Wigan and Leigh Hospice

Updated 4 April 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 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 5 and 6 October 2016 and was announced. The inspection team consisted of three adult social care inspectors. At the last inspection on 8 October 2013 the hospice was meeting the required standards inspected at that time.

We gave 48 hours’ notice that we would be visiting the service. This was because the service provided a hospice at home service to people in the local community and we needed to arrange to visit people in their own homes. We also wanted to ensure the registered manager would be available to facilitate our inspection.

We looked at information we held about the hospice. We looked at notifications we had received. Statutory notifications are documents that the registered provider submits to the Care Quality Commission (CQC) to inform us of important events that happen in the 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 used the information they had given us to help with our planning.

At the time of our inspection, there were 12 people on the inpatient unit. During the inspection we spoke with the medical director, the chief executive officer, the registered manager, the palliative care education lead, the cook, the receptionist, two volunteers, a ward sister on the inpatient unit (IPU), the senior staff nurse administering medicines, a staff nurse on the IPU, three people receiving services on the IPU, two relatives on the IPU, two occupational therapists, a dietician, three health care assistants, and a social worker. We also spent time with three health care assistants and a nurse working in the community and spoke with one person and their relative, when we visited them at home.

During the inspection we looked at the care records for four people using the inpatient unit and six medicine administration records (MAR’s). In addition we reviewed a range of records relating to how the service was managed; these included five staff recruitment files, training records, quality assurance systems and policies and procedures.

Updated 4 April 2017

This inspection took place on 5 and 6 October 2016 and was announced. We provided 48 hours’ notice of our visit to ensure the registered manager would be available to facilitate our inspection. The service was last inspected on 8 October 2013 and was found to be meeting all the regulations we reviewed at that time.

Wigan and Leigh Hospice is a registered charity, situated in the Hindley area of Wigan. The hospice was founded in 1982. It is an adult hospice for people aged 18 or over and delivers specialist palliative care to people who have a life threatening illness from any disease and who are thought to be in the last year of their lives. The hospice is a purpose built unit and provides ground level accommodation for up to 14 in patients. Facilities included: 14-bed inpatient unit in 14 separate rooms; a patient and visitor lounge; an overnight room for families; a multi-faith room; three complementary therapy rooms; two counselling rooms; outpatient clinics; free of charge car parking; meeting rooms for hire.

Exceptional management and leadership was demonstrated at Wigan and Leigh hospice. Our discussions throughout the inspection demonstrated that there was an open culture which empowered people to plan and be involved in the high quality care provided at this service. This meant that people continuously had a say in how they wanted their care to be delivered. The strong and positive management approach resulted in people receiving a tailored inclusive service which focused on them receiving individualised care.

There was a hospice in your home service provided by a team of nurses, healthcare assistants and volunteers. The team offered one-to-one time with patients and gives practical as well as emotional support alongside hands-on nursing care, including daytime visits and occasional overnight stays. By providing additional support in this way the team enabled more people to stay in their own homes as they come towards the end of their lives.

There was also a team of clinical nurse specialists employed by and based at the hospice who provided support in person or via the telephone advice line.

Medical and Nurse Specialist outpatient clinics were held in the Hospice’s Woodview Centre. They offered specialist assessment or review for patients with complex or rapidly changing symptoms who needed specialist assessment.

There were five hospice doctors of whom four were very experienced in hospice care. In addition there were two registrars on the on-call rota with one doing a half day a week of daytime clinical work at the hospice as well as some teaching. The medical director was part of the leadership team and a member of three hospice governance committees. There were three consultants working at the hospice.

Wigan and Leigh hospice is registered with the Care Quality Commission (CQC) to provide care for up to 14 people on the inpatient unit. At the time of our inspection there were 12 people being cared for and approximately 250 people receiving care and support in the community. Of these 250 people, the manager told us that provision of personal care was limited and they provided more emotional and practical support.

All the people we spoke with during the inspection told us they felt safe when they received care and treatment from hospice staff. There were appropriate policies and procedures in place with regards to safeguarding and whistleblowing. This told staff how they would be supported if they reported poor practice or other issues of concern.

We looked at the way medicines were prescribed and managed at the hospice and found that medicines were managed safely. There were clear, detailed policies and procedures covering the different aspects of medicines management.

