All inspections: The Rotherham Hospice - Care Quality Commission

The hospice is a local charity ‘committed to delivering compassionate holistic care for those with terminal illnesses and their families’. They cared for over 1,700 patients a year. Their services were available to anyone over the age of 18.

Rotherham were the only regional hospice to provide the full spectrum of palliative care services, at no cost to patients and families. The service’s staff and volunteer teams worked together to provide palliative care. This incorporated psychological, physical, social and spiritual support to help patients, and their families to achieve the very best quality of life.

Services included a 14-bed inpatient unit, Hospice at Home, which is the only 24-hour community hospice service in South Yorkshire, day services offering a broad range of therapeutic support, bereavement and counselling services for both adults and children, including dedicated teenage bereavement support, and chaplaincy services with extensive multifaith engagement.

We conducted this assessment due to the provider having an aged rating. We reviewed all case and notification activity from October 2023 up to our assessment date.

On this inspection CQC found the issues and recommendations from our last inspection in March 2019 had been addressed.

All staff and volunteers now had the appropriate level of safeguarding training for their role. Overall staff had achieved 97% safeguarding training compliance.

Hospice leads had clearly planned how to increase future provision to meet demand for their services. All staff were consulted on and understood strategic plans.

Hospice leadership had undergone a transformation since our last inspection in March 2019. Leads had implemented a clear strategic vision (‘Living Life’s Wishes’), modernised governance structures, and ensured robust engagement at all levels.

We also found the following outstanding practice.

Service leads accepted referrals from neurodiverse people. Leads recognised how people experienced bereavement could be different to others. Assistive technology was provided where needed.

The hospice had introduced a ‘Paws at Peace’ kennel service for cats and dogs. This supported the timely care of people’s pets. This reduced delays when admitting people into the service.

Leads and staff had developed and embedded a strong, positive, open, inclusive and forward-thinking culture. Managers proactively worked to challenge the hospice’s legacy culture. This enabled staff to speak out, raise concerns and report incidents more.

The hospice was pioneering community engagement through unique initiatives. Leads prioritised and invested in this area, recognising the needs of their diverse community. The outreach team raised awareness of services whilst developing new and existing relationships. Their vital and varied work tied in with the recently launched strategy’s objectives.

The hospice actively used local census data to analyse patient demographics. This helped staff proactively tailor services to better meet the needs of the diverse communities they served.

Rotherham Hospice is operated by Rotherham Hospice Trust. The service provides hospice care for adults. The hospice cares for over 2,200 patients and their families from across the Rotherham and surrounding areas. Rotherham Hospice is registered as a charitable trust and also receives funding from the NHS.

The hospice has 14 inpatient beds. They also support 200 to 300 people per month in their own homes. We inspected both the inpatient unit and services provided in people’s homes during this inspection.

We carried out an unannounced inspection on 9 and 10 March 2019 using our comprehensive inspection methodology. Our inspection was unannounced (staff did not know we were coming) to enable us to observe routine activity. We inspected all five key domains.

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.

Services we rate

Our rating of this service improved. We rated it as Good overall because;

The service had addressed all of the issues found at our last inspection in 2016 and had continued to monitor these areas carefully.
Medicines were well managed. They were given to patients when needed and recorded appropriately. Those giving medicines had their competencies checked regularly by a medical supervisor.
Care plans put the person and those close to them at the heart of their care and took account of their physical and spiritual needs and choices. Staff completing care plans did so accurately and with people’s active involvement and consent.
The service was responsive to the needs of patients. Good communication between doctors and nurses working in the community and in the hospice itself, meant that moving between services was straightforward and people received joined up planning for their care.
The hospice had a dedicated and responsive staff and volunteer team who protected patients’ privacy and dignity, and ensured they were given enough to eat and drink. People told us that the care they received was good.
The hospice worked well with other organisations to ensure people received good quality care. Strong links with local voluntary groups and the local hospital meant that patients could access the right services for them and those close to them.
The service was supporting local care homes by providing advice and guidance. We saw that less people were being admitted to hospital unneccesarily as a result, and more people were able to stay in their home or care setting if this was their wish.

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

Not all volunteers and staff had the right safeguarding training at the right levels. Trustees had not received training in safeguarding adults, and most staff had not received training in safeguarding children. Although the service supports mainly adults, children visited the hospice daily and therefore staff should have been offered appropriate training.
Not all areas used by patients had call bells so patients may not have been able to summon assistance if they fell or became unwell when alone in these areas.
One of the organisation’s risk registers was not reviewed in line with policy and had not been kept up to date.
People’s experiences, comments and suggestions were not being used in a methodical way to drive service improvements, and further work was needed to ensure that barriers were identified and removed for those who could potentially find it more difficult to access the service.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals, North.

The Rotherham Hospice is purpose built and offers a range of services for the people in area of Rotherham. It is situated on the outskirts of Rotherham town centre and has good transport links.

The hospice has a 14 bed inpatient unit. All bedrooms are single occupancy with ensuite facilities.

The hospice provides a day hospice service and a day therapy and treatment service. The day hospice is open six days a week.

The purpose of the day hospice is to offer support and advice to people, a range of activities, and incorporates therapies such as physiotherapy and occupational therapy alongside complementary therapies and emotional support.

The day therapy and treatment service offers day treatments, such as blood transfusions, to improve symptom control to aid the feeling of “well-being” to enable people to remain independent for as long as possible.

Health and well-being services are delivered in day hospice. The service includes a 12 week group programme focusing on key issues that need to be addressed to aid well-being. Advice is given on areas such as staying active, diet and pain management.

The hospice has counselling, bereavement and psychology services which are available to people, children and their families. People can be seen individually or with their family.

Rotherham Hospice has a 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.

Day-to-day operation of the hospice is delegated by the Board of Trustees to the Chief Executive Officer (CEO). The CEO discharges responsibilities through the Hospice Executive Team.

Specialist palliative care practitioners provide medical cover together with two part time consultants in palliative medicine. 24 hour cover by the medical team is provided.

As part of Rotherham Hospice community team the ‘Hospice at Home’ team support people and their families in their home 24 hours a day. There is also an advice line available to people, their families and professionals 24 hours a day. The line is operated by a qualified specialist nurse who provide advice on the phone or by visiting the person with any concerns or care needs.

Our last inspection at Rotherham Hospice took place in July 2014. Rotherham Hospice was found to be meeting the requirements of the regulations we inspected at that time.

This inspection took place on 15 and 17 August 2016. The inspection on 15 August 2015 was unannounced. This meant staff at the hospice did not know we were coming. On 15 August 2016 nine beds on the in-patient unit were occupied and the ‘Hospice at Home’ team were supporting 23 people.

We found suitable arrangements were in place to help safeguard people from abuse. Staff knew what to do if an allegation of abuse was made to them or if they suspected that abuse had occurred.

The service was not consistently following safe practice surrounding medicines management.

We found people were cared for by sufficient numbers of suitably skilled, competent and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

People were supported to maintain a nutritious diet at the service and people told us about the high quality of the food. There was a choice of menu, drinks and snacks provided.

Staff worked within the principles of the Mental Capacity Act (MCA) where appropriate. People had choices about their care and their consent was sought by staff although this consent was not always clearly recorded.

People, who used the service, and their families, told us that they were supported by caring, kind staff and treated with respect.

Some care plans did not fully reflect the person’s needs. The care plans did not contain sufficient information to identify the person had been fully involved in the initial and ongoing assessment process’s and so were not person centred.

There was a complaints process in place. We found the service had a robust process in place to enable them to respond to people and/or their representative’s concerns, investigate them and take action to address their concerns.

We received positive comments regarding the overall management of Rotherham Hospice from staff, other care professionals, relatives and people who used the service.

There were quality assurance systems and audits in place. However, the systems and audits were not always effective in monitoring performance.

The registered provider was notifying the Care Quality Commission appropriately of notifiable events and incidents.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Our inspection looked at our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were given guidance to ensure that they cared for people safely, and detailed risk assessments and records were in place to ensure people received the care, treatment and support they required. People were cared for in a clean, hygienic environment and were protected from the risk of infection. The premises were safe and fit for purpose.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

Care plans contained assessments of people's care and support needs. These assessments described the steps staff should take to ensure each person's needs were met. Evidence we checked showed that staff were following people's care plans and risk assessments.

Audits and reviews took place to ensure that care was delivered in a way that met people's needs.

Is the service caring?

People we spoke with praised the service. One said: 'They really look after you.' Another person told us: 'I feel like it's tailored around me. It's personalised support that I get because the staff know me well.' We observed that staff interacted warmly and considerately with people.

Is the service responsive?

Where the provider identified areas for improvement, these were implemented. The provider was remodelling the way it provides day services, to better meet people's needs.

Is the service well-led?

There was a quality assurance system in place, where audits of all aspects of the service were carried out. This was thorough, and where action was required we saw it was implemented.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person using the service told us 'staff talk to me about everything they wish to do.'

People were protected from the risks of inadequate nutrition and dehydration. One person using the service told us 'the food here is great; I am well fed with plenty to choose from.'

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People's privacy, dignity and independence were respected. One person using the service told us 'staff always use language I understand'.

People experienced care, treatment and support that met their needs and protected their rights. One person told us, "staff here are fantastic, they are doing a great job". One relative told us 'visiting is not restricted in any way'.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member said 'we have an effective and supportive staff team'.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

The Rotherham Hospice

All Inspections

During an assessment under our new approach

09 - 10 March 2019

During a routine inspection

15 August 2016

During a routine inspection

21 July 2014

During a routine inspection

13 May 2013

During a routine inspection

11 December 2012

During a routine inspection