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Inspection carried out on 7 August and 17 and 23 September 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission, which looks at the overall quality of the service. This inspection was unannounced, which meant the provider and staff at the service did not know we were visiting.

Ashgate Hospice is a independent registered charity for the delivery of care and treatment for people across the community of North Derbyshire. This is provided using the 21 bedded inpatient unit, the hospice at home service, the day hospice service and the lymphoedema service. Medical, nursing, therapy and palliative care clinical nurse specialists (CNS) are provided across the hospice’s inpatient unit, day unit and community services, together with an in-reach service to the local acute hospital from the CNS team. People may also receive support from the hospice's transport service, a patient and family support bereavement service, a telephone advice line and a spiritual care service. All of these services provide specialist palliative and end of life care to people with progressive and advanced disease and a limited life expectancy.

At the beginning of our inspection there were 19 people using the inpatient unit. The average number of beds occupied on the hospice inpatient unit for the period 1 April 2013 to 31 March 2014 was 93%, which is higher than the national average of 80%. For the same time period the hospice community CNS service provided 1867 face to face and 4338 non face to face person care contacts and the hospice in-reach CNS services provided 4321 face to face contacts. The hospice at home service provided 1930 face to face and 411 non face to face contacts and the hospice spiritual care service provided 30 – 40 face to face contacts per week. The hospice lymphoedema service team received 307 referrals and the patient and family support service provided telephone advice and support to over 700 patients and carers.

Care, treatment and support was provided within the hospice environment and people’s homes dependent upon their assessed needs and preferences.

There is a registered manager in post at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law, as does the provider.

People were protected from harm and abuse and robust staff and volunteer recruitment procedures were followed for people’s safety . There were sufficient staff and volunteers to meet people’s individual needs and to respond flexibly to changes and unforeseen emergencies. Systems were effective to manage known risks associated with people’s care and treatment needs. For example, to protect them from the risks associated with medicines, falls, pressure sores, poor nutrition and hospice acquired infections.

Staff followed and understood the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards 2009 (DoLS). These set out requirements to ensure, where appropriate, that decisions about people’s care are made in their best interests when they are unable to do this for themselves.

People received care that was tailored to their individual needs Both they and their relatives or carers were highly complimentary and satisfied with the care provided, which they often described as excellent, exceptional or outstanding. People were treated as equal partners in determining their care and treatment plans and their rights, wishes, preferences and diverse needs were respected. People, their families and staff felt that they mattered and that their views were taken seriously and acted on.

Staff treated people with care and compassion and were highly motivated and committed to providing people with the best possible palliative and end of life care. Staff worked with people and their families on an individual basis, to agree their care, involvement and support and to enable them to live as full a life as possible. People were supported to receive end of life care that met with their needs and wishes and to achieve a private, dignified and pain free death. People, their families and staff were provided with the emotional and bereavement support they needed.

People’s medicines were effectively managed and they received effective care, treatment and support that met their needs in an environment designed to promote their comfort, emotional wellbeing and independence. Staff and volunteers received the training and support they needed and were highly motivated to perform their roles and deliver sustained outstanding care. Managers supported staff to undertake relevant research and development, to ensure best practice and make improvements in care when required.

Staff worked closely and in partnership with external health and social care professionals and providers and also health commissioners, educators and national organisations concerned with palliative and end of life care. This helped to ensure that people received the right care at the right time and that knowledge was appropriately shared and used to influence best practice for people’s care.

Clear governance and management strategies were employed. This helped to ensure clear management oversight and scrutiny of the service against recognised practice and guidance. People and their families, staff and key stakeholders, were actively informed and involved in developing the service. Their views were used to continuously inform service improvements and development and to influence the management and running of the service. Care and strategic planning was coherent and inclusive to meet the diverse and changing care needs of the local population.

The provider used a wide range of methods to determine the quality and safety of people’s care and made improvements when required. This included checking their service against, and also pioneering recognised standards for palliative and end of life care. This, together with recognition and good practice awards received by the service, assured that high quality, safe and innovative care was being provided.

Inspection carried out on 17, 19 July 2013

During a routine inspection

On the day of our site visit there were fourteen people staying at the hospice.

Additional funding had been secured from the Clinical Commissioning Group (CCG) which was formerly the Primary Care Trust (PCT). This funding was short term funding that had allowed the hospice to increase its capacity from 17 to 21 beds for a few months.

The registered manager said that the average length of stay for patients was 14 to 16 days. The main aims were to assess and offer symptom control, to allow patients to become stable, and to offer support to the patients and their families.

We spoke with two people who were staying at the hospice, and one person in the day centre. The person in the day centre said: �They are absolutely brilliant. I can�t fault them at all; we do something different every week. The volunteers are absolutely spot on; they would do anything for you, really marvellous.�

One of the patents staying at the hospice said: �They are very good; I definitely get treated with dignity and respect. The food is marvellous, there�s a good choice, and the quality, you can�t complain about the quality it�s really very nice indeed.�

A second patient said: �It�s brilliant! It�s like staying in a hotel. The staff are very good, and nothing is too much trouble, and they come straight away if I push my buzzer. There is a really beautiful buffet for tea, so you can choose what you want, and have as much or as little as you like.�

Inspection carried out on 23 August 2012

During a routine inspection

Ashgate Hospice is registered to take up to 21 people, however there were only 17 bed places in use.

We spoke with four patients who were staying at the hospice. Comments were all extremely positive. We spent several hours in the hospice, and our observations were of staff talking with patients in a respectful, friendly and calm manner.

Among the things that patients said were: �The staff are very attentive, when I buzz the call bell they come straight away. � �Everyone talks to you from the cleaners to the receptionists, I�ve come on leaps and bounds since being here, I�ve got something to do every day, and all of the staff are really committed, and helpful.�

Every one we spoke with said that they were happy with the care that they were receiving, with the following comments among those received: �I can�t fault the staff, they are marvellous, nothing is too much trouble, and I feel I�m being really well looked after here.�

Inspection carried out on 21 October and 24 November 2011

During a routine inspection

The patients we spoke to said they were satisfied with the care they were receiving and felt the quality of the service being provided was good. One patient said in regard to the nursing staff that "nothing is too much trouble for them".

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