Great Oaks Hospice

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant that people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported all incidents that they should report. Incidents were reviewed by the senior management team and any findings and learning were cascaded back to staff. We saw incidents were discussed at senior leadership meetings and weekly safety group meetings. Staff we spoke with knew how to report an incident.

Staff understood the duty of candour regulation and the need to be open, honest, and transparent with people when things went wrong with their care. We saw evidence from incident reports that duty of candour was followed.

There was a positive learning culture. Staff were encouraged to challenge and ask questions so learning was achieved.

The provider worked with external organisations to provide relevant training opportunities for staff. For example, some staff were sent to the oncology department at the local NHS trust to expand their knowledge around cancer care. Staff were encouraged to attend training in addition to mandatory training. For example, health care assistants were trained in medicine management despite this not being part of their current role.

We scored the service as 4. The evidence showed an outstanding standard. The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service provided a comprehensive range of support options to ensure patients were fully supported throughout their end-of-life journey. These included wellbeing groups, social events, and activities tailored for individuals with life-limiting conditions, alongside family and carer support and an extensive complementary therapy programme. This holistic approach enabled patients and their loved ones to engage with the hospice early, often from the point of diagnosis, and benefit from coordinated care across multiple departments. One staff member explained, “We support people from diagnosis,” and shared an example of a patient with cancer who initially attended wellbeing groups but later became unable to visit the hospice. In response, the team maintained contact through engagement calls and, as the patient approached end of life, provided Hospice at Home visits. The hospice took pride in accompanying patients and families through the entire journey, ensuring continuity, compassion, and dignity at every stage.

The service’s referral and admission processes ensured all essential information about the patient was received to determine if the patient’s needs could safely be met. Between July and October 2025 for the Hospice at Home service, there were 44 referrals into the hospice at home service from a variety of health professionals, including district nurses, GPs, hospitals, carers and relatives and specialist palliative care nurses. Patients remained on the service until they were discharged or died. The length of time patients were cared for varied, with the smallest time being 2 days and the longest being 53 days. During the same period there were 311 referrals into the service, which included referrals into family and carers support, bereavement support, complementary therapy, spiritual and psychological, community engagement and wellbeing support.

Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. There was a fortnightly multi-disciplinary meeting which included the hospital palliative care team, district nurses and the hospice. At these meetings people’s needs, preferences and clinical management were discussed. Staff told us they had a good relationship with GPs in the area and we saw feedback from one GP who was impressed at the speedy response the service was able to offer one of their patients.

Communication amongst the different healthcare providers for patients ensured there were safe transitions between services. For example, all services used an orange folder system which held all the patient information should an ambulance be called to take the patient to hospital. This was because not all services had access to the same electronic patient recording system in the Gloucestershire area.

District nurses completed fast track referrals for crisis end of life patients. The district nurses had access to an on call number for the Great Oaks team and regularly called them to assist with end of life patients.

The service had a morning and afternoon handover meeting. This was used to discuss patient concerns and a debrief session.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did that when appropriate. All staff and volunteers had completed the right level of adult safeguarding (level 1,2 and 3) which was mandatory. Clinical staff were also trained in children safeguarding in case they should encounter children when they carried out home visits. The service was for adults, however we were told the service was considering introducing children’s safeguarding training for all staff and not just clinical staff which would exceed the requirements of the royal college’s safeguarding children intercollegiate guidance (2025). Post inspection, we received confirmation from the provider that this training had been rolled out. A qualified social worker was the lead for safeguarding and they were appropriately trained for the role.

Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act. We reviewed safeguarding incidents which showed staff dealt effectively with safeguarding concerns and knew how to escalate concerns.

Staff knew how to identify adults at risk of, or suffering significant harm. This included working in partnership with other agencies. We were given examples of patients experiencing mental health crisis, where these patients were swiftly and appropriately referred to their general practitioners to receive additional support.

Staff felt supported by the organisation, the training they had and the support available to them to deal with any safeguarding issues.

We scored the service as 4. The evidence showed an exceptional standard. The service always worked well with people to fully understand and manage risks by thinking holistically. They provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The hospice provided a range of services which supported patients during their end of life journey, from the time a patient had a life limiting diagnosis to receiving support during the last days of life. The service had a holistic approach to caring for its patients, offering community engagement, complimentary therapies and group led clubs such as seated ballet, cycling and men and women groups. There was counselling and practical advice offered to patients, their family and carers. It was the aim of the service to offer expert clinical advice and services, but also to offer patients experiences which may help to give them something other than their diagnosis to focus on.

