The Prince of Wales Hospice

Updated 10 December 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 03 and 04 October 2016. The first day was unannounced. The inspection team consisted of two adult social care inspectors.

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.

We also reviewed the information we held about the home and requested feedback from other stakeholders. These included Healthwatch Wakefield, the local authority safeguarding team and the Clinical Commissioning Group; they did not have any information of concern to share with us. After the inspection we also contacted eight other healthcare professionals involved with people using the hospice. Those that responded all gave very positive feedback.

During the inspection we spoke with people, their relatives and care staff to get their feedback about the hospice. This included 4 people who were inpatients, nine people’s relatives, one visitor, the clinical services manager, the medical director, the chief executive, the deputy chief executive/facilities manager, an administrator, the inpatient ward manager, a deputy inpatient ward manager, seven other care workers (including nurses, a student nurse, a bank nurse and health care assistants) and a nurse providing outpatient services. We also spoke with an occupational therapist, a social worker, an activities coordinator and the chaplain, all of whom were based at the hospice.

As part of the inspection we looked at four people’s care files, which included their risk assessments, care plans and medicine records. We also inspected three care staff recruitment records, staff training records, appraisal documents, audit and monitoring records and various policies and procedures related to the running of the service.

Updated 10 December 2016

We inspected The Prince of Wales Hospice on 03 and 04 October 2016. The first day of the inspection was unannounced, which meant the service did not know we were coming.

The hospice was last inspected in October 2013. We found it was compliant in all the aspects of care we inspected at that time.

The Prince of Wales Hospice provides specialist palliative care, including symptom control, respite, and end of life care for people with life limiting diseases and other progressive illnesses. The hospice is run by a registered charity which has a volunteer board of trustees. There are 14 inpatient beds and a day care service; care staff also provide a 24 hour/seven day a week advice line for people living in the community, carers and healthcare professionals. On the first day of our inspection there were six inpatients; two more were admitted on the second day.

The hospice is located in a residential area of Pontefract. The building is all on ground floor level. There is a car park and reception area to the front of the building, with separate areas for day care, inpatients and administrative activities. All inpatient bedrooms are ensuite and had French doors to allow patients to access a patio and garden area.

During summer 2016 the hospice had undergone significant refurbishment and improvement. At the time of our inspection this work was nearly complete, with nine inpatient beds available. The service planned to have the other five inpatient beds ready for admissions within the week following our inspection.

There was no registered manager in post. The last registered manager left in December 2015. A clinical services manager had been appointed in February 2016; they were in the process of applying to be 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.

Medicines were managed and administered safely by staff. People told us they had access to pain-relieving medicines when they needed them. Staff were encouraged to report any medicines errors so lessons could be learned.

Risks to people had been assessed and managed appropriately. Regular safety checks had been completed on the building, facilities and equipment used to support people. We saw the hospice was clean.

People and their relatives told us there were sufficient care staff deployed to meet people’s needs. Our observations supported this.

Procedures for the recruitment of new staff at the hospice were updated shortly after our inspection to make them fully robust. A system was in place to ensure nursing staff had the correct professional registration.

Hospice staff could describe the forms of abuse people might be vulnerable to and told us they would report any concerns appropriately.

Staff received a comprehensive programme of induction and training. Annual appraisals were recorded but staff said supervisions had not been happening regularly. The clinical services manager was in the process of sourcing supervision training and improving their oversight of staff development.

Care staff members’ knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) was good. We saw capacity assessments and best interest decisions in people’s files. The service considered and documented whether care provided constituted a deprivation of people’s liberty.

Feedback about the food and drinks at the hospice from people and their relatives was extremely positive. The cook was knowledgeable about the nutritional needs of people receiving palliative and end of life care and could describe the needs of individual inpatients.

People had access to a team of healthcare professionals based at the hospice. People’s holistic healthcare needs were discussed daily during the week and a consultant could be reached over the telephone for advice at all times.

A programme of refurbishment had been completed shortly before our inspection. The inpatient bedrooms we saw were of a high standard. Other modifications to the building had been made to meet the specific needs of the people using the service.

People and relatives told us staff were caring and respected their dignity and privacy. We saw staff supporting people to remain independent and observed warm and positive interactions between staff and people. Staff respected the wishes of people and their relatives in terms of the subject of discussions they wanted to have and those they did not.

Care plans showed people and their relatives were involved in designing their care and people had signed consent forms when they were able. Care plans encompassed people’s spiritual and emotional needs, as well as their physical needs.

The service used national guidance to ensure the palliative and end of life care provided was evidence-based and of a high standard. Staff could recognise when people needed advocacy services and knew how to make referrals if they needed to.

People’s care files contained risk assessments and care plans which met their assessed needs. Daily records were shared between the team of healthcare professionals providing care; we saw they were detailed and evidenced people had been supported according to their care plans.

People had access to a range of activities at the hospice. Complementary therapies were available to relatives and staff, as well as to the people using the service.

None of the people or relatives we spoke with told us they had ever made a complaint. The hospice sought feedback about the service it provided and we saw improvements were made as a result.

People and their relatives were very happy with the service provided by the hospice. There was no registered manager in post; however, the clinical services manager who joined the hospice in February 2016 had applied to be registered manager.

Three statutory notifications had not been made to CQC in 2016 that should have been. We also found the system of audit in place did not assess day to day aspects of the service for themes and trends in order to identify improvements. The commitment to high level service audit in relation to national guidance and evidence-based practice was impressive.

Staffing had been an issue in early 2016 and we saw this had been addressed. Efforts had been made to assess staff satisfaction and team-building in the summer of 2016 while parts of the hospice were being refurbished. Staff we spoke with gave positive feedback about working for the service.

The hospice worked well in partnership with external organisations and community healthcare professionals. Staff had worked hard to make the hospice welcoming and part of the local community.