There was an accountable officer who submitted reports to the controlled drugs local intelligence network (LIN) and attended LIN meetings. Controlled drugs were handled safely and nurses checked stocks weekly. The accountable officer audited the medicines every six months. Staff were encouraged to report medicine errors so lessons could be learnt and practices made safer.

People and relatives we spoke with in the inpatient unit told us they did not have to wait to receive assistance from staff and that call bells were always responded to in a prompt manner; this was confirmed by our observations during the inspection.

Our review of staff rotas and our observations confirmed there were sufficient numbers of staff on duty to provide the care people required.

We observed that the standards of cleanliness throughout the entire building were very high and everywhere was very clean, tidy and fresh. The hospice premises were subject to monthly checks and results were recorded and acted upon. An infection control committee met regularly to review standards, discuss policy and ensure implementation of appropriate guidelines.

An external contractor had carried out a risk assessment of the premises and provided a report to the chief executive officer. This helped to identify and manage health and safety risks within the premises.

There was an emergency contingency plan in place which included information about what action to take as a result of an unforeseen event.

Regular fire alarm checks were undertaken and water chlorination and Legionella testing was carried out and recorded. All equipment was subject to annual checks or as required as part of their maintenance schedule and comprehensive records were maintained and up to date.

People who used the service and relatives consistently told us they felt staff were well trained and had the skills to provide effective care. They had access to a range of training as part of their on-going development.

Staff completed a period of induction when they started their employment. Volunteers were also required to complete a period of induction and topics covered included specialist palliative care within a hospice setting, confidentiality, responsibilities/boundaries, moving and handling, fire safety, health and safety and safeguarding. Staff were knowledgeable about people and told us that they received appropriate training and support.

Each person had a care plan with regards to eating and drinking. The kitchen staff worked with the dietitians to make sure that food was nutritionally sound and food was homemade.

We saw that teams within the hospice engaged proactively with other professionals to achieve good outcomes for people.

People's legal rights were respected because staff understood their responsibilities in relation to the Mental capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). At the time of the inspection there was nobody subject to a DoLS order. There was a policy and procedure in place for consent to care and treatment. Best interest decision making care plans were in place as required when someone lacked capacity and capacity assessments were completed by doctors.

The building was light and airy and pleasantly decorated with high ceilings and lots of light. People had a spacious individual room and all bedrooms overlooked the garden area.

Everyone we spoke with was positive about the hospice and said that staff were caring and kind. Staff also told us they cared for each other. The same care was applied to making sure staff were aware of patients' communication needs. A section within the care plan noted people's information access needs.

People were encouraged to discuss their care and were involved in advanced care planning. The hospice carried out an initial assessment which looked at their pain, level of comfort, family and their mood. We saw that staff spoke in a quiet tone and ensured they were at the same eye level of the person when talking with them.

When staff were completing advance care plans with people who used the service they discussed with them whether or not they wished to be resuscitated. There was a counselling service at the hospice and the service held placement agreements with local educational establishments and offered placement contracts to student counsellors. The counselling service was involved with bereavement support for people. They supported people to create keepsakes if they wished. The counselling service had identified a need to develop carers groups and was forging links with another local organisation to do that.

There was a focus on people’s spirituality if that was important for them. The hospice had consulted with patients and carers to look at how to make the original chapel more accessible.

There was a team of bereavement support volunteers, counsellors and complementary therapists that could be accessed by anyone linked to a person using the hospice who required it.

We saw that sensitive conversations took place in private with confidentiality fully maintained and information was only shared, with the patient's consent, with those who were authorised to see it.

All the people we spoke with during the inspection told us the hospice had been responsive to their needs, providing them with an excellent service. Care plans were person centred and contained risk assessments where needed with guidance for staff.

Care plans contained contact details for people’s relatives, friends and others and their GP’s. Any allergies were also recorded and noted on people’s MAR charts. Any tasks for the day were visible in people’s care plans.

People’s views about their strengths and levels of independence and health and what their quality of life should be, were taken into account and explanations were given to people about their care plans. There was a range of palliative care information for each person. This identified their clinical diagnosis, resuscitation status, and the’ patient insight’ section identified whether or not the person was aware of their diagnosis. Daily records, which recorded what had happened each day for each person, were completed in a timely manner.

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