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Inspection Summary


Overall summary & rating

Good

Updated 9 November 2017

This unannounced focused inspection took place on 30 October 2017. The last unannounced comprehensive inspection took place on 17, 18 and 22 August 2017. At that inspection we rated the service as ‘Requires Improvement’ and found one breach of a regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines management. After the comprehensive inspection the provider sent us an action plan and told us they would make the necessary improvements by 6 October 2017. We had also made a recommendation in relation to auditing and monitoring processes. At this inspection we found that action had been taken to address the shortfalls from the last inspection and processes for auditing and monitoring were in place and working effectively.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harlington Hospice on our website at www.cqc.org.uk.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider's premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of fluid in body tissues). The service is located in welcoming and comfortable premises with a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider did not have any inpatient services and offered three different types of care packages to support people in their own homes. At the time of our inspection there were 12 people receiving care in their own homes.

The 'Homesafe Night Service' provides a maximum of three nights' of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person's needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The 'Home2Assess' service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by healthcare assistants.

The 'End of Life Care at Home Service' is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people's needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people's assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service is required by legislation to have 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 service had been without a registered manager since January 2017 and was recruiting to this post. The nom

Inspection areas

Safe

Good

Updated 9 November 2017

We found that action had been taken to improve safety.

Improvements had been made with the medicines management for people using the service and medicine administration records were being correctly completed and monitored.

We have changed the rating for this key question from �Requires improvement� to �Good�.

Effective

Good

Updated 26 September 2017

The service was effective.

Staff received the training they needed to provide them with the skills and knowledge to care for people effectively. Supervision had been taking place and staff received individual and group supervisions to support their learning and development.

Staff respected people�s rights to make choices about the care and support they received and knew to report if a person�s mental capacity deteriorated.

Where required staff provided people with assistance with food and drink to help meet their nutritional and hydration needs.

The service worked with other health care professionals to ensure people�s health needs were being met.

Caring

Good

Updated 26 September 2017

The service was caring.

People confirmed staff treated them with respect and were friendly and kind. Staff took the time that was needed to meet people�s care and support needs.

Staff knew the importance of treating people well and providing kind and compassionate care.

Responsive

Good

Updated 26 September 2017

The service was responsive.

Staff respected people�s right to receive the care they wanted in a person-centred way so their individual needs were met. Care records were not always personalised and work was ongoing to address this.

There was a complaints procedure in place and complaints were thoroughly investigated and responded to so they were robustly managed.

Well-led

Good

Updated 9 November 2017

We found that action had been taken to improve governance arrangements around auditing and monitoring processes.

Processes had improved to ensure each aspect of the service was being monitored and action taken to address any shortfalls identified.

We have changed the rating for this key question from �Requires improvement� to �Good�.