St Oswalds Hospice

Updated 26 January 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.

This inspection took place on 11 August and 4 and 7 September 2015. The inspection was unannounced.

The inspection team was made up of one adult social care inspector; 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.

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 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 within required timescales.

We contacted other agencies such as local authorities, clinical commissioning groups and Healthwatch to gain their experiences of the service. We received no information of concern from these agencies.

During the inspection we toured the building and talked with three people using the service, six relatives, a visiting social worker, and two visiting professionals. We spoke with 18 staff, including the registered manager; the chief executive; the human resources and finance directors; the managers of the adult inpatient and children’s inpatient units; the chaplain; the learning and development, facilities and therapeutic activities managers; and eight nurses and support staff. We ‘pathway tracked’ the care of four people and two children, by looking at their care records and talking with them (or their relatives) and staff about their care. We reviewed a sample of 10 people’s care records; four staff personnel files; and other records relating to the management of the service.

Updated 26 January 2016

This inspection took place on 11 August and 4 and 7 September 2015 and was unannounced.

We last inspected this service during December 2013. At that inspection we found the service was meeting all the legal requirements in force at the time.

St Oswald’s Hospice provides specialist care for people with life limiting illnesses, including day and inpatient services for children, young adults and adults. It provides nursing care. It has 19 beds and had 13 adults and six children living there at the time of this inspection.

The service had a registered manager who had been in post for five years. 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 and their relatives told us they received an exceptional quality of care from all the staff at the hospice. They said staff were wholly and genuinely committed to meeting all their physical, social and emotional needs, in highly person-centred, imaginative and flexible ways. They described a culture that was positive and life-affirming. Typical comments received from relatives included, “This is a marvellous place, even if you were a multi-millionaire you couldn’t pay for the care you get here”; “They’re like a second family, they wrap themselves around you to support you”; and, “They go above and beyond what you get in the community.”

There were very good staffing levels which allowed staff to meet people’s needs in a safe, timely and personalised manner. Extensive use was made of a large team of trained, experienced and dedicated volunteers (many of them qualified) in all areas of the service. This gave hospice staff the space to work with people in a particularly individualised way, and added considerably to the well-being of people and their families. People felt they were fully involved in all aspects of their care and treatment, and that their views were paramount in how their care was given.

The service had a well-defined, dynamic management structure that provided strong, effective and innovative leadership. There was a well-articulated vision for the next ten years’ development of the service. This focussed on breaking away from the traditional model of the hospice, as there was a recognition that many people were not currently receiving the support and care they needed in their own homes. By taking services out into the community and working in partnership with other hospices, hospitals and agencies, the service was developing new ways of supporting a much wider range of people with their end of life care needs.

End of life care was given in sensitive and appropriate ways that acknowledged people’s rights and preferences. The service promoted a ‘focus on living’ approach to care, which supported people and their families to appreciate and enjoy the time they had together and enhance their feelings of well-being. People were given a wide range of social stimulation and activities, supported by trained activities specialists in well-equipped on-site facilities, and could access complimentary therapies. As part of the ‘focus on living’ approach people were encouraged to develop skills and enjoy new experiences. A relative told us, “My perception of places like this was that it was a place you came to die. I’ve changed my perception, it’s far from that.”

There was a shared commitment by all staff to the service’s values of ‘care, compassion, dignity and love’. We found these values to be clearly demonstrated in the approach of staff and in the care given to people and their families. Staff morale was high and they told us that all the management team actively listened to their views, gave them the support they needed and made them feel valued and respected.

The staff team were highly qualified and very experienced. The service had its own training team and ensured staff were kept up to date with all training needs and supported in keeping the knowledge and skills updated. New staff were given structured induction and close mentoring. Regular supervision and annual appraisal were used to support clinical and non-clinical staff.

People using the service and their relatives told us they felt safe and well protected whilst in the service. Staff had been trained to recognise and report any possible issues of abuse. No safeguarding incidents had occurred in the unit since the last inspection.

The service carefully assessed all risks to people using the service and took appropriate measures to control risks. However, people were able to take risks necessary for them to maintain their independence.

All accidents and incidents were recorded and analysed, to allow for lessons to be learned and appropriate steps taken to prevent recurrence.

Regular checks were made regarding the safety of the building and equipment. Staff were given training in safe working practices and were provided with any necessary personal protective equipment to keep them safe. Effective systems were in place to monitor the control of infection.

Robust staff recruitment systems were in place which ensured that only applicants who met the service’s high specifications regarding qualifications, experience, character and caring abilities were employed. This included the recruitment of volunteers who were subject to the same processes as staff employed by the service.

The safe management of people’s medicines was given a high priority. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff had been trained in this important area and were aware of their responsibilities regarding protecting people’s rights. The registered manager submitted appropriate applications to the local authority for authorisation to place restrictions on certain people’s movement, in their best interests.

Effective systems of communication were in place to enable people to express their needs and wishes clearly. People were asked to give their formal consent to their care. Where they were deemed to lack capacity to do this, appropriate ‘best interest’ decisions were made on their behalf, in conjunction with family and professionals.

People were given appropriate support to take a nutritious diet.

People’s general and specific health needs were kept under constant assessment and met, by treatment within the service or by referral to other professionals.

People said their right to privacy was fully protected, and told us they were always treated with dignity and great respect by all staff and volunteers. Staff demonstrated a commitment to maintaining confidentiality of people’s personal information.

Every effort was made to enhance people’s independence whilst at the service. Appropriate mobility and communication aids were available. People were given choice in all aspects of their daily living and were encouraged to express their individuality.

People were fully involved in assessing their care and treatment needs and their wishes and preferences were incorporated in planning how those needs were to be met. Regular reviews of people’s care were held and people were encouraged to take full part in discussing how their needs were being met.

Systems were in place for responding to concerns and complaints, but we found no complaints had been received about in-patient services.

The service worked closely with other professionals and agencies to ensure people’s holistic needs were fully met.

Robust systems were in place to continually monitor the quality of the service being provided and to identify and implement areas for further development. Staff at all levels were genuinely committed to a culture of excellence and demonstrated this in their day-to-day work.

There was clear evidence of close and effective partnership working between families and carers, and between the service and external professionals.