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Royal Trinity Hospice Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 27 August 2019

Royal Trinity Hospice is operated by Royal Trinity Hospice. The service has 28 beds and provides care to patients in their own home or care home through their community teams. The service also provides dementia respite care in the inpatient unit. Facilities include an open art studio, community café, a large garden, patient and family services including bereavement support and welfare advice and a hairdresser.

The service provides hospice care for adults. We undertook an unannounced inspection of the inpatient and community services using our comprehensive inspection methodology. The inspection took place on 15 – 16 May 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospice was palliative care and care of the dying.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

  • Staff kept patients safe from avoidable harm and abuse. Risks were assessed, monitored and managed appropriately.

  • Patients care, and treatment records were clearly detailed and accurate in content. They were stored securely and managed safely.

  • Staff recognised incidents and knew how to report them. Managers investigated incidents and made improvements to the service.

  • Staff followed best practice in relation to infection prevention and control.

  • Staff had the appropriate skills, training, knowledge and experience to deliver effective care and treatment. Care and treatment was delivered in line with evidence-based practice.

  • Staff involved patients and carers in decisions about their care and treatment.

  • Staff cared for patients with compassion, treating them with dignity and respect. Staff truly respected and valued patients as individuals and empowered them as partners in their care, practically and emotionally, by offering an exceptional service.

  • The services provided aimed to meet the needs of people from their whole community, and the needs of the population served, which ensured flexibility, choice and continuity of care.

  • The service was proactive at engaging with groups that were hard to reach to ensure they could access its services.

  • There were clear processes for staff to manage complaints and concerns.

  • There was an open and transparent culture, with engaged and experienced leadership.

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced.

  • Leaders were visible and approachable in the service for patients and staff.

  • The service had a clear vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders.

However, we also found the following issues that the service provider needs to improve:

  • The management of the rotation of single use consumable equipment was not as good as it could be.

  • Some areas of mandatory training completion did not meet the services own expected targets.

Dr Nigel Acheson

Deputy Chief Inspector of Hospitals (London and South)

Inspection areas

Safe

Good

Updated 27 August 2019

Our rating of safe stayed the same. We rated it as Good because:

  • Staff we spoke with understood how to protect patients from abuse. Systems for the management and referral of safeguarding concerns reflected current best practice in relation to safeguarding adults and children

  • The service controlled infection risks well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection before and after the patient died.

  • Staff completed and updated risk assessments for each patient. They kept clear records and asked for support when necessary. Staff identified and quickly acted upon patients at risk of deterioration.

  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses.

However,

  • Single use equipment was not always checked, replaced and disposed of.

  • Mandatory training rates in some subjects required improvement.

Effective

Good

Updated 27 August 2019

Our rating of effective stayed the same. We rated it as Good because:

  • The service provided care and treatment based on national guidance and evidence-based practice. Staff protected the rights of patients in their care.

  • Staff gave patients enough food and drink to meet their needs and improve their health.

  • Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way

  • The service made sure staff were competent for their roles.

Caring

Outstanding

Updated 27 August 2019

Our rating of caring stayed the same. We rated it as Outstanding because:

  • Staff truly cared for patients with compassion. Feedback from all patients and those close to them confirmed that staff treated them well and with kindness.

  • Staff understood the importance of providing emotional support to patients and those close to them.

  • Staff always communicated with patients about their care and treatment in a way they could understand. Staff involved patients and those close to them in decisions about their care and treatment.

Responsive

Outstanding

Updated 27 August 2019

Our rating of responsive improved. We rated it as Outstanding because:

  • The service was planned and was proactive in meeting the needs of people from their whole community. The services provided reflected the needs of the population served and ensured flexibility, choice and continuity of care. It also worked with others in the wider system and local organisations to plan care.

  • The service was inclusive and took account of patients’ individual needs and preferences. It had a proactive approach to understanding individual needs, was accessible and promoted equality. Care plans were person-centred and took a holistic approach to patient care. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

  • People could access the service when they needed it and received the right care in a timely way. Arrangements to admit and treat patients were in line with good practice.

  • It was very easy for people to give feedback and raise concerns about care received.

Well-led

Outstanding

Updated 27 August 2019

Our rating of well-led improved. We rated it as Outstanding because:

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • The service had a clear vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

  • Staff felt respected, supported and valued. They were fully focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

Checks on specific services

Hospice services for adults

Outstanding

Updated 27 August 2019

Hospices for adults was the only activity provided at this location.