Archived: John Taylor Hospice

Updated 9 August 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 25 May 2016 and was unannounced. Further phone contact was made with people using the hospices community services on 1 June 2016.

The inspection was carried out by one inspector, a member of the CQC medicines team, a specialist advisor and an expert by experience. The specialist advisor had the experience working as a nurse within the field of palliative care. An expert by experience is a person who has personal experience of caring for someone who has used this type of care service.

Before our inspection we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. The registered manager had submitted the information as we requested.

We also reviewed the information we held about the service including notifications of incidents that the provider had sent us. Notifications are reports that the provider is required to send to us to inform us about incidents that have happened at the service, such as accidents or a serious injury.

We contacted commissioners from a number of local Clinical Commissioning Groups (CCG) who had commissioned the service to provide care to people from their own locality to ask for their views on the service. The CCG is responsible for buying local health services and checking that services are delivering the best possible care to meet the needs of people.

We spoke with eight people who used the hospice services, five relatives and 21 staff members. This included a volunteer, a student nurse, the ward manager, an administrator, a locum consultant, a clinical medical specialist a chef, the registered manager, the day hospice manager, the director of corporate and clinical services and the chief executive officer.

We reviewed three people’s care records, to see how their care was planned and delivered. We spent time observing how staff interacted with people and their relatives. We also looked at other records related to people’s care and how the service operated. This included five people’s medicines records, two staff recruitment records, meeting minutes, quality assurance documents, clinical and environmental audits and records of complaints.

Updated 9 August 2016

This inspection took place on 25 May 2016 and was unannounced. Further phone contact was made with people using the hospices community services on 1 June 2016.

John Taylor Hospice is an independent community interest (social enterprise) company providing palliative and end of life care, advice and clinical support for adults with life limiting illness and their families. The hospice delivers physical, emotional and care from a multidisciplinary team of nurses, doctors, counsellors and other professionals including therapists. The hospice has a 16 bedded in-patient unit that accepts admissions for terminal end of life and palliative care, symptom control and respite care. At the time of our inspection there were people receiving care and treatment in the inpatient unit. The day hospice service offered a range of care and treatment to people diagnosed with life limiting conditions. This included specialist clinical advice, courses, complimentary therapy sessions and clinics. The hospice community service supported people in their own homes via included the hospice at home team which supported on average eight people and the clinical nurse specialist team who supported up to 300 people. The hospice also provided patient transport services and a health symptoms management programme.

The manager was registered with us as is required by law. 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.

Staff followed the guidance provided within risk assessments when providing care and support for people in order to maintain their safety. Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. People were given their medicines in the right amounts at the right times by properly trained staff. Accident and incident reporting procedures were in place and all clinical incidents were investigated and the findings were shared with all levels of staff. Regular checks and audits of the safety of the environment were routinely undertaken. The provider had effective recruitment processes in place. Daily cleaning schedules were completed by housekeeping staff.

Staff received all the training that was required for them to work effectively and to support them to provide the best quality of care. The provider offered the same level of development opportunities to staff at all levels who worked at the hospice. A comprehensive induction programme for newly appointed staff was provided that included training, shadowing opportunities and a period of supernumerary practice. Staff were suitably supported in their roles and attended regular one to one meetings with their line manager. Staff were able to discuss when Deprivation of Liberty Safeguard applications should be made and provided us with specific examples of when this had been necessary. DNACPR decisions or 'do not attempt cardiopulmonary resuscitation' were clearly documented and they outlined who had been involved in the discussions. People were supported to receive a nutritious diet at the service. When people needed specialist healthcare support, this was easily accessible to people as the hospice employed a variety of healthcare professionals such as occupational therapists, physiotherapists and a dietician.

People and relatives were very positive about the care provided by the hospice and spoke of the