Archived: Sam Beare Hospice

Updated 27 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 was carried out on 11 and 12 July 2016 and was unannounced. The inspection team consisted of one inspector, a specialist nurse in end of life care, an expert by experience and a pharmacist inspector. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. We previously inspected the service on 08 May 2013 and no concerns were found.

Before the inspection, the provider completed a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also sent questionnaires to staff and people who used the service to gain their feedback. We reviewed the PIR, previous inspection reports, notifications and all contacts we had about the service. A notification is information about important events which the service is required to send us by law.

During the inspection we spent time with three people on the in-patient ward, two people at the day hospice and one relative. We also spoke with five people and one relative by phone who used the hospice at home service. We spoke with the registered manager (who is also the director of nursing), the chief executive officer, three nurses, the Practice Development Sister, the ward manager, the hospice at home team leader, two health care assistants, one of the doctors (specialist registrar in palliative care), the physiotherapy team leader, the cook, two cleaning staff, one student nurse and one clinical nurse specialist.

We attended the weekly multi- professional team (MDT) meeting, observed the doctor and nurse leading a handover meeting and observed one new admission assessment to the inpatient unit. We viewed a range of records including seven care documents for people who used the service, three people’s medicine prescription and administration charts, five personnel files, and records relating to the running of the service.

Updated 27 September 2016

This inspection was carried out 11 and 12 July 2016 and was unannounced. At the time of our visit seven people were using the inpatient unit and the hospice at home service had around 400 people registered as accessing the service.

Sam Beare Hospice is an independent registered charity for the delivery of care and treatment for people across Surrey, owned by Woking Hospice Trust. The service is provided using the 10 bedded inpatient unit, the hospice at home service and the day hospice service. Medical, nursing, therapy and palliative care clinical nurse specialists (CNS) are provided across the hospice’s inpatient unit, day unit and community services. People and their relatives may also receive support from the 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. The hospice was experiencing a period of change as the service prepares to move location and merge with the provider’s other hospice in the next year. The provider was sensitive to the uncertainty this might cause people and staff and a change management programme was being implemented to ease the process.

There is a registered manager in post. 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.

There was a defined governance and management structure in place, which staff understood. This provided clear lines of responsibility and authority for decision making about the management, operation and direction of the hospice and its services. Systems were in place to support the registered manager and board of trustees to identify risk and quality concerns and drive improvement across the service. We saw examples of improvements made in relation for example, to the staff appraisal process, recruitment records and medicine management.

People were protected from harm and abuse and robust staff recruitment procedures were followed to keep people safe. There were sufficient staff 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 such as falls, pressure sores, poor nutrition and hospice acquired infections.

People were supported to eat and drink sufficiently and adjustments were made to ensure people at risk of choking could eat and drink safely. Regular reviews took place of people’s symptoms and changes were made as required to ensure people’s pain would be well managed.

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.

There was a holistic approach to people’s care with the physical, well-being, social and spiritual needs of each person given equal importance, together with the needs of those closest to them.

People and their families received a responsive service. People were treated as equal partners in determining their care and treatment plans and their rights, wishes, preferences and diverse needs were respected. The service was responsive to the changing needs of people and had developed the service in response to the local communities changing needs. Care, treatment and support were provided within the hospice environment and people’s homes in line with their assessed needs and preferences. People, their families and staff felt that they mattered and that their views were taken into account and acted on.

People and their relatives were complimentary about and satisfied with the care provided, which they described as “Excellent”. Staff treated people with care and compassion and were motivated and committed to providing people with the best possible palliative and end of life care. 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.

Staff received the training and support they needed to perform their roles and deliver good care. Managers supported staff to undertake professional 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.