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Inspection Summary

Overall summary & rating


Updated 20 January 2017

This inspection took place on 8 and 9 November 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available.

Prospect Hospice’s principal activities were to provide timely and responsive care and support for people living with and dying from advanced and progressive life limiting illnesses. The 16-bed in-patient facility provided respite care, symptom control and care at the very end of life. There was a range of day services offering therapeutic and social opportunities for out-patients, including complementary and creative therapies. The Prospect at Home service provided practical support and nursing care up to 24 hours a day, in people’s own home. Their clinical nurse specialist service provided advice, support and information for people at home and in local care homes, plus supported end of care life at the local hospital in Swindon.

A consultant-led medical team provided care across the range of the hospice services. Rehabilitation services included physiotherapy, occupational therapy and dietary advice through a dietician employed by the local hospital. The family support team worked with people and their families and offered bereavement services including welfare advice, drop-in sessions, carer’s cafes and a carers’ course.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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.

People who used the hospice services were safe. All staff received safeguarding adults and children training and would know what to do if there were any concerns about a person’s welfare. Nurses and health care assistants were trained how to use moving and handling equipment safely. All risks to people’s health and welfare were assessed and then well managed, in order to reduce or eliminate, that risk. Safe recruitment procedures were used to ensure that only suitable staff were employed. Medicines were well managed. This meant the service had the appropriate steps in place to protect people from being harmed and to keep them safe.

People were safe because the staffing levels were sufficient to meet their needs. The staffing levels in the in-patient unit and the day hospice were determined by the number of people being looked after and their care and support needs. The Prospect at Home service had a flexible workforce in order to be able to accommodate demand. This part of the service was already recruiting additional staff because of the increase in referrals from people who wanted to be supported to die in their own home.

All staff had a programme of mandatory training to complete. This enabled them to carry out their roles and responsibilities. New staff completed a robust induction training programme and there was a programme of refresher training for the rest of the staff. Staff received palliative and end of life training and had the necessary skills and qualities to provide compassionate and caring support to people and their relatives.

People were supported to make their own choices and decisions where possible. Staff understood the principles of the Mental Capacity Act (2005) and key staff understood the Deprivation of Liberty Safeguards and how this affected their service. Where people lacked the capacity to make decisions because of their condition or were unconscious staff worked within assumed consent but checked with healthcare professionals and relatives before providing care and support.

People were provided with a nutritious meal or food they liked or were able to eat, when they were an in-patient or attending the day hospice. They were provided with the assistance they needed to eat and drink where this was required. Those people supported by the prospect at home service were assisted with eating and drinking but staff were not expected to prepare meals. The staff from each of the hospice services worked collaboratively with hospital staff, district nurses and the person’s GP when needed.

People said staff were very kind and caring towards them and respectful of their views. People were involved in having a say about how they were looked after, listened to and assisted promptly when they needed help. End of life care wishes were documented and staff were passionate about supporting people to die in their preferred place of care. Relatives were also well looked after and all feedback we received before and after the inspection was overwhelmingly positive. Families were provided with post-bereavement support where this was identified as needed.

People were provided with a service where their specific needs were at the heart of how this was delivered. People were included in decision making about the support they, and their relatives needed. The Prospect at Home team worked in partnership with the district nurses and had good channels of communication to ensure significant information was reported and changes in people’s health was reported.

The service was well led with a strong senior management team. All staff had a passion for providing a quality service and ensured people received a good and safe service. For those people who were at the end of their life they strived to ensure that person had a good death. Where things did not go as well as expected, they looked at the reasons why and made adjustments accordingly. There was a continual programme of review to drive forward improvements.

People’s views and opinions were at the heart of the service provision. Feedback was gathered from people using the in-patient unit, the day hospice and the Prospect at Home service. All feedback that the service received was used to drive improvements and took account of the fact there was an increasing trend for people to be looked after in their own homes.

The service worked with other care service providers to educate and teach their care workers to provide good end of life care, sharing their expertise with others. This meant people could then remain with the care and support services they were used to but still receive good end of life support.

The service had systems in place to ensure it remained safe, effective, caring, responsive and well-led.

Inspection areas



Updated 20 January 2017

The service was safe.

Staff looked after people safely and were aware of their responsibilities to safeguard them from harm. Recruitment procedures for new staff were safe and ensured suitable staff were employed.

Risks to people’s health and welfare were well managed. People were assisted with their medicines by qualified and competent nurses.

The service had sufficient staff to meet people’s needs and a flexible workforce for the Prospect at Home team. This enabled the service to be able to respond to referrals promptly and to expand to meet any increasing demand for support.



Updated 20 January 2017

The service was effective.

People were looked after by staff who were well trained and supported to do their jobs effectively. They had the right qualities and skills, to provide compassionate care and support.

Staff understood the importance of obtaining consent from people before helping them. Staff were aware of the principles of the Mental Capacity Act (2005).

People were assisted to eat and drink safely and there was good communication with the GP’s, district nurses and other healthcare professionals.



Updated 20 January 2017

The service was caring.

People using each of the services were treated with respect and kindness. People were supported to express their views about their care. They were involved in making decisions about their care, support and treatment. The service also cared for relatives and family members.

The staff team had good relationships with people and talked respectfully about the people they looked after.



Updated 20 January 2017

The service was responsive.

People received the care and support that met their specific needs and relatives were supported. The service was adjusted to take account of any changes in people’s needs.

People were listened too and their views were seen as important. Feedback was used to drive forwards improvements.



Updated 20 January 2017

The service was well led.

The service promoted a positive culture that was open, inclusive and empowering. People and families remained at the heart of their work.

Feedback from people who used the service and their relatives was regularly gathered and used to make improvements to make the service better.

There was a clear management structure in place. There was a programme of checks and audits in place to ensure that the quality of the service was monitored. Any accidents, incidents or complaints were analysed to see if there were any lessons to be learnt.

Checks on specific services

Hospice services for adults

Updated 19 November 2018

Prospect Hospice inpatient

unit provides respite care,

symptom control and end of life care for up to 16 adults.

We found that the provider

had not made improvements to the service at sufficient pace, in response to the

warning notice we served on them in March 2018.

There had been insufficient

scrutiny and challenge from leaders and this was compounded by the absence of

some key managers.

There was a lack of

managerial and board level oversight of patient safety and quality.

This was demonstrated by

our incidental findings, which represented potential safety risks. These

included delayed patient risk assessments, poor infection control practice and

ineffective systems for reporting and learning from incidents.