Eden Valley Hospice

Eden Valley Hospice is located in the outskirts of Carlisle. It is registered to provide palliative and end of life care for up to12 adults and five children. The hospice has a 12 bed adult in-patient unit with eight single ensuite rooms and one four bed room. Care and support services for children and young adults with life limiting conditions are provided within a separate unit on the site called Jigsaw. Adults and children may be admitted for care during the last weeks and days of their life, symptom control, and assessment and / or respite care. There is a Day Hospice that provides care and support for up to 15 people a day, four days a week. The hospice provides bereavement support, complimentary therapies, counselling and carer support services and wellbeing programmes. There is a multidisciplinary team who are all experienced and trained in palliative care. Medical cover is provided by dedicated doctors who are supported by a Palliative Care Consultant.

At the time of our inspection there were 10 people using the adult inpatient unit and two children in Jigsaw.

There was a registered manager in post. 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 management team demonstrated a desire to learn about and implement best practice throughout the service. There was a clear organisational structure and a visible management presence throughout the service. Feedback from people and families using the service, health and social care professionals and visitors was very positive and people praised the care and compassion of the staff and volunteers.

The hospice environment was calm and it was open to families to visit and stay 24 hours a day. Hospice staff facilitated pre and post bereavement support for children, young people and adults through the hospice’s family support team. Those offering bereavement support and counselling had specific training for this role in line with ethical practice.

We saw people had been able to discuss with staff their spiritual and cultural beliefs and how they wanted these to be met. There was a well established chaplaincy team to offer pastoral and spiritual support whatever a person’s individual beliefs.

Hospice nursing and medical staff spent time with people and planned ahead to find out what people’s needs and goals were. A holistic approach was used to help make sure people’s emotional, spiritual and social needs were met as well as their physical needs. This meant people approaching end of life or with life limiting conditions were supported to lead a full and meaningful life. People told us they could speak openly about what they wanted and how they felt about their illnesses and were given the information needed to help them make their own treatment decisions.

Records we looked at demonstrated that staff took a lot of time working with people and giving them the time and information they needed to make decisions about their care and treatment. We saw that this process was led by the adult or child’s family.

There was a safeguarding policy in place that included information about the protection of adults and children. The safeguarding policy covered both adult services and Jigsaw and referred to relevant policies and national guidelines.

There were policies and procedures in place covering all aspects of the management of medicines within the adult inpatient unit and the Jigsaw unit. Medicines were stored in appropriate cabinets and fridges and were administered in accordance with the prescriber’s instructions. Controlled Drugs were handled appropriately.

We made some recommendations regarding medication good practice that we discussed with the management team. We made a recommendation in regard to areas that required review to incorporate current best practice and to include this in policies and procedures being used. Also we made recommendations about assessment in aspects of security and action planning following audit findings. We agreed the actions that would be taken and some were addressed on the day..

Records demonstrated that people were being well supported physically and emotionally and had been consulted throughout their care and treatments. There was evidence of risk assessments for people before and on admission that stated the actions staff were to take to reduce the possibility of harm without applying any unnecessary restrictions on people’s freedom. The records in people’s care files indicated that consent to support, care and treatment was being sought in line with legislation and guidance.

People's care plans included clear planning with regard to the control of distressing symptom and pain management that were being updated on a continual basis. The updates included changes in people's health and what was agreed when people experienced changes in their conditions, symptoms or pain levels

Care plans in use in the hospice included risk assessments using accredited measuring and monitoring tools. Records demonstrated that incidents, accidents and near misses were reported, recorded and reviewed through the management reporting process and action taken where any trends were identified.

There was a high ratio of staff to people/children using the service of suitably experienced and skilled staff to keep people safe and meet their needs and expectations. Safe recruitment practices were followed when new staff were employed or volunteers taken on. The hospice has its own bank staff to cover for holidays, for training and sickness and they had been recruited using the same process as permanent staff.

The hospice had a training and development strategy in place and there was a comprehensive mandatory and statutory training programme for all those working or volunteering in the hospice. All staff received supervision and support and an annual appraisal of their work.

Nutrition risk assessments were carried out and used to identify specific risks associated with people and these were subject to continuous review. People and their relatives were very complimentary about the food provided which was cooked daily from fresh ingredients. We were told “The food is lovely”.

There were clear strategic plans in place for the continual development of hospice services and a business plan which clearly summarised the organisation's aims and objectives, with forward planning strategies being implemented.

We observed staff supporting people in ways which maintained their dignity. Staff communicated clearly with people, asked prior to carrying out any tasks and ensured people were in private if they required personal care.

People we spoke with in the adult unit told us: 'I couldn't get any more benefit from being here,' 'They are kind, do what I ask, absolutely brilliant,' and 'Staff check on you all the time to make sure you are okay, everyone is willing to help.'

We looked at care records for both children and adults and saw people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others.

The staff were able to demonstrate clear understanding of their roles and responsibility to safeguard children and adults from abuse and to keep the environment safe.

The provider had an effective system to regularly assess and monitor the quality of service that people received.