Staff communicated with patients so they understood their care and treatment, including finding effective ways to communicate with patients with communication difficulties. We saw examples of health passports and plans which included information on the best way for people to communicate with the patient.

Staff enabled patients to give feedback on the service they received through a variety of methods. Most of the feedback received by the service was positive. One family member stated, “staff are always focused on ‘service user’ and involve them and ’service user’ in care and planning.”

Staff would support patients and family members to fill in Recommended Summary Plans for Emergency Care and Treatment (RESPECT) forms if that was their wishes. Staff advocated for patients who wished to die at home. We were given an example of a patient who lived alone with end stage Chronic Obstructive Pulmonary Disease (COPD). They text the hospice ‘help’ and the hospice at home team responded immediately, stayed with them and advocated for their wish to die at home. The service provided a charity night sit for this patient, which allowed the patient to die peacefully at home.

The hospice at home service discussed patient needs and wishes with the patient and the family at the first visit and the level of support the patient wanted. This information was then updated at regular intervals.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The hospice building was well designed, welcoming, well maintained, clean and suited people’s needs. All equipment we checked for safety was appropriately tested and the tests had been carried out within the necessary timescales. The hospice was situated in a beautiful location with gardens well maintained by a team of volunteer gardeners.

Most of the regulated activity occurred via the hospice at home team where they visited patients in their own homes. Risks to staff in a patient’s home environment were assessed by a registered nurse prior to a referral being accepted. Staff had safety devices on their mobile phones which would flag to other staff members should they not confirm the end of a visit at the expected time.

The district nurse team managed the ordering of home equipment to support patients. We were told Great Oaks staff could also contact the supplier if there were any equipment issues. Staff worked in pairs if there were any manual handling risks such as the patient not having a hospital bed.

We scored the service as 3. The evidence showed a good standard.The service had enough staff to keep patients safe. Managers accurately calculated and reviewed the number and grade of staff needed for each shift in accordance with national guidance.

The regulated service was carried out by the hospice at home team. This team consisted of health care assistants and was led by a registered nurse. The team had to be flexible to manage the varying number of patients on the caseload. The service used to operate by mainly employing bank staff, however over the past 2 years the service had made the switch to contracted staff which allowed the service to pick up more referrals. We were told by the leadership team this model better supported patients in terms of consistency and safety. The service still used bank staff when necessary, however the number of hours bank staff had been employed had declined from July 2025 where there were 458 hours, to September 2025 where there were 284 hours. Other staff from the different areas of the hospice, such as the community support lead, were also available to support the hospice at home team when demand for the service was high.

Staff had received and were up to date with mandatory training. The training was appropriate for the patient group using the service. Volunteers also completed a range of mandatory training. Staff receive email reminders if their mandatory training was due. Both clinical and non-clinical mandatory training compliance was at 87%. Staff received training for working with patients with autism and learning disabilities.

Staff turnover and sickness rates were low. Sickness for the last 3 months was 0.33%. The service was recruiting for part time registered nurses to cover weekend shifts. Staff that had recently left the service had retired.

Staff received competency-based training in catheter care, communication, oral care and wound care. Health care assistants had additional training on assisting with medicines, however this was not currently in the remit of their role. All training was delivered by a senior nurse, qualified training provider / assessor or an experienced staff member who had completed the relevant training and who was competent at the level required for this skill.

Staff had regular supervision and appraisals, whereby 91% of staff had received an appraisal within the last year. There was an induction programme which lasted for 6 months. We spoke to 1 member of staff who said they were supported through this programme with regular meetings and were helped to access policies and procedures. They felt supported by their line manager.

The service followed safe recruitment processes. We reviewed recruitment files for employees and found the service was compliant with Schedule 3 of the Health and Social Care Act.

Volunteers said they felt supported in their role and could approach anyone with questions or concerns. Volunteers were trained in a range of areas.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. All hospice areas were clean, had required furnishings and were well-maintained.

Cleaning records were up to date and demonstrated hospice areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing. The service carried out infection prevention and control audits which showed good adherence to infection prevention and control practices.

Staff wore uniforms. There was a uniform policy which described how staff should be bare below the elbow and included instructions on the correct temperature to wash uniforms to ensure they were thoroughly cleaned and free of pathogens. People said staff were always clean and tidy.

Waste was disposed of in an outside bin and there was a specific yellow bin for personal protective equipment in the hospice office area.

We scored the service as 3. The evidence showed a good standard. The service did not manage people’s medications, this was led by the district nursing team. However, health care assistant staff were trained in medicine management and registered nurses were able to administer just in case medication.