Sue Ryder - Manorlands Hospice

Updated 3 November 2016

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 visit was carried out on 30 August 2016 and was unannounced. On 12 September 2016 we carried out telephone interviews with people who used the service.

The inspection was carried out by two adult social care inspectors, a pharmacy inspector, a specialist advisor in palliative care and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service, in this case palliative care services.

Before the visit we reviewed the information we held about the service, this included notifications of significant changes or events. We contacted Heathwatch and the Airedale, Craven & Wharfedale CCG (Clinical Commissioning Group). Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

The registered provider completed a provider information return (PIR) prior to the inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

During the visit to the hospice we spoke with two people who used the service and two relatives. We spoke with 11 staff including the registered manager, the support services manager, the ward manager, a doctor, nurses, health care assistants, social workers and the chef. Following the site visit we spoke by telephone with seven people who were being supported in the community.

We looked around the hospice and looked at various records which included people’s care records, medication records, staff recruitment files, training records, meeting notes and other records relating to the management of the service such as maintenance records and policies and procedures.

Updated 3 November 2016

The inspection was carried out on 30 August 2016 and was unannounced. On the day of inspection there were seven people receiving care and treatment on the in-patient unit and the hospice was supporting approximately 200 people in the community.

Sue Ryder Manorlands provides palliative care and complementary therapy services to support people with life-limiting conditions which can involve complex physical or psychological problems. The hospice offers support to people living in Craven, Airedale, and Wharfedale as well as central, northern and western areas of Bradford. The hospice has a 16 bed in-patient unit, a day therapy unit and a team of specialist nurses who support people in the community. This inspection did not include the day therapy unit.

The last inspection was carried out in September 2013 and at that time the service was meeting all the regulations inspected.

The hospice had a registered manager in place. 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.

There were systems and processes in place to protect people from the risk of harm and people told us the service was safe. Staff had been trained and understood the different types of abuse. They knew how to recognise signs of abuse and how to report any concerns about people’s safety and welfare.

The building was clean and well maintained. Checks were carried out on the premises, equipment and installations to make sure they were safe. Risks to people’s safety and welfare were identified, assessed and managed.

Staffing levels were kept under review and there were enough staff to provide people with the care and support they needed in a timely way. The hospice employed a multi-disciplinary team of health and social care professionals. The recruitment procedures were robust and all the required checks were completed before new staff started work. This helped to protect people from the risks of receiving care, support and treatment from staff unsuitable to work with vulnerable adults.

People’s medicines were managed safely and people told us they were able to have their medicines when they wanted them.

There was a comprehensive programme of staff training which showed staff were supported to develop their skills and knowledge. Staff had annual appraisals and had the opportunity to attend reflective sessions which were led by the Chaplain.. The arrangements for clinical supervision had changed recently and we found some staff were unclear about the arrangements and the provider’s expectations.

The hospice was working in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We found staff understood their responsibilities. There was a multi-disciplinary approach to assessing people’s capacity to understand and make decisions about their care and treatment. We found appropriate referrals had been made when people lacked capacity to consent to their care and treatment. This helped to make sure people’s rights were protected.

We found people were asked for their consent to care and treatment and their wishes were respected. This included their right to refuse interventions.

People’s nutritional status was assessed and their dietary needs and preferences were catered for. People were offered a variety of food and drinks and snacks were available outside of set meal times.

People had access to the full range of health and social professionals and complementary therapists. Everyone we spoke with told us they were extremely satisfied with the support they received. People who used the community services told us they had full access to the out of hour’s services and praised the effectiveness of the communication between the different teams. They said the fact that the out of hours team knew about their individual circumstances was very reassuring.

Everyone we spoke with told us they were treated with respect, compassion and kindness. People were involved in discussions about their care and treatment and given time to make decisions. The family support team provided practical and emotional support for people who used the service, their carers and children.

People’s needs were assessed. We found the hospice was responsive to people’s individual needs and the care which people received was person centred. However, this was not always reflected in people’s care records. The management team had identified this and were addressing it.

People told us they knew about the complaints procedure but told us they had never any reason to complain. The provider obtained feedback from people who used the service in a variety of ways which included leaflets and notices in the hospice and real time surveys carried out by volunteers.

The provider had systems in place to assess, monitor and improve the quality of the services provided. However, we found these systems were not always as effective as they should be. When we looked at the action plan from the providers audit in June 2016 we found some actions which had been marked for completion within one month were still outstanding.

We found there was one breach of regulation. You can see the action we asked the provider to take at the back of the full version of this report.