Severn Hospice Bicton Site

Severn Hospice Bicton Site is registered to provide specialist palliative care and clinical support for adults with life limiting illnesses. The service provides care on their in-patient facility which catered for up to 16 people over two wards. At the time of the inspection there were 15 people using the inpatient service. The Hospice at Home service was based on site and provided a service to both the Apley and Bicton sites. At the time of our inspection two people were receiving support from the Hospice at Home team. The clinical nurse specialist team also provided expert advice, support, liaison with other healthcare professionals and signposting for people in the community.

The service provided counselling and bereavement support, day hospice care, family support, chaplaincy, out-patient clinics, occupational therapy, physiotherapy, complementary therapies and a lymphedema service (for people who may experience swellings and/or inflammation following cancer treatment).

The manager was registered with us as is required by law. 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 and related confidential data were not always stored securely in treatment rooms and audits were not completed on the safe storage of medicines. Some medicines, requiring extra security arrangements that had past their expiry date, were not always separated from other medication. The provider had safeguarding procedures that were well understood by staff and ensured people were kept safe. Audits were undertaken to make sure all equipment and the building were checked and serviced as required. Risk assessments reflected how care should be provided to the person to minimise any risks to them; they were regularly reviewed to adapt the level of support needed in response to people’s often rapidly changing needs.

There were sufficient staff on duty to care for the needs of each individual. Ongoing learning was encouraged and staff were supported to access a variety of training courses which included communication skills, care of the dying and mentorship. The service had an education lead who was responsible for arranging training programmes to meet the needs of staff. All new staff had a thorough induction which included working alongside other disciplines both within the hospice and externally in order to gain an understanding of how the services worked together. Staff were able to access clinical supervision and were provided with an annual appraisal. Robust staff recruitment systems were in place which ensured that only applicants who met the service’s high specifications regarding qualifications, experience, character and caring abilities were employed.

The provider recognised that people's capacity to make informed decisions about their care could fluctuate, so this was reviewed at regular intervals throughout their stay. Documentation in relation to people’s decisions about resuscitation known as Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were flexible. These could be transferred for use within the hospice and also remained valid when people were at home. People were complimentary about the food on offer; it looked appetising and people’s specific dietary needs were well catered for. The provider employed a range of healthcare professionals including a team of doctors who worked across all the services provided by the hospice to ensure all aspects of people’s health was considered.

People described the care and compassion they received from staff. Staff were motivated and showed a high level of empathy and kindness to people. Staff used warmth and caring terms when discussing people’s needs, including their psychological and emotional well-being and those of their family. People’s spiritual and cultural needs were considered and met by staff with support from the chaplaincy service and the social work team. People were fully involved in the planning of their care and were encouraged to express their views, preferences and wishes in regard to their care, support and treatment. People were supported by staff in a dignified and respectful manner, with a focus on how they could maintain their optimum level of independence. Staff were knowledgeable about how to access independent advice and support for people when this was required.

People told us they were enabled to achieve a good quality of life from the support of staff and this had helped them to adapt to the changes brought about by their illness. The Hospice at Home service enabled people to be at home if they had chosen this as their preferred place of death, with the assurances they needed that their needs would be met in a timely manner. An emergency discharge pathway was in place to facilitate people being able to go home quickly if they changed their mind and wished to die at home. Staff demonstrated to us they knew people well and understood their individual needs. People’s preferences and wishes were always respected by staff, with clear examples of how they made significant efforts to ensure these were possible. Staff were familiar with the complaints procedure, it was clearly displayed and leaflets were also available for people to refer to. Arrangements for recording, acknowledging, investigating, responding and learning from complaints were comprehensive.

The provider, management and staff team demonstrated an open and inclusive culture existed which focused on people and supported its staff to provide high quality care. Staff were happy in their work and were clear about their roles and responsibilities; they felt supported by management and involved in the development of the service. The registered manager had recently completed a program of education in order to expand their knowledge and in turn used this to improve the leadership within the hospice environment. As a result of analysis and investigation of incidents, learning had taken place and changes to practice shared and implemented.

The provider promoted quality end of life care for all, not just those people using the service, but also the wider community. The provider provided training and education through the development of external professionals, which included speaking at national conferences. Staff practiced within relevant key guidance as it emerged, for example those set out by the National Institute for Clinical Excellence (NICE) Quality Standards for End of Life Care. Medical staff had also worked in partnership with the local council to provide accredited training in end of life care for all levels of external care staff. A comprehensive program of in-house audits such as medicines, education and the environment were completed and the findings fed into the governance meetings.

Patients and relatives were given appropriate information and support and felt listened to. One person commented 'They go out of their way to explain things. I have felt listened to and always welcomed.'

Admission assessments reflected people's individual care needs, which enabled staff to offer the support that people required, in ways that they preferred. Care plans were detailed and covered all aspects of care and treatment. This helped ensure that all the needs of patients were met.

The hospice had suitable arrangements for the safe storage, handling, administration and disposal of medication. This ensured patients got the right medication at the right time. There was a system in place for assessing and monitoring the quality of the service. This ensured patients received a service which was of high quality and met their needs.