28 October 2016
During a routine inspection
The service provides a hospice at home service and a day hospice service. For some people ‘out-patient’ appointments were made for them to attend Great Oaks to see complementary therapists, nutritional therapist, a social worker, a nurse or to attend a clinic with doctors or specialist nurses. Other service providers within the Gloucestershire area provide in-patient services. The service is for people with a life-limiting illness. This includes malignant diseases (cancer) and chronic disease management, such as heart and lung failure and progressive neurological conditions. The service was not bound by strict criteria and people were not excluded from a service if they did not have the right condition. There was also an out-reach service where practical help from a volunteer or referral onto other services may be made and various support groups, including bereavement support.
Great Oaks is a purpose built facility, has a pleasant and relaxing atmosphere and is surrounded by beautifully maintained gardens. The service employs nurses, health care assistants, social care and allied health care professionals, complementary therapists and business managers. A team of committed volunteers support the day hospice, maintenance of the gardens and visit people in their own homes for companionship.
There was a registered manager in post. 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.
At the time of the inspection the hospice at home team were supporting seven people. Their care was delivered by trained health care assistants or qualified nurses. This number varied from one week to the next. The criteria for receiving a service was the person was living with a life limiting illness. The majority of service provision was delivered overnight in order to provide relief for families. Health and social care professionals referred people to the service for support and whilst a hospice at home service was provided, the district nurses remained the lead health care professional. Hospice at home staff worked in partnership with the district nurses.
A day hospice service was provided on two days a week and people were allocated a place for 12 weeks on a Tuesday and Friday and on other days the premises were used by a variety of support groups. Examples of these groups included carers support, family support, friendship groups, drop-in coffee mornings, a breathe easy group, MS and MND support groups.
People who used the service were safe. Risks to people’s health and welfare were well managed. Staff were trained on how to moving and handling equipment and had received safeguarding adults training. Safe recruitment procedures were followed to ensure that only suitable staff were employed. The appropriate steps were in place to protect people from being harmed.
Staffing levels were sufficient and adjusted as and when necessary, to ensure people’s needs were met. The hospice at home service had a flexible workforce in order to be able to accommodate demand for their service.
New staff completed an induction training programme and there was a programme of refresher training for the rest of the staff. Staff had the necessary skills and qualities to provide compassionate and caring support to people and their families. Families were assisted with bereavement support by the service where this was needed.
Staff understood the principles of the Mental Capacity Act (2005) and supported people to make their own choices and decisions. Where people lacked the capacity to make decisions because of their condition or were unconscious, the service assumed consent but checked with healthcare professionals and family members before providing care and support.
People were assisted to eat and drink where they needed this level of support. Those attending the day hospice were served a midday meal and given refreshments throughout the day. People had access to a nutritional therapist if there were concerns about diet and fluid intake. Staff liaised with the district nurses and GPs when needed. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.
Staff and volunteers were kind, compassionate and fully respected the people they were supporting. The hospice at home staff developed good caring, working relationships with the people they were looking after and also supported and cared for their families. People were supported to die in their preferred place because the hospice at home service were able to provide a service promptly. These working relationships could be only for a matter of days, but it was evident from feedback we received that these relationships impacted on the family members left behind. The families had extremely complimentary views of this service. Staff were well supported emotionally by their colleagues and managers.
People were provided with a service from Great Oaks that met their own individual needs. The service was delivered in the day hospice or in people’s own homes by the hospice at home team. People were always included in decision making about the support they, and their family needed. The hospice at home staff worked in partnership with the district nurses and other health care professionals. Communication between Great Oaks and other professionals ensured significant information was reported and any changes in people’s health were reported. This meant people continued to be supported in the way that met their needs.
The service was well led with good leadership and management provided by the registered manager and the other members of the senior management team. The service had a regular programme of audits in place. These ensured the quality and safety of the service was monitored so that adjustments could take place where needed.
The staff were dedicated and compassionate about their jobs and totally committed to getting it right. Where they were looking after people at the end of their life they ensured the person had a good death and their families were supported. Where things did not go as well as expected, they reflected on why this had been and took measures to do things differently next time. There was a continual programme of review to drive forward improvements.
People’s views and opinions were gathered using a range of different methods. They were asked how they felt about the service they received and encouraged to make suggestions. The service also received feedback and suggestions from the user group, listened and took action. These measures ensured the service remained appropriate for what was needed.
Great Oaks worked in partnership with other care providers and hospice services in Gloucestershire. This enabled Great Oaks to share good practice with others, to learn from their improvements and improve care for people who were at the end of their lives.