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Inspection Summary


Overall summary & rating

Outstanding

Updated 8 November 2017

The inspection took place on 25, 26 and 27 July and was announced. 48 hours’ notice of the inspection was given because the children community service was office based and we needed to be sure that the manager and staff were available and to arrange visits to families in the community.

At our last inspection to the service on 11 and 12 May 2016 Ellenor Gravesend provided specialist palliative care, advice and clinical support for adults with life limiting illness and their families. Since this inspection, the service has been registered as one service with Ellenor’s children services and now provides palliative care for babies, children and adults. They deliver personal, emotional and holistic care through a multi-disciplinary team of nurses, doctors, counsellors, physiotherapists, therapists, spiritual leaders and a range of volunteers. On site the 15 bedded ‘Inpatient Ward’ admits people from 14 years to adulthood and the ‘Hospice day service’ provides support for up to twenty adults. Community teams provide services for babies, children and adults. There are two adult teams: 'The Hospice at home’ for people in their own homes and the ‘Care Home Support team' for people in care and nursing homes. Children's services include a respite service for parents/carers; cancer care for children so they can receive chemotherapy in their own homes and a range of clubs and activities. The service was providing support for around 1420 people and their families at the time of the inspection.

A registered manager was 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.

At the last inspection on 11 May 2016, we asked the provider to take action to make improvements in the management of medicines and record keeping with regards to the care and treatment. This was with regards to adults in the Inpatient Ward. Guidance was not in place for the use of some medicines and creams and waste medicines were not disposed of in a timely manner. Accurate records were not always kept with respect to each person's individual care. The breaches were of Regulation 12, Safe care and treatment and Regulation 17, Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan in August 2016 which stated that they would comply with all Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by the end of September 2016.

At this inspection on 25, 26 and 27 July 2017 improvements had been made to the management of medicines in the Inpatient ward and people’s records with regards to their care and treatment.

There were safe systems in place for the administration, recording, handling, storage and disposal of medicines. Staff were trained in how to give medicines safely, a pharmacy technician ensured medicines were available when people needed them, and a community pharmacist provided a clinical review of people’s prescribed medicines.

Since the last inspection to the adult service on 11 and 12 May 2016 and the children’s service on 19 and 20 July 2016 the service had maintained standards of care and continuously strived towards developing creative and innovate ways of supporting children, adults and their family members.

In the children’s service there had been a major cultural shift led by the head of children’s nursing. Staff reported that the head of children’s nursing had been very brave in the changes and developments within the team, and this had resulted in them having a shared understanding of the aims of the service. This benefitted children and their carers as they were able to take assessed risks and positively engage the whole family, by directing their resources where

Inspection areas

Safe

Good

Updated 8 November 2017

The service was safe.

People’s medicines were stored safely and improvements had been made to the administration of medicines to ensure people received them as prescribed.

There were sufficient numbers of trained and experienced staff to meet people’s needs. Checks were carried out on all staff who were employed by the service to ensure they were suitable in their role.

Staff were trained in safeguarding adults and children and knew how to report any concerns.

Assessments were made of potential risks to people and control measures were in place to minimise their impact.

The service was clean and procedures were in place to promote good infection control.

Effective

Good

Updated 8 November 2017

The service was effective.

The service worked in partnership with other organisations to deliver staff training which followed best practice in supporting children and adults with long-term illness or who approached the end of their lives.

The service worked continuously towards identifying and supporting people in the community with palliative care needs which had resulted in less hospital admissions.

Adults and children were supported by a multi-disciplinary team and experienced care and treatment that was appropriate and promoted their well-being.

Staff understood the importance of people’s nutritional needs and staff ensured people’s preferences were met.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005 and how to act in people’s best interests.

Caring

Outstanding

Updated 8 November 2017

The service was exceptionally caring.

Adults and children were supported by staff who were exceptionally compassionate, understanding, enabling and caring. Staff relationships were valued and they went the ‘extra mile’ to meet the needs of children and adults.

The service was highly complimented for the manner in which it consistently treated everyone as individuals and with dignity and respect.

Providing support to the child or adult and their family members was central to the values of the service. The range of support available to people’s families included carers support, counselling and bereavement services and support groups, which continued after the death of their loved one.

Responsive

Outstanding

Updated 8 November 2017

The service was exceptionally responsive.

Children and adults’ care and support was planned proactively with them and reflected their choices and preferences. Advanced care plans detailed where and how adults and children wanted to receive their care.

At the end of life, children and adults were enabled to experience a comfortable, dignified and pain-free death.

Children and adults were given opportunities to engage

in a wide variety of activities and therapies that included companionship and socialising with their peers.

The service had developed links with other professionals and the community in order to improve and develop it for the benefit of children, adults and carers.

People were actively encouraged to give their views and raise concerns. When complaints had been received, they were used to drive improvements in the service.

Well-led

Good

Updated 8 November 2017

The service was well led.

There was an open culture where children, adults and their relatives were asked for their experiences about all aspects of the service.

The management team disseminated the vision and values of the service to the staff team. A cultural shift had taken place in the children’s service which ensured that all staff were motivated to provide personalised care.

There were systems of governance and audit in place which effectively monitored the quality of the service.

Education, research and training were undertaken to help make improvements to the lives of children and adults with palliative care needs.