Weston Hospicecare

Updated 21 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was announced and was undertaken by two inspectors, a specialist advisor and an expert by experience. The specialist advisor was a nurse who had experience in working in a hospice care environment. An expert by experience is a person who has had a family who has used this type of service in the past. The previous inspection of Weston Hospicecare was in February 2014. There were no breaches of the legal requirements at that time.

Prior to the inspection we looked at the information we had about the service. This included notifications that had been submitted by the service. Notifications are information about specific important events the service is legally required to report to us. The Provider Information Record (PIR) was shared with the inspection team during the inspection. This is a form that asks the provider to give some key information about the service, tells us what the service does well and the improvements they planned to make.

We received feedback from five health or social care professionals prior to our inspection. We had asked them to tell us about their views of the service. Their comments have been included in the body of the report.

During our inspection we spoke with two of the five people who were staying in the in-patient unit and five relatives. We spoke with 19 members of staff including qualified nurses, health care assistants, heads of departments. We also spoke with the registered manager and the chief executive officer.

We looked at care records and the newly introduced electronic care records for five people, five staff employment records, training records, policies and procedures, audits, quality assurance reports and minutes of meetings. During our inspection, we looked at the systems in place for managing medicines; spoke to six members of staff involved with prescribing and giving people their medicines and looked at five people’s medicines charts.

Updated 21 February 2017

This inspection took place on 14 December 2016 and was announced. We gave the registered manager 48 hours’ notice of the inspection because we wanted key people to be available for the inspection team.

Weston Hospicecare has a 10 bedded hospice ward, a day hospice service and a well-being centre providing complementary therapies. It provides support for people over the age of 18 who have life limiting illnesses such as cancer, heart failure, lung disease and degenerative neurological illnesses. When our inspection took place the hospice ward was only able to accommodate up to seven or eight people at a time because of the available medical cover. There were five people being supported by the hospice at the time of our visit.

The hospice staff team included doctors, nurses, nursing auxiliaries (NA’s), occupational and complementary therapists. The family support team consisted of the chaplain, a bereavement counsellor and a team of trained volunteers. The community nurse specialists were attached to specific GP surgeries and provided support and advice to people living in their own homes or care homes. The various services provided by the hospice worked in conjunction with people’s own GP, community district nurses, and other health and social care professionals.

There was a registered manager 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.

We found that some improvements were required with the management of medicines although there was no breach in the regulation. The improvements were in respect of people’s individual medicine records, storage of medicines and some of the checking systems that were in place. The service were advised of the need to make improvements in this area during the inspection and assured us that action would be taken.

All staff including the volunteers received safeguarding adults training as part of their mandatory training programme. Ward staff and the community nurse specialists also received safeguarding children training. This was because they may be supporting or looking younger people who have children. This meant they would be able to recognise if people and children they came into contact with were being harmed and would know what to do to report those concerns.

The nurses and NA’s were trained how to use moving and handling equipment safely. Safe management plans were written to ensure people were moved correctly and not harmed. Any other risks to people’s health and welfare were identified during the assessment of care needs and were then well managed. Safe recruitment procedures were followed to ensure that only suitable staff were employed.

The numbers of staff on duty in the hospice ward was calculated according to the number of people being supported and the level of complexity of their care and support needs. At the time of the inspection the service did not have sufficient medical cover to look after 10 people at the same therefore the maximum number of people was limited to seven or eight. The hospice had recognised the need to adhere to this limit to ensure safe staffing levels.

The hospice had a programme of mandatory training for staff to ensure they had the knowledge and skills to carry out their roles. The volunteers who gave their time to the hospice also had to attend some of these training sessions. New staff had an induction training programme at the start of their employment. The measures the hospice had in place ensured all staff had the required skills and qualities to provide a compassionate and caring service to people and their families.

On admission to the hospice ward people’s capacity to make decisions was assessed. Where possible people were supported to make their own choices and decisions. The name of the staff member completing the assessment appeared on the electronic record when inputting data. Staff received training regarding the principles of the Mental Capacity Act (2005) and ensured consent was given prior to providing any care and support.

People in the hospice ward and those attending the day hospice were provided with a well-balanced and nutritious diet. Alternatives were always available in order to meet people’s specific needs. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

The staff developed close working relationships with the people they looked after and their families. People and their families said the staff were kind and caring and looked after with compassion and sensitivity. The hospice received overwhelmingly positive feedback from families and examples are written in the main body of the report. The hospice service not only cared for the people they looked after but also looked after the staff. Staff were emotionally well supported by their colleagues and the managers.

People were provided with person-centred care and support because their individual needs were assessed. They were involved in having a say how they wanted to be looked after. Their care and support needs were regularly reviewed. People and their families were encouraged to have a say about the service and to make suggestions about how things could be done differently.

The service was well led. There was a team of experienced managers and senior staff, all committed to providing a high quality service that was safe, effective, caring and met people’s needs. The was a programme of checks in place to drive forward any service improvements needed.

Feedback from people in the hospice ward and used the day hospice service was gathered and used to measure how people felt about the care and support they received. All feedback was also used to make changes to the service and make improvements. The service worked in partnership with other hospice care providers in order to share good practice with other care providers and improve medical and nursing standards of care for people who were at the end of their lives or living with a life limiting condition.