The Katharine House Hospice

Updated 18 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The objective of the inspection was 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.

We inspected Katharine House Hospice on 19 and 20 June 2017. The inspection was unannounced.

The inspection team consisted of three inspectors, a pharmacist inspector, an expert-by-experience and a specialist advisor. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. A specialist advisor is someone who has up-to-date knowledge and experience of working in a specific field. The specialist advisor who participated in this inspection had an extensive knowledge and experience in palliative care. Palliative care is a holistic, multi-disciplinary approach to providing patients with relief from the symptoms of a life-limiting illness such as pain and stress.

Before the inspection, the provider had 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 improvements they plan to make. We reviewed the PIR and other information we held about the service prior to our inspection. This included the notifications we had received from the provider about significant issues such as safeguarding, deaths and serious injuries. The provider is legally obliged to send us this information within required timescales. The PIR was used as a prompt to follow up specific areas at the inspection and to support our findings.

During the inspection we observed how staff interacted with people using the service. We spoke with seven people who used the service. We talked to the registered manager, the chief executive officer, two doctors, and the pharmacist. We spoke with the in-patient unit staff, including the in-patient nurses’ manager, three nurses, three health care assistants and three volunteers.

We looked at the care files for six people who used the service. We also looked at the documentation concerning medicines handling, including medicines administration records for four people. We observed a handover meeting where medical and nursing staff shared information about the care and treatment of people using the service. We were present at two Multidisciplinary Team Meetings (MDT). An MDT is a meeting of a group of professionals from different clinical disciplines who together make decisions regarding the recommended treatment of people.

We looked at a selection of documentation relating to the management and running of the service. These included six staff recruitment files, training matrix, staff rotas, minutes of committee groups meetings, surveys, quality assurance audits and record relating to the maintenance of the equipment.

We completed a tour of the building to look at how hygiene and cleanliness were maintained.

Updated 18 August 2017

This inspection took place on 19 and 20 June 2017 and was unannounced.

We had found three breaches of the regulations at our previous inspection in March 2016. Quality assurance systems in place were not effective in assessing, monitoring and improving the quality and safety of services provided. The registered person did not report notifiable safety incidents. Staff did not always receive supervision to enable them to carry out the duties they are employed to perform. At this inspection we looked to see what measures had been taken to improve the quality of the service and whether these had been effective. The provider told us that all the actions required to meet the regulations had been completed by the end of March 2017 as scheduled in the actions plans. During our inspection on 19 and 20 June 2017 we found that most of the required actions to improve the service had been completed.

Katharine House Hospice provides palliative and end-of-life care, advice and clinical support to adults with life-limiting illnesses, their families and carers. The hospice delivers physical, emotional and holistic care with the aid of teams of nurses, doctors, counsellors and other professionals including therapists. The hospice runs a 10-bed in-patient unit and accepts admissions for end of life care, symptom control and respite care. At the time of our inspection six people were in the unit. The hospice also provides community services designed to support people in their own homes. At the time of the inspection the hospice was providing support to 160 people in their own homes. The hospice’s day service welcomes up to approximately 30 people per week and was being used by six people during our inspection.

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.

The service did not have a business continuity plan. Although some emergency cases had been taken into account in different risk assessments, there were no contingency plans to address such issues as a data breach, adverse weather conditions or a pandemic. Staff we spoke with did not know who to contact in case of an emergency if the registered manager was not available.

A range of audits were in place to monitor the health, safety and welfare of people. However, relevant actions were not always taken to address the issues identified by the audits. Therefore, we were not confident that the quality monitoring system was effective and provider could act on the findings of the audits in a timely manner.

Staff told us they received regular supervision, but the supervision meetings were not recorded by the provider. As a result, we were not able to determine how effective the supervision meetings were. We couldn’t find out whether appropriate action was taken to act on issues raised at the meetings either.

Medicines were safely stored and those requiring refrigeration were stored within their recommended temperature range. Nurses recorded the administration of medicines on medicine administration charts including prescribed creams applied by care workers. Staff had the skills needed to effectively manage people's medicines and ensure they were administered safely to people.

People said they felt safe receiving care provided by the hospice. Staff had been trained in safeguarding adults and received regular refresher courses. Staff gave clear explanations of the different types of abuse to be aware of and knew what steps to take in the event of any suspicion of abuse.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs and showed explicitly how the risks could be minimised. The service carried out environmental and health and safety checks to ensure that the environment was safe and that the equipment was in good working order.

Accidents and incidents were recorded and monitored to identify how their recurrence could be prevented.

Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people's individual needs and to respond flexibly to changes.

Staff received the training they needed and were highly motivated to undertake their roles and deliver sustained high quality care. People were extremely confident and positive about staff’s abilities to meet their individual needs.

The service manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had made applications under DoLS to ensure that people were not deprived of their liberty unlawfully.

Staff provided meals that were in sufficient quantities and met people's needs and choices. People and their relatives praised the food they received and they enjoyed their meal times.

The hospice provided a relaxing, comfortable, clean and attractive environment. There was a quiet reflective area in the sanctuary and well-maintained gardens where people could spend their time.

Staff were aware of people’s individual needs and the support they and their family members required. We saw that people were provided with care by staff who were kind and compassionate. People and their families spoke very highly about the service.

Staff were highly motivated and committed to providing people with the best possible palliative and end-of-life care. The service had received a large number of compliments concerning the kind, compassionate and caring manner of the staff team. People told us staff dedicated their time to listening to people and never rushed them.

The service had a holistic approach to caring for people at the end stages of life. Supporting the person and their family members was seen as key to their well-being. Family members received support after the death of their beloved ones and bereavement counselling was offered to them. People's spiritual needs were met and there was a range of different complementary therapies available to people.

People's needs were thoroughly assessed before and at the time of being admitted to the service. The staff team ensured that care and support were offered in a timely way, and services were offered as flexibly as possible to suit people's needs.

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' various needs were fully met. Clear information about the service, the facilities, and the complaints procedure was made available to people and visitors. People told us they knew how to make a complaint if they had any concerns.

There was an open culture at the hospice where people and their relatives were encouraged to share their experience of the service. Staff understood the ethos and values of the service and knew how to put these into practice. They felt valued, listened to and well supported. This resulted in the staff team being motivated to give a high standard of care to people.