23, 26 and 27 March 2015
During a routine inspection
The inspection took place on 23, 26 and 27 March 2015. The first visit was unannounced and the other visits were announced. The service was last inspected on 21 November 2013 and was found to be meeting the regulations we inspected.
The registered provider operates both Alice House Trading Limited and Hartlepool and district hospice from the same location. Alice House Trading Limited is a trading subsidiary of Hartlepool and district hospice. We found it operated in line with the hospice’s policies and procedures with some additional local policies where required to reflect the care delivered in people’s own home. Alice House Trading Limited provides a range of services to people in their own homes including, domiciliary care, day care, complimentary therapies and respite care. As well as community services, the service provides eight long stay beds within the same building as the hospice, with people accessing the facilities within the hospice. At the time of our inspection four people occupied the long stay beds.
The service had a registered manager. The registered manager was the same for both Alice House Trading Limited and Hartlepool and district hospice. 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 were actively in control of their own care. They said they received excellent care from kind, compassionate and caring staff who listened to them. People commented: “Very good care”; “I have really good carers, outstanding. I have to say excellent”; and, “Very good, can’t complain.” One person described the way their care was delivered as, “All my choice.” They said, “They [staff] didn’t sit down with me, I sat down with them and said what I would like.” Another person said, “Yes I am in control.”
People told us their staff were, “Brilliant, very kind and caring.” One family member said, “I get good support, I really do.” They also said, “They are a great help. I do appreciate them.”
The service was adaptable and flexible, allowing people living in the community to choose to receive their care at a time suitable to their needs. People received care from a consistent and reliable staff team who knew them well. One person said they were always supported by, “People [staff] who I know.” They said, “Yes, they are reliable and stay for the full length of time.” Another person said staff were always, “On time.” The registered provider had effective recruitment and selection processes to ensure new staff were suitable to work with vulnerable people.
People told us they felt safe. They had been given telephone numbers to contact staff if they needed to speak with anybody. People had been assessed to protect them from a range of potential risks and assessments had been reviewed regularly. For people living in their own home, staff undertook a separate environmental risk assessment.
We found medicines were administered safely and appropriately. Staff demonstrated a good understanding of safeguarding adults and whistle blowing. They knew how to report concerns.
The hospice building, within which Alice House Trading Limited was located, was well maintained and clean. One visiting family member told us, “They [staff] are always cleaning the place, the standards here are impeccable.” People were encouraged to bring important items from their home to personalise their room. There were systems in place to check the hospice building and equipment were safe.
The registered provider delivered a dynamic and constantly evolving training programme. Training available to staff included person-centred care, palliative care and specialist training relating to specific health conditions such as Lymphedema, lung cancer and heart failure. The registered manager told us the provider had invested in providing three days leadership training to all staff within the organisation. This ensured people received care from an effective, cohesive and skilled staff team. Staff told us they received excellent support from their colleagues and managers.
People were always asked for permission before delivering any care. One person said, “[Staff] normally ask for permission. They don’t do anything without asking.” Staff had a good understanding of the Mental Capacity Act (MCA) 2005. Where required DoLS applications had been made to the local authority in line with the requirements of MCA.
People received the care and support they needed to meet their nutritional needs. People were assessed when they were admitted into Alice House to identify any potential concerns with eating and drinking. People gave us very positive feedback about the meals the service provided. Staff told us they were able to cater for people’s special dietary requirements. Staff supported people living in their own homes to ensure they had enough to eat and drink.
The registered provider was forward thinking in its approach and committed to empowering people to take control of their situation. For example, the registered provider was running a unique innovative pilot ‘breathlessness programme’ to support people including those in the local community to self-manage their health condition. People in the long stay beds had access to specialist health professionals both employed by the hospice and external to the service. This meant people could quickly access specialised treatment for complex conditions and symptoms.
There was a strong focus on people’s social and psychological wellbeing. People and family members using the services offered by Alice House Trading Limited were able to access a 24 helpline for advice which was available every day. People could access day services, social activities and therapeutic support in the purpose built holistic wellbeing centre.
People took part in organised activities which they had chosen. One person said, “There is always somebody coming in such as the kids singing and the male voice choir.” They also said, “[Day care] everybody enjoys it.” People were encouraged to remain independent. One person said, “They [staff] take me further than I can get.” People said staff responded to their wishes.
People were actively involved in deciding how they wanted their health and care needs to be met. A ‘holistic assessment’ was used to develop person-centred care plans. Care plans were centred around caring and supporting people to deal with what was important to each person. People were supported to think about their plans for the future, including their preferred place of care and their future care needs. Care plans were reviewed regularly.
People knew how to complain. None of the people we spoke with raised any concerns with us about their care. The registered manager told us they usually received very few complaints. People and family members had opportunities to give their views, through completing postcards and questionnaires. Feedback from the last consultation in 2014 was positive.
The registered manager and all staff were very knowledgeable and enthusiastic about the service. They were passionate and enthusiastic as they spoke about the service and believed in the philosophy and values of the registered provider. Similarly people and family members were very positive about the service.
The registered provider was pro-active about delivering it’s values, as well as being creative and modern in its approach to the services it offered. We found excellent examples of innovation, such as the breathlessness group, the helpline, the wellness centre, contributing to the development of a nationally recognised care pathway and the development of eight long stay beds within Hartlepool and District Hospice. The provider actively shared good practice to improve care for people at the end of their lives. The service had developed and was delivering a specific competency based training programme aimed at care home staff.
The provider had an effective quality assurance programme in place. The audits we viewed were effective in identifying areas for improvement and ensuring action was taken to improve the service. The registered manager told us they looked for opportunities to learn and improve practice and procedures. The registered provider had clear aims and objectives for its future development.