This inspection took place on 20 April 2016 and was unannounced. Further phone contact was made with people using the hospices community services on 27 April 2016. Compton Hospice provides palliative and end of life care, advice and clinical support for adults with life limiting illness and their families and carers. The hospice delivers physical, emotional and holistic care through teams of nurses, doctors, counsellors, chaplains and other professionals including therapists. The hospice had a 18 bedded in-patient unit that accepted admissions for terminal care, symptom control and respite care, at the time of our inspection 14 people were on the unit. The hospice day service welcomes up to approximately 72 people per week and was being used by 10 people on the day of our inspection. The hospices community services that supported people in their own homes was provided by the homecare team which at the time of our inspection was supporting 14 people and the clinical nurse specialist service who were supporting approximately 275 people.
The manager was registered with us as is required by law. The registered manager held the role of Quality and Governance Manager within the organisation. 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.
Staff were trained in how to protect people from abuse and harm; they knew how to recognise signs of abuse and how to raise an alert if they had any concerns. There were sufficient staff on duty. Staffing levels were reviewed and adjusted according to peoples’ changing needs. The recruitment process was robust and the provider was as sure, as possible, that staff employed at were suitable and safe to work with people who were cared for by the service.
Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Medicines were prescribed, recorded, administered and disposed of in safe and appropriate ways. People received their medicines in a timely manner and in line with their preferences.
The staff team were highly qualified and experienced; people felt confident in the abilities and skills staff displayed and that they were well trained. The provider had its own training team and ensured staff were kept up to date with all their training needs and were supported in keeping their knowledge and skills updated. New staff were provided with a structured induction. Regular supervision and annual appraisal were used to support clinical and non-clinical staff.
Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and supported people in line with these principles. Staff established consent from people before providing care and supported people to access independent advice and support when necessary. Resuscitation issues were discussed with people or their representative and the appropriate documentation was completed to a high standard.
People were provided with meals that were sufficient in quantity and met their needs and preferences. Staff knew about and provided for peoples’ dietary preferences, restrictions and reduced appetite. People were supported to access all the support they needed in order to maintain their health and wellbeing, including effective symptom management.
Peoples’ right to privacy was fully protected and they were always treated with dignity and respect by all staff and volunteers. People told us they were extremely satisfied with the staff approach and about how their care and treatment was delivered. Staff demonstrated they were kind, compassionate and forward thinking in meeting people’s needs. People were fully involved in the planning of their care, from symptom and pain management to end of life care. Communication within the service was effective and people felt fully informed of their options for care and treatment. People were involved in the planning of activities that responded to their individual needs. A broad range of activities were available that included creative ways to keep people occupied, engaged and stimulated.
Regular multi-disciplinary meetings were undertaken to review and respond accordingly to peoples’ changing needs. The management and staff worked closely with other professionals and agencies to ensure peoples’ holistic needs were fully met. Clear information about the service, the facilities, and how to complain was made available to people and visitors. Complaints received were fully investigated and responded to, with evidence of the provider using them as a learning opportunity in order to make improvements to the service. Peoples’ feedback was actively sought, encouraged and acted upon. People were overwhelmingly positive about the service they received.
Staff were clear about the leadership structure within the hospice and were fully involved in its development. Emphasis was placed on continuous improvement of the service. Comprehensive audits were carried out about every aspect of the service to identify how it could improve. When the need for improvement was identified, remedial action was taken to improve the quality of the service. A variety of regular clinical, governance and senior management and trustee meetings took place to share and review updates about the service. The hospice supported its staff to take on and lead on projects that would benefit people, staff and improve the quality of the service they provided whilst also meeting the needs of the local community.