St Wilfrid's Hospice

Updated 6 July 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.

Before the inspection, the provider completed 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 any improvements they plan to make. Before the inspection, we checked this information and other information that we held about the hospice and the service provider. This included previous inspection reports and statutory notifications sent to us by the provider about incidents and events that had occurred at the service. A notification is information about important events which the provider is required to tell us about by law. We reviewed feedback from two healthcare and social care professionals. We used all this information to decide which areas to focus on during our inspection

This inspection took place on 19 and 20 April 2016 and was carried out by one inspector, a registration inspector, a pharmacist inspector and a specialist advisor. A specialist advisor provides specialist clinical advice to the inspection team.

We spoke with a member of the board of trustees, chief executive, the registered manager, three relatives, four people and eleven members of staff. We looked at six care records, four staff records, medication administration record (MAR) sheets, staff rotas, the staff training plan, logs of complaints, quality assurance audits and other records relating to the management of the service.

The service was last inspected 1 October 2013 and no concerns were identified.

Updated 6 July 2016

St Wilfrid’s Hospice is a charity which provides specialist end of life care and support to adults living within the local area. It provides a 14 bedded In-patient beds unit, a day hospice services and a community service. A range of other services are also provided including occupational therapy, physiotherapy, counselling and spiritual care.

The service has a registered manager. 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 cared for by staff who knew how to recognise the signs of possible abuse. Staff were able to identify a range of types of abuse including physical, emotional and neglect.

Systems were in place to identify risks and protect people from harm. Where someone was identified as being at risk, actions were identified on how to reduce the risk and referrals were made to health professionals as required. Risk assessments were centred on the needs of people and were reviewed daily by nursing staff. When people’s risk had changed the assessments were updated to reflect these changes.

People being cared for at the hospice were protected against the risks associated with medicines because the provider had appropriate arrangements in place for the proper and safe management of medicines.

The registered manager compiled a report on accidents and incidents and these were reviewed by the chief executive and reported to the provider's governance team. There was an audit of accidents and incidents which identified trends and patterns, all clinical incidents were reviewed by the registered manager and following investigation an action plan was agreed.

There were sufficient numbers of staff with the required skills and experience on duty to keep people safe and meet their needs. We reviewed the staff rota that confirmed this. Staff told us they felt there were enough staff on duty. People’s needs were responded to in a timely way.

Staff had undertaken appropriate training to ensure they had the skills and competencies to meet people’s needs effectively. Staff received regular supervision and an annual appraisal to ensure that any issues with staff practice or areas for development could be identified and responded to.

People’s rights were upheld as the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) had been adhered to. The registered manager told us that at the time of our inspection no-one was subject to DoLS.

People spoke positively of the food and told us their food likes and dislikes were taken into consideration including their preference on portion size. For people who needed a pureed diet the chef created “moulded meals”. This involved moulding pureed food into the shape of recognisable food. This improved the experience of meal times for people.

There was always a doctor on call including at weekend and overnight. People told us that the community nursing team had regular contact with other professionals involved in their care. This ensured that people received the support and advice they needed and changes to people’s health was monitored and responded to promptly.

People and their relatives spoke overwhelmingly positively about the caring approach of staff. An example of what people told us was “the care you get is exceptional”. People valued their relationships with the staff team and felt they often “went the extra mile”.

Staff were highly motivated to offer care that was kind and compassionate. They placed a high value on building relationships with people and there were examples of how they supported people in a way that ensured they felt understood and valued.

Staff had an in-depth appreciation of people’s individual needs around privacy and dignity. Staff responded to people in an empathetic way while encouraging people to build on their strengths and maintain their independence. People and relatives spoke highly of the focus on promoting people’s dignity.

Bereavement services were tailored to people’s individual needs and were provided for as long as needed. Staff were highly motivated in ensuring that people remained as independent as possible. People were encouraged to set goals and to focus on these goals. Staff felt supported by colleagues and the management team. Staff had the opportunity to reflect on the emotional aspects of their work which helped them to manage their own stress.

People told us that staff were “exceptional” at responding to changes in their needs. People’s care was planned in partnership with them to ensure that their wishes were central to the care provided. Staff also had a good understanding of how people may feel when considering the planning of their care, and they ensured that they responded in an understanding and compassionate way.

People told us that staff involved them in decisions about their care and listened to them if they preferred things done another way.

People and family members were encouraged using a variety of methods to give feedback on the services offered. Feedback was gathered through an Inpatient Unit survey, VOICES survey and evaluations forms from day services and the rehabilitation group.

There was an effective leadership team responsible for the running of the hospice that included the chief executive (the provider), the registered manager and the medical director. Staff spoke positively about the registered manager's style of leadership and told us they led by example. Staff felt valued and motivated to provide a high level of care.

There was an extensive programme of clinical audits including infection control and medicines to ensure that the quality of the care provided was maintained. There was an open culture about reporting and investigating incidents. This ensured that people were kept as safe as possible as risks were identified and measures put in place to reduce the risk of reoccurrence.

The hospice worked in partnership with other organisations to ensure they provided a high quality service. The community nursing team also worked alongside local care homes to ensure that standards of end of life care were upheld for people using these services. The education department ran a series of workshops “Six Steps Programme” which staff delivered to care homes in the local area to improve their understanding of end of life care and improve the outcomes for people receiving end of life care.