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Inspection Summary

Overall summary & rating


Updated 25 June 2016

The inspection took place on 13 and 14 April and was unannounced. Wisdom Hospice is one of a range of services provided by Medway Community Healthcare. The hospice offers specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional and holistic care through a multi-disciplinary team of nurses, doctors, counsellors, social workers, occupational therapists, physiotherapists, spiritual leaders and a range of volunteers. The service cares for people in four types of settings: at the hospice in a 15 bedded ‘In-Patient Unit’; in the ‘Hospice day service’; in people’s own homes; and in hospital, where people received care from the hospital palliative care team, based at Medway Foundation Trust. The service was providing services for 392 people in the hospice and the community 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.

People said that they felt at ease receiving care from the service and relatives reported that people were in safe hands. Ensuring that staff understood how to safeguard adults and children was central to the running of the service. Staff received training and regular updates throughout the year and demonstrated that they knew how to recognise and report potential abuse.

Assessments of risk were individual to people’s specific needs and identified how risks could be minimised. Environmental and health and safety checks were carried out to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements.

Checks were carried out on all staff at the service, to ensure that they were fit and suitable for their role.

People said that there were enough staff available to promptly attend to their needs. The numbers of staff and volunteers available meant that staff had time to give people one to one attention.

Safe systems were in place for the ordering, storage, administration, recording and disposal of medicines.

New staff received a comprehensive induction and received effective support from a mentor. Training was provided which was necessary to their roles and included specialist training in bereavement and end of life care to make sure that they had the right knowledge and skills to meet people’s needs effectively.

People’s health, medical, nutritional and hydration needs were assessed and closely monitored. People’s needs were individually discussed and effectively communicated when the staff team changed on the in patient unit. People were supported by a multi-disciplinary team and referrals were made to other professionals to seek their advice and input when it was required.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes, hospitals and hospices are called the Deprivation of Liberty Safeguards (DoLS). The service manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service

Inspection areas



Updated 25 June 2016

The service was safe.

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.

Protecting people from potential abuse was a priority in the service. Staff were trained in safeguarding adults and children and knew the action to take if they were concerned that abuse might be taking place.

People were supported to take risks in order to realise their wishes and choices.

People�s medicines were managed safely.

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



Updated 25 June 2016

The service was effective.

Staff were trained to ensure that they had the skills and additional specialist knowledge to care and support people at the end of their lives, and to provide on-going care and support to their families.

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

People�s dietary needs and preferences were taken into account and they were encouraged to eat as little or as much of anything they wanted. Meal times were significant social events, which could be shared with other people, staff and/or family members.

The hospice used a multi-disciplinary approach to meet people�s health needs. This included providing people and their families with information, practical assistance and 24 hour telephone support, so that they were able to seek advice at any time.



Updated 25 June 2016

The service was caring.

Staff were friendly, kind, caring and passionate and supported people in a calm and gentle manner. They knew people well and advocated on behalf of people to ensure their individual wishes were taken into account.

The service was highly complimented for the manner in which staff treated people and their family members with dignity and respect.

Providing support to people, and their family members, was key to the service. This included people�s spiritual and emotional needs.

A range of support was available to people�s families and children. It included counselling and bereavement services and support groups, which continued after the death of their loved one.



Updated 25 June 2016

The service was exceptionally responsive.

People were fully involved in planning their care, treatment and support, which reflected their choices and preferences. Advanced care plans detailed where and how people wanted to receive their care. Staff went �the extra mile� to respond to people�s psychological needs.

The service had received a large number of compliments about the outstanding way it had responded to people�s needs. At the end of life, people were enabled to experience a comfortable, dignified and pain-free death.

Staff knew how to respond to people�s emotional needs and enhance their sense of creativity and self-esteem. Innovative and creative activities were offered which helped people reflect on and plan their lives through the use of art, creative writing and memories.

Information about how to make a complaint was available and people were able to �text� their concerns. When complaints had been received, they were used to learn lessons and drive improvements in the service.



Updated 25 June 2016

There was an open culture where people and their relatives were asked for their experiences and they felt supported.

There was a clear management structure. Staff understood the vision and values of the service and how to put these into practice. They felt well supported and were motivated to provide individual care to people at the end stage of their lives.

There was a robust system to maintain and monitor the quality of the service which was effective in driving continuous improvement. When shortfalls were identified, action was taken to improve the quality of service and care.