North London Hospice

Updated 7 December 2016

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 planned 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 took place on 11, 13 and 17 October 2016 and was unannounced. The inspection team consisted of an inspection manager, two inspectors, pharmacist inspector, specialist nurse advisor who had palliative care knowledge and experience and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection, we asked the provider to complete a Provider Information Return [PIR]. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR had been completed comprehensively and was discussed with the registered manager during the inspection.

We also reviewed other information we held about the service which included previous inspection reports and notifications. A notification is important information events which the service is required to send us by law.

During the course of the inspection we spoke either in person or on the telephone with eight people who used the hospice services. We also spoke with seven relatives of people using the services. We spoke with the Chief Executive Officer [CEO], Chair of Trustees, 30 members of staff and four volunteers. Staff spoken with included the registered manager, medical consultant in palliative care, practice educator, assistant directors of quality, facilities manager, chef, director of patient and family support, associate director outpatients, a physiotherapist , spiritual lead, nurses, healthcare assistants and other staff including management. We contacted three external health care professionals who had contact with the hospice but at the time of completing this report had not received feedback from them.

We looked at eight people's care records and other records relating to the management of the hospice. These records included; six staff recruitment records, training records, staff duty rosters, accident and incident reports, policies and procedures, complaints, compliments, health and safety, maintenance, governance and quality monitoring records and reports.

Updated 7 December 2016

The inspection took place on the 11, 13 and 17 October 2016 and was unannounced. The previous inspection took place on the 19 December 2013 and met legal requirements.

North London Hospice is a registered charity which provides a range of services including inpatient, outpatient, community and day services for adults with life limiting illnesses and palliative care needs for people in the London boroughs of Barnet, Enfield and Haringey. The hospice has an 18 bed inpatient unit. There is also a multi-professional community palliative care team which provides symptom control advice, psychological, spiritual and emotional support, and a palliative care support service based at the hospice that provides practical care for approximately 200 people who live in Barnet, Enfield and Haringey.

Other services offered by the hospice included; complementary therapies, outpatients, physiotherapy, spiritual support and bereavement support for families, friends and carers of people using its services.

The service had a registered manager who was the Director of Clinical Services of the hospice. A registered manager is a person who has registered with the Care Quality Commission [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 and associated Regulations about how the service is run. The registered manager was supported in the managing and running of the services by the Chief Executive Officer (CEO), Board of Trustees, Medical Director and other management staff.

People were supported to be fully involved and to take the lead in all decisions about the care and support they received. People were positive about the care and support they received from staff. People said their right to privacy was fully protected, and told us they were always treated with dignity and great respect by all staff. They told us staff were kind and listened to them and respected their wishes and preferences regarding their care and support needs. Each person had a specific up to date plan of care which provided information about their medical, physical, emotional, social and spiritual needs. People’s specific wishes were recorded in advance care plans [ACPs].

People’s physical, emotional, social and spiritual needs were met by a multi-disciplinary team [MDT]. The staff and volunteers we spoke with from all the services provided by the hospice spoke positively about their jobs. They had a very good understanding of their roles and responsibilities and cared very much about the people they supported and were committed to deliver a high standard of service.

Staff and volunteers received the training and learning they needed to be skilled and competent to provide people who often had complex needs with the care and support they needed. Some volunteers had the opportunity to complete specific training to develop their skills in supporting people with their emotional and spiritual needs.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. Staff knew when safeguards needed to be in place to protect people who were unable to make decisions about their care. Staff established consent from people before providing care.

Risks to people's safety were appropriately assessed, managed and monitored to minimise the risk of people being harmed and to keep them safe. People told us they felt safe when receiving care and support from the hospice services. Staff received the training they needed to protect people and knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

There was a system in place to record, assess and monitor accidents and incidents. Incidents were analysed to minimise avoidable risks and the risk of re-occurrence.

The hospice environment was welcoming, clean, warm and well lit. Systems were in place to maintain the safety of the hospice and its services. This included addressing maintenance issues, fire prevention and carrying out health and safety checks of equipment and the building.

Systems and processes were in place to monitor standards of hygiene and control of infection and to make improvements when needed.

Systems were in place to make sure people’s medicines were managed and administered safely. People’s medicines were reviewed frequently to ensure they met each person’s specific needs.

The provider's staff recruitment process made sure that staff and volunteers were suitable to work with people who needed care and support. Staffing levels and skills combination ensured enough staff were available to meet people’s varied and often complex care, treatment and support needs in a personalised and safe manner.

People told us they enjoyed the meals, were offered choices and had their individual food preferences catered for. Nutritional assessments were undertaken to identify risks associated with poor nutrition and hydration so these could be minimised.

Inpatients and outpatients had the opportunity to participate in one to one and group activities to help minimise social isolation and promote their well-being.

The hospice was responsive to people’s feedback and proactive in working in partnership with a number of external professionals and organisations to develop best practice and provide people and those important to them with a range of services that met their individual needs including advice and emotional support.

People using services and their families and friends were provided with a range of information about the hospice services. A variety of leaflets were also available which included details about each of the hospice services, therapies, medical interventions and bereavement.

People knew what to do if they had a complaint. They were confident that they would be listened to and any concerns they raised would be addressed appropriately. Staff were committed to learning from people’s experiences and made improvements to the services when this was required.

The registered manager and other senior staff showed clear lines of responsibility and leadership. They and Trustees demonstrated a strong commitment to provide people with a safe and caring service and also to develop and improve the hospice services when required so people benefitted from effective services that met their individual needs.

A range of comprehensive checks and monitoring systems including regular inpatient and management meetings where all aspects of the services were discussed and reviewed were in place to monitor and improve the quality of the services provided.