The inspection was carried out on 13 & 29 September 2016. The visit on 13 September 2016 was unannounced which meant the provider and staff did not know we would be visiting. We informed the provider we would be visiting on 29 September 2016. The last inspection took place in January 2014 and at that time the service was compliant with the regulations inspected.
The hospice offers specialist care for people with cancer and other life-limiting illnesses and support for families. The hospice has a 16 bed in-patient unit and also provides day services. The day services did not form part of this inspection. On 13 September 2016 there were 15 people receiving care and treatment on the in-patient unit.
The service had a registered manager. 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.
Everyone we spoke with told us they felt the hospice was a safe place where they were cared for by caring and competent staff. There were systems in place to make sure people were safeguarded and staff knew how to recognise abuse and how to report any concerns about people’s safety and welfare.
The recruitment procedures were robust and all the required checks were completed before new staff started work. This helped to protect people from the risks of receiving care, support and treatment from staff unsuitable to work with vulnerable adults.
The hospice employed a range of medical and nursing staff and health and social care professionals such as social workers. There were enough staff to ensure people received the right care and treatment and without exception people told us staff responded promptly to their changing needs. Staffing numbers and skill mix were reviewed to ensure they remained appropriate to people’s needs.
People’s medicines were managed safely and symptom control and pain relief was available at all times during the day and night.
We found risks to people’s health, safety and welfare were well managed. People’s care records included information about individual risks and how these were managed.
The hospice was clean and well maintained and equipped to meet people’s needs. Checks were carried out on equipment and installations which helped to ensure the premises were safe for people to use. There were clear systems and processes in place to deal with emergencies, both medical and non-medical emergencies.
Incidents and accidents were recorded and reviewed and whenever possible action was taken to reduce the risk of recurrence.
People told the staff were well trained and had an air of confidence which they found reassuring. We found staff were supported to continue to develop their knowledge and skills and to deal with the emotional challenges of their work.
The management and staff showed us they had a good understanding of their responsibilities in relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. This helped to make sure people’s rights were protected and promoted. However, this was not always reflected in the records where we found mental capacity assessments and best interests’ decisions were not clearly documented.
People were offered a choice of food which took account of their ethnic, cultural and dietary needs and preferences. We found the catering staff were committed to doing whatever they could to accommodate people’s requests. Although nutritional assessments were not being carried out routinely at the time of the inspection people received support from dieticians and speech and language therapists where necessary.
People were supported to maintain their wellbeing by a multi-disciplinary team. People spoke very highly about the nursing and medical staff, they said communication was excellent and this helped them to understand what was happening.
Without exception people told us the staff were very caring. They told us the staff were excellent and talked about staff who had a passion for their work. Care and support was person centred and people’s choices were respected. People’s privacy, dignity and cultural diversity were respected.
People told us they were fully involved in decisions about the care and treatment. Families and carers were supported when people were receiving care and treatment and after bereavement. Staff showed a good understanding of people's individual needs and preferences and spoke fondly about the people in their care.
Without exception people told us the hospice was responsive to their individual needs and responded quickly to their changing needs. We found people had access to complementary therapists but this was only provided by volunteers and therefore may not always be available when people needed it.
People told us they knew how to make a complaint if they needed to. Complaints were taken seriously and we saw an example of how a complaint had been used to make improvements to the service.
People were supported to share their views of the service.
There were systems and processes in place to monitor and assess the safety and quality of the services provided. We found the management team was open and promoted a culture of continuous improvement.