Archived: Thames Hospice - Windsor

Updated 7 July 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 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.

We inspected Thames Hospice – Windsor on 9 and 10February 2016. The inspection was unannounced which meant that staff and the provider had not been informed about our visit.

The inspection team consisted of five members: two adult social care 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 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 within required timescales. The PIR was used as a prompt to follow-up a specific areas on inspection, and support our findings.

During the inspection we observed how staff interacted with people using the service. We spoke with four people who were provided with care and support by the service. We interviewed the chief executive officer, the registered manager, the human resources officer, the clinical educator, and the pharmacist. We spoke with inpatient staff, including five nurses, six health care assistants and one volunteer.

Updated 7 July 2016

This inspection took place on 9 and 10 February 2016 and was unannounced.

We had last inspected this service in July 2013. That inspection had found the service had been meeting all the legal requirements in force at the time.

Thames Hospice - Windsor is a 17 bed inpatient unit delivering end-of- life care as well as assessment, care and treatment to people with life-limiting illnesses. People receive care and treatment at Thames Hospice when their condition is too severe for outpatient treatment and the symptoms cannot be relieved if they stay in their homes. People are also provided with care on a respite basis. At the time of our inspection 15 people were using the hospice service.

The registered manager has been in post as Director of Patient and Family Services for 10 months and has been the Registered Manager from 9 December 2015. 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 safely stored. However, we were not assured that medicines were always stored within their recommended temperature ranges, or appropriately ordered. We did not see that people had experienced any negative outcomes as a result of these shortfalls.

People said that they felt safe receiving care from 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. They also demonstrated that they 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 recognised risks could be minimised. Environmental and health and safety checks were carried out to ensure that the environment was safe and that the equipment was in good working order. There were systems in place to review accidents and incidents enabling relevant improvements to be made.

There was a robust recruitment process and staff had undergone induction when they commenced their employment. Checks were carried out on all staff at the service to ensure that they were fit and suitable for their role. These included interviewing applicants and undertaking criminal record/barring checks and character references. Staff told us that they received support and supervision from their line managers. They understood their roles and responsibilities, as well as the guiding values of the hospice.

People said that there were sufficient staff available to promptly attend to their needs. Staff displayed patience in their interactions with people and relatives. They did not rush people and were ready to give support to them and their family members. Staffing levels were flexible and suited people’s individual needs.

Staff had been given training in safe working practices. They were provided with any personal protective equipment such as disposable gloves and aprons that were needed to keep them safe while handling potentially harmful substances but also to stop germs being passed on . Effective systems were in place to monitor and prevent cross infection at the service.

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.

The legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

The staff and volunteers were trained to provide the specialist care people required. A holistic approach to care was promoted within the service. It assumed that staff should look after each individual and their family rather than simply attempt to treat the person’s medical condition. People’s health and well-being were closely monitored so that they could receive the right care at the right 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.

People were supported to express their views, expectations and wishes regarding all aspects of their care. Each individual had a plan of care which covered their support needs and personal preferences. We saw the care plans were evaluated on a daily basis. This meant staff were provided with up- to-date relevant information. People were supported to take part in therapies and treatments to help them maintain their physical and emotional well-being.

We saw evidence that the delivery of the end-of-life care involved promoting sensitivity, dignity and respect. People’s wishes and expectations were taken into account, noted and acted upon.

Thames Hospice - Windsor had established positive contacts with other professionals who ensured effective delivery of specific care to people whenever they needed and wanted it. The service was responsive to people’s needs and continually looked for ways to improve. Feedback was used in a constructive way to enhance the quality of the service.

There was a strong management team who listened to and supported staff and volunteers working for the service. There was a clear clinical governance structure in place that involved staff at all levels to establish and maintain the best possible care for people.

There was an open culture and people were kept informed of changes that might affect the service. Staff and managers gave people opportunities to express their views and concerns and provided support to reduce people’s anxiety.

The registered manager used the findings from the quality audits to take action to improve the service. The management team adopted a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews.