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We are carrying out checks at Prospect Hospice using our new way of inspecting services. We will publish a report when our check is complete.

Reports


Inspection carried out on 8 November 2016

During a routine inspection

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 carried out on 25 February 2014

During a routine inspection

Prospect Hospice provides dedicated end of life care and specialist palliative care services to people living in the Swindon and North East Wiltshire. At this inspection visit we looked at the in-patient services and day services. These are situated within the hospice.

The hospice was currently undergoing a programme of refurbishment to provide two lodges which families could access during their relatives stay.

People came to the in-patient unit and day services for a variety of reasons. This could be to help them with symptoms that they may have found difficult to manage. This could include sickness, pain or breathlessness. People could also access support with their emotional needs or for their family if required. We spoke with people who received a service from the hospice who told us they were happy with the quality of care and treatment provided. We were told the staff were friendly, respectful and professional.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Staff we spoke with explained that they would always seek permission before undertaking any tasks. They said they respected people’s right to refuse care if ‘they didn’t feel up to it’ but would always check if they required support later.

We found clinical and non-clinical areas were clean and tidy and free from odours. Patients we spoke with and their relatives said they had no concerns about hygiene standards within the hospice. There was personal protective equipment, such as gloves and aprons available for the use of staff.

Policies and procedures that were followed by staff promoted the safe obtaining, storage administration and disposal of people’s medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff we spoke with told us they felt supported and could raise any concerns. They said that managers had an ‘open door’ policy which meant that they could seek guidance and support as needed.

Inspection carried out on 28 January 2013

During a routine inspection

We met with six service users; four visitors and five staff. All of the service users and their visitors were unanimous in their praise of the quality of care they received and the way that staff cared for them.

One person said that their care was "spot on" and that staff were "fantastic". Another person said that "nothing was too much trouble" for the staff.

Service users and their visitors told us that they felt involved in their care and that they were provided with information to enable them to make informed decisions and choices.

We saw that staff from all disciplines took pride in their work and noted that the hospice was clean; welcoming and well maintained. Service users told us that their rooms were cleaned daily. We saw catering staff offering choices to people and we were told that their meals were "beautifully presented" and also of a high quality.

People receiving care told us they felt that staff treated them with respect and kindness and we observed staff talking to people in a friendly and professional way. One of the service users was having some banter with one of the staff and that demonstrated that staff had been able to engage with people and build up a rapport with them.

People told us that they felt safe within the hospice and staff told us that they were able to identify and discuss any concerns they had in relation to safeguarding.

We saw that there were effective systems in place to evaluate care and treatment.

Inspection carried out on 29 December 2011

During a routine inspection

A person who was using the hospice for the first time told us they had been reluctant to go there but that the experience was positive. They told us their ”health had improved due to the confidence they had in the service”. They said it had been a "marvellous experience".

The person told us how the hospice had been instrumental in arranging for specialist furniture to assist them when they returned home and how this had meant they were able to return home for Christmas.

Another person said that the hospice staff had helped resolve issues with their diet and that this had an overall effect on their well being. We saw that there were choices available for lunch and people told us how they had been given other options.

People said they were admitted for pain management and treatment was successful.

We saw the accommodation and how spacious the rooms were. One of the people told us how staff had arranged for their spouse to stay in their room overnight.

People told us about the welfare benefits advice they had been given and how this was very much appreciated.

Both of the people we spoke with told us they would return to the hospice whenever they needed.

A member of staff told us they “liked being able to give so much” they said they “liked contact with people and saw many positives in their work including seeing people achieve their goals”. They also told us they had learnt so much from the dignity and respect shown to people”. Another staff member said they felt supported by their colleagues and the management and was confident that if they needed help they would receive it. A further member of staff told us about completing statutory training and attending various study days recently.

Relatives told us how they intended to “give something back to the hospice” by fundraising or volunteering.

Reports under our old system of regulation (including those from before CQC was created)