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Severn Hospice Apley Site Requires improvement


Inspection carried out on 20 April 2021

During an inspection looking at part of the service

Severn Hospice Apley site is operated by Severn Hospice Limited. The service provides end of life care had 10 inpatient beds and provided services in the community.

The service is registered to provide the following regulated activities:

  • Diagnostic and screening.
  • Treatment of disease or injury.
  • Personal care.

Following this inspection, we told the provider that it must take some actions to comply with regulations. Following this inspection, we told the provider that it must take some action to comply with regulations. We also issued the provider with three requirement notices and a S29 warning notice.

Inspection carried out on 22 October 2019

During a routine inspection

Severn Hospice Apley Site is operated by Severn Hospice Limited. The hospital has 10 beds. The service had seven open beds at the time of the inspection. Facilities include a day unit, spiritual room, indoor and outdoor relaxation spaces and a mortuary.

The service provides hospice care for adults. We inspected hospice services for adults during this inspection.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on Tuesday 22 October 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

We found areas of outstanding practice in relation to hospice care for adults:

  • Staff consistently treated patients and those close to them with compassion and kindness. There was a strong, visible person-centred culture. Staff were highly motivated to offer care that promoted people’s dignity and respected patient’s entire holistic needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. Staff recognised the impact of small gestures in supporting patients and those close to them. Staff went above and beyond to ensure patients and those close to them had the emotional support throughout the hospice journey.
  • Patients and those close to them were fully involved in their care. Staff consistently empowered people who used the service to have a voice and to realise their potential. Staff were fully committed to working in partnership with people and making this a reality for each patient.
  • People’s individual needs and preferences were central to the delivery of tailored services. The service had innovative ways to provide integrated person-centred pathways. Services were flexible to patient’s needs.
  • The service had a proactive approach to understanding and meeting the needs and preferences of different groups of people. Staff made reasonable adjustments to meet the needs of patients, including those with protected characteristics. Staff understood how to support people’s sexuality and gender identity whilst receiving care. The service coordinated care across services.
  • Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. Leaders at all levels had the skills, experience and capacity to deliver excellent and sustainable care.
  • Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. There was a strong culture of teamwork and support across all levels of the service. Staff shared a common goal to improve the quality and safety of care and people’s experiences.

We found good practice in hospice care for adults:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. However, policies did not consistently support staff to safeguard patients.
  • The service controlled infection risk well. Staff used control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
  • The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers reviewed and adjusted staffing levels and skill mix.
  • The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
  • The service did not use the safety thermometer, but did monitor safety information to help improve patient safety.
  • The hospice provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
  • Doctors, nurses, other healthcare professionals and non-healthcare staff worked together as a team to benefit patients. They supported each other to provide good care.
  • Key services were available seven days a week to support timely patient care.
  • Staff gave patients practical support to help them live well until they died.
  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions.
  • People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were monitored.
  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
  • Leaders and staff actively and openly engaged with patients, staff, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

  • The provider should review the complaints policy to ensure it is reflective of the full complaints process.
  • The provider should review the use of friends and relatives to translate information to patients.

Heidi Smoult

Chief Inspector of Hospitals

Inspection carried out on 21 March 2016

During a routine inspection

This inspection took place on 21 March 2016 and was unannounced.

Severn Hospice Apley 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 eight people. At the time of the inspection there were five people using the service. People within the locality of the hospice could also access support from the hospice at home and clinical nurse specialist services in their own homes and or community which were based at the provider’s sister site in Shrewsbury.

The services provided included 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.

People were kept safe by staff who were trained in the safeguarding of adults and health and safety. They were able to fully describe their responsibilities with regard to keeping people, in their care, safe from all forms of abuse and harm. There were safe systems in place to safely manage and administer medicines to people. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways. People received their medicines in a timely manner and in line with their preferences.

Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Recruitment practices were safe and ensured staff employed were safe and appropriately skilled to care for people using the hospice. Systems were in place to ensure records related to accidents and incidents captured the relevant information and this was considered and analysed without delay. Appropriate remedial actions were taken following such occurrences and action was taken to minimise any immediate or future risks to people.

Staffing was at a level which allowed staff to meet people’s needs in a safe, timely and personalised manner. Staff were well supported with the provision of a wide range of support in the form of training, a comprehensive induction, ongoing supervision and appraisal along with peer support and debriefs. Learning within the service including adopting and sharing best practice was highly prioritised. People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and supported people in line with these principles. Staff established consent from people before providing care and supported people to access independent advice and support when necessary. Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were flexible and could be transferred for use within the hospice and also applied when people were at home, thus reducing any unnecessary distress and repetition.

Staff were very caring and showed people and their families kindness. Staff demonstrated they were both motivated and passionate about their work and had a clear commitment to providing the best quality care in a compassionate way. People were encouraged to remain as independent as possible by staff. Staff acted in a way that maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People were fully invol

Inspection carried out on 7 November 2013

During a routine inspection

We spoke with three patients and two relatives on the in-patient unit and two patients on the day unit. All were very positive about the care and treatment they had received. For example, one patient described the standard of care as "brilliant" and told us staff were �affectionate� and said that they could not speak highly enough of staff.

Patients and relatives were given appropriate information and support and felt listened to. A relative commented �this is the one place where I have felt listened to, staff are extremely helpful.� Patients� privacy and dignity was respected.

Admission assessments reflected people's individual care needs, which enabled staff to offer the support that people required, in ways that they preferred. The provider may wish to note however that it was not clear from the records checked how a patient and or their relatives had been consulted with when making a decision relating to resuscitation.

The hospice had suitable arrangements for the safe storage, handling, administration and disposal of medication. This ensured patients� safety.

There was a system in place to identify and manage all clinical and non-clinical risks and for assessing and monitoring the quality of the service. This ensured patients received a service which was of high quality and met their needs.

Inspection carried out on 17 April 2012

During a routine inspection

As part of this inspection we spoke with seven people who received a service at the hospice, four relatives, three staff, one volunteer, the volunteer coordinator and the ward manager. During our visit we observed interactions, and reviewed the care records of two people. We also looked at other records as detailed within the report.

Everyone we spoke with said that they had been consulted and involved in their care and treatment. People said that their needs and wishes were identified and staff supported them in ways that they preferred.

People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

At the day hospice people enjoyed a wide range of activities and therapies. People told us that there was always something to do and that they always looked forward to visiting.

People were very happy with the quality of care received at the hospice. Everyone told us that staff met all of their care and support needs in ways that they preferred. Peoples� needs were comprehensively assessed and care and treatment was planned and delivered in line with individual care plans. People told us that their medical, personal and emotional care needs were met. Relatives told us that people received excellent care and support from a staff team who �couldn�t do enough for people�.

People told us that they felt safe and risk assessments demonstrated how risks were identified and reduced as far as possible. Risks were regularly reviewed and people were enabled to be as independent as they were able. Staff were aware of risks, people�s rights and their responsibilities in order to enable people to do this.

People were supported by a knowledgeable and well trained staff team who knew people�s care and support needs well. Staff were offered a range of training opportunities that were specifically designed to meet the needs of the people that they supported. People were protected because staff were confident to recognise and report abuse.

Volunteers were seen to provide essential support to nursing staff and were knowledgeable of their role and remit.

The hospice had systems in place to seek the views and opinions of people who received a service. Staff told us that the service was patient led.

Telford hospice had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. They effectively sought people�s views about their care and listened to them.

Reports under our old system of regulation (including those from before CQC was created)