Nottinghamshire Hospice

Updated 24 February 2017

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 was 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 28 November 2016 and was unannounced.

The inspection team consisted of two inspectors and a specialist advisor (SpA). A specialist advisor is a person who has up to date knowledge of research and good practice within this type of care service.

Before the inspection, we 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 they plan to make. The provider returned the PIR and we took this into account when we made our judgements in this report.

We looked at the information we held about the hospice such as notifications, (which are events that happened in the hospice that the provider is required to tell us about), and information that had been sent to us by other agencies such as service commissioners.

We spoke with 12 people who used the hospice services and three relatives both during our visit to the day therapy centre and by telephone. We looked at five people’s care records. We also spent time observing how staff provided care for people using the day therapy centre to help us better understand their experiences of care.

We spoke with the organisation’s Chief Executive Officer, the registered manager, two qualified nurses, five healthcare assistants, two volunteer workers, a student nurse and two administrative staff members. We looked at nine staff files, supervision and appraisal arrangements and staff duty rotas. We also looked at records and arrangements for managing complaints and monitoring and assessing the quality of the hospice services.

Updated 24 February 2017

We inspected Nottinghamshire Hospice on 28 November 2016. The inspection was unannounced.

The hospice provides care and support for people with life limiting conditions and those who are nearing the end of their lives. The provider operates a day therapy centre which can support up to 35 people each day and a hospice at home service. The hospice at home service can provide support from nurses and healthcare assistants across a 24 hour period within the county of Nottinghamshire. The hospice also provides a range of therapies and counselling and bereavement services. These services are available to people who use other hospice services and their family members and loved ones.

There was an experienced registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 family members spoke highly of the compassionate and personalised nature of the hospice services. They praised staff for their warm and attentive approaches to care and support. They told us staff were knowledgeable and skilled and this inspired confidence in the services.

The emotional and social impact of life limiting conditions and palliative care was fully recognised by service managers and taken into account when planning and developing hospice services. The commitment to providing a holistic service for people and their family members was central to the organisation’s vision.

People were at the heart of the service. They were fully involved in developing and reviewing their own care packages. Family members and those who were important to them were also consulted. Care plans were personalised and took account of people’s preferences and wishes, including those related to the end of their lives.

People’s consent was sought before any part of their care package was delivered by staff. Staff were aware of how to provide support for those people who were not able to give their consent, either by following the wishes and decisions they had set out in advanced care planning discussions or by following the guidance of the Mental Capacity Act, 2005 (MCA). This meant that people’s rights were protected.

People were protected by robust systems to manage their health, safety and welfare. Staff followed detailed risk management plans when providing care and support. They demonstrated a clear understanding of how to recognise and report any situation that may put people at risk, including those situations which may be abusive in nature. Medicines were managed in a safe way and people received all of the healthcare and nutritional support they needed.

There were effective systems in place to recruit, train and support staff. This included volunteers. This meant that there were enough suitably skilled staff to provide the support and care people wanted and needed.

Strong leadership and effective management systems promoted a culture of continuous improvement, openness and inclusiveness. Learning from mistakes and listening and responding to people’s views was embedded in this culture. A programme of audits designed to monitor the quality of services supported this approach. This meant that people would benefit from services that were flexible, responsive and could be tailored to their needs.