The Prince of Wales Hospice

The hospice was last inspected in October 2013. We found it was compliant in all the aspects of care we inspected at that time.

The Prince of Wales Hospice provides specialist palliative care, including symptom control, respite, and end of life care for people with life limiting diseases and other progressive illnesses. The hospice is run by a registered charity which has a volunteer board of trustees. There are 14 inpatient beds and a day care service; care staff also provide a 24 hour/seven day a week advice line for people living in the community, carers and healthcare professionals. On the first day of our inspection there were six inpatients; two more were admitted on the second day.

The hospice is located in a residential area of Pontefract. The building is all on ground floor level. There is a car park and reception area to the front of the building, with separate areas for day care, inpatients and administrative activities. All inpatient bedrooms are ensuite and had French doors to allow patients to access a patio and garden area.

During summer 2016 the hospice had undergone significant refurbishment and improvement. At the time of our inspection this work was nearly complete, with nine inpatient beds available. The service planned to have the other five inpatient beds ready for admissions within the week following our inspection.

There was no registered manager in post. The last registered manager left in December 2015. A clinical services manager had been appointed in February 2016; they were in the process of applying to be 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.

Medicines were managed and administered safely by staff. People told us they had access to pain-relieving medicines when they needed them. Staff were encouraged to report any medicines errors so lessons could be learned.

Risks to people had been assessed and managed appropriately. Regular safety checks had been completed on the building, facilities and equipment used to support people. We saw the hospice was clean.

People and their relatives told us there were sufficient care staff deployed to meet people’s needs. Our observations supported this.

Procedures for the recruitment of new staff at the hospice were updated shortly after our inspection to make them fully robust. A system was in place to ensure nursing staff had the correct professional registration.

Hospice staff could describe the forms of abuse people might be vulnerable to and told us they would report any concerns appropriately.

Staff received a comprehensive programme of induction and training. Annual appraisals were recorded but staff said supervisions had not been happening regularly. The clinical services manager was in the process of sourcing supervision training and improving their oversight of staff development.

Care staff members’ knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) was good. We saw capacity assessments and best interest decisions in people’s files. The service considered and documented whether care provided constituted a deprivation of people’s liberty.

Feedback about the food and drinks at the hospice from people and their relatives was extremely positive. The cook was knowledgeable about the nutritional needs of people receiving palliative and end of life care and could describe the needs of individual inpatients.

People had access to a team of healthcare professionals based at the hospice. People’s holistic healthcare needs were discussed daily during the week and a consultant could be reached over the telephone for advice at all times.

A programme of refurbishment had been completed shortly before our inspection. The inpatient bedrooms we saw were of a high standard. Other modifications to the building had been made to meet the specific needs of the people using the service.

People and relatives told us staff were caring and respected their dignity and privacy. We saw staff supporting people to remain independent and observed warm and positive interactions between staff and people. Staff respected the wishes of people and their relatives in terms of the subject of discussions they wanted to have and those they did not.

Care plans showed people and their relatives were involved in designing their care and people had signed consent forms when they were able. Care plans encompassed people’s spiritual and emotional needs, as well as their physical needs.

The service used national guidance to ensure the palliative and end of life care provided was evidence-based and of a high standard. Staff could recognise when people needed advocacy services and knew how to make referrals if they needed to.

People’s care files contained risk assessments and care plans which met their assessed needs. Daily records were shared between the team of healthcare professionals providing care; we saw they were detailed and evidenced people had been supported according to their care plans.

People had access to a range of activities at the hospice. Complementary therapies were available to relatives and staff, as well as to the people using the service.

None of the people or relatives we spoke with told us they had ever made a complaint. The hospice sought feedback about the service it provided and we saw improvements were made as a result.

People and their relatives were very happy with the service provided by the hospice. There was no registered manager in post; however, the clinical services manager who joined the hospice in February 2016 had applied to be registered manager.

Three statutory notifications had not been made to CQC in 2016 that should have been. We also found the system of audit in place did not assess day to day aspects of the service for themes and trends in order to identify improvements. The commitment to high level service audit in relation to national guidance and evidence-based practice was impressive.

Staffing had been an issue in early 2016 and we saw this had been addressed. Efforts had been made to assess staff satisfaction and team-building in the summer of 2016 while parts of the hospice were being refurbished. Staff we spoke with gave positive feedback about working for the service.

The hospice worked well in partnership with external organisations and community healthcare professionals. Staff had worked hard to make the hospice welcoming and part of the local community.

'The staff always explain things and check out my choices.'

'The care is excellent, and the food and facilities are also fantastic.'

'The staff work very well together. They are all different professionals, but all equally supportive.'

A relative commented: 'The care here is wonderful. The staff look after me as well as my relative.'

We spoke with the Registered Manager and five staff members from a variety of roles working within the hospice about the care and treatment of people who used the service. All staff spoke knowledgeably about the needs of the people in their care. Staff told us they worked well together as a team.

We reviewed four people's care records which documented multi-disciplinary discussions and communication with other agencies. We saw the records were fit for purpose and contained accurate assessments of people's needs.

We saw people's care records, staff files and other key documents were stored securely and could be located promptly by staff when required.

People using the service received care from a multi disciplinary team consisting of doctors, nurses, therapists, social workers and healthcare support workers. We spoke with six staff members from a variety of roles. We found staff were clear about their role and responsibilities within the multi disciplinary team and how they worked together to meet the needs of the people in their care.

During our visit we identified that one person had missed a dose of a controlled drug. The person had come to no harm or suffered as a result of missing this medication. We saw that appropriate action had been taken by the hospice staff to ensure the safety and well being of the person. How the incident was managed demonstrated a commitment to learn from mistakes.

All people spoken with were complimentary about the staff. A visitor told us 'The staff always make me feel welcome as a visitor at any time of day or night.' One person commented 'It feels like they have plenty of staff as they are always there when you need them.