Background to this inspection
Updated
3 February 2015
Our inspection team consisted of two inspectors, a pharmacist inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses services. The expert by experience on this inspection had experience in elderly care.
Prior to our inspection we checked the information we held about the service and the provider. We also asked the provider to complete a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements that they plan to make.
We spoke with 17 people who used the service and five relatives. We also spoke with eight nurses, a physiotherapist, eleven members of care staff, three managers, two volunteers and two health professionals who accessed the service on behalf of their patients.
We observed the care people received in communal areas and we visited three people who used the community services in their own homes whilst staff reviewed their needs.
We looked at 11 people’s care records to see if their records were accurate and up to date. We also looked at records relating to the management of the service. These included audits, health and safety checks and minutes of meetings. We also looked at the results of the most recent satisfaction surveys that had been completed by 1078 people who used the service or their relatives.
Updated
3 February 2015
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
Our inspection was unannounced which meant the service and staff did not know we were visiting.
The Douglas Macmillan Hospice provides care and treatment to people using the 28 bedded inpatient unit, three community led beds, the hospice at home service, the domiciliary care service and outpatient clinics. People may also receive support from the hospice's ambulance transport service and a telephone advice line. All these services provide specialist palliative and end of life care to people with progressive, advanced disease and a limited life expectancy. The hospice also runs a day therapy unit that provides a service for up to 25 people per day. This service falls outside of our regulatory role, therefore we did not include this in our inspection.
At the beginning of our inspection there were 26 people using the inpatient unit, three people were using the community beds, 708 people were using community and outpatient services and 37 people were using the domiciliary care services. There were 75 people using the hospice’s transport service to access the day therapy unit, and in the two weeks prior to our inspection 175 calls had been made to the telephone advice line.
Care and support was provided within the hospice environment and within people’s own homes dependent upon their care preferences and needs.
The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
People and their relatives told us they were very happy with the care. We saw that people were treated with dignity, respect and compassion. People were involved in the planning of their care which meant their care preferences and choices were identified so they could be met by the staff.
People were safe because there were effective systems in place to help manage the risks posed to people. For example procedures were in place to protect people from the risks associated with medicines and the risk of falling.
There were sufficient numbers of staff to meet people’s individual needs and keep people safe. Volunteers were innovatively used to help manage the risks posed to people and to improve the effectiveness of the care.
The staff and volunteers were trained to provide the specialist care people required. A holistic approach to care was used which meant the staff treated the whole person and their family rather than only treating the person’s medical condition. People’s health and wellbeing were closely monitored so they could receive the right care at the right time.
The staff worked closely with other professionals and services so that people received consistent care. The staff responded positively and inclusively to people’s changing needs and the diverse needs of the local population.
The staff worked with people on an individual basis to plan their end of life care. When people required end of life care, it was provided with the aim of achieving a private, dignified and pain free death.
The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.
Managers regularly assessed and monitored the quality of care by completeing audits and seeking feedback from people who used the service and the local community. The service actively engaged in project work and research to identify best practice and make improvements in care.