate and pro-active; they were skilled at giving people the information and explanations they needed in a sensitive manner. They often went beyond the scope of their duties to meet people and their families’ needs.
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.
People and relatives told us they were extremely satisfied about the staff approach and about how care and treatment was delivered. They described the way staff responded to their needs in emphatic terms. Dementia care was provided by the service as an innovative response to the increase of dementia in the community.
The service responded to the community’s need for information on palliative care, aiming to take the stigma out of hospice care. People’s feedback was sought, valued and acted on.
A new robust quality assurance system was implemented and embedded in practice. A range of audits and checks were carried out throughout the service to identify how the service could improve and action was planned and taken as a result.