Archived: Peace Hospice Care

Updated 7 July 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 28 April 2016 and was unannounced.

The inspection was carried out by one inspector, a pharmacy inspector, a specialist advisor and an expert by experience. The specialist advisor had the experience of working as a nurse within the community and within the field of palliative care. The expert by experience is a person who has personal experience of having used a similar service or who has cared for someone who has used this type of care service.

Before our inspection we reviewed information that the provider had sent to us which included notifications of significant events that affect the health and safety of people who used the service.

We spoke with eight people who used the inpatient service and hospice at home service, 12 relatives, three volunteers, 10 staff and this included nurses, physiotherapist and care assistants. In addition we talked to a pharmacist, two service managers, the chief executive and the director of patient services who was also the registered manager for Peace Hospice.

We reviewed people’s care plans to see how their support was planned and delivered. We looked at a selection of medication records to check medicines were managed safely. We looked at a range of policies and procedures, quality assurance and clinical audits and meeting minutes for different departments.

Updated 7 July 2016

This inspection took place on 28 April 2016 and was unannounced.

Peace Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families .They deliver physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an ‘In-Patient Unit’, Day Service, `Out- Patient Care` and `Community Outreach Team`. The out -patient services included rehabilitation, wellbeing, bereavement and counselling support. The community outreach team consisted of a single point of referral for `Hospice at Home` service and `Herts Neighbours` service which reached out to people in the community and provided a range of services offered by volunteers employed by the hospice. `Herts Neighbours ‘service did not include an activity regulated by the Care Quality Commission (CQC).

At the time of the inspection there were six people using the inpatient service and 60 people using hospice at home services. The day services called `Starlight Centre` offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complimentary therapy sessions and clinics and aimed to empower people to be in control of their condition and achieve what was important to them. The Starlight Centre also offered counselling and bereavement service through teams of volunteers and contracted accredited counsellors to people and family carers.

Peace Hospice had 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risks to people`s well-being were assessed by staff daily and the majority had measures in place to mitigate risks and keep people safe. Hospice at home staff communicated any risks to people`s health and well-being to health and social care professionals involved in peoples` care in the community. They followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. There were sufficient numbers of staff to ensure people received support when they needed it.

The service operated a 24 hour medical and duty manager on-call system for all the services offered by the hospice to ensure people received the same support and advice during the day as during the night. People using the inpatient service had their medical needs met by a team of doctors employed by the hospice.

People who used the Starlight Centre told us that this service enabled them to meet people with similar conditions and helped them prepare for the future. People told us that staff understood their individual care needs and were compassionate and understanding. Staff told us they undertook training which enabled them to provide good quality care to people in the inpatient unit and in their own homes.

People’s medicines were administered by trained and qualified staff who had their competency assessed by the practice development nurse and monitored by their manager. Any changes in people`s medication were discussed by the medical team, nurses and pharmacist to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.

People and relatives were very positive about the caring and compassionate attitude of the staff delivering the service. They told us they were completely satisfied with their care and thought highly about staff and management. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected; staff went beyond their duty of care to ensure people could have their last wishes fulfilled.

The management structure was under review and the provider was making changes in lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. Although this was under review staff we spoke with were clear about their responsibilities and the lines of authorities within the service. The registered manager and the provider was committed to improve and broaden the services the hospice offered.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.