14 September 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 25 and 26 January 2016 and was unannounced.
The inspection was carried out by a team which included two inspectors, two specialist advisers, a pharmacy inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisors had experience and additional knowledge in pressure care and end of life care.
Prior to this inspection the Care Quality Commission (CQC) received information of concern relating to the provision of care and management of pressure ulcers at the service. We reviewed all the information we held about the service, including data about safeguarding and statutory notifications. Statutory notifications are information about important events which the provider is required to send us by law. We reviewed this information to help focus our planning and determine what areas we needed to look at during our inspection.
During our inspection we observed how staff interacted with people who used the service.
We spoke with four people who used the service and seven relatives. We also spoke with the director of clinical services, team leader for clinical governance, a consultant, a doctor, a pharmacist, a senior sister, three nurses, a physiotherapist, lead nurse for community care, the hospice at home lead and volunteer staff.
We reviewed four people’s care records to ensure they were reflective of people’s current needs, three medication records, eight staff files and additional records relating to the management of the service, such as quality audits.
14 September 2016
This inspection took place 25 and 26 January 2016 and was unannounced.
Isabel Hospice provides care for people with life limiting illnesses through its inpatient unit, hospice at home service, day care unit and its specialist community palliative nursing care service.
There was a manager in place who was in the process of registering with the Care Quality Commission (CQC) to be the registered manager. 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 felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them. People had risk assessments in place to enable them to be as independent as they could be.
There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Effective recruitment processes were in place and followed by the service.
Medicines, including controlled medicines, were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service.
Staff received a comprehensive induction process and ongoing training. They were well supported by the management team and had regular one to one time for supervision. Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.
Staff gained consent before supporting people and ensured their choices were acted on. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.
People were able to make choices about the food and drink they had, and staff gave support when required.
People were supported to access a variety of health professionals when required.
Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support.
People’s privacy and dignity was maintained at all times.
People were supported to follow their interests and join in activities.
A complaints procedure was in place and accessible to all. People knew how to complain. Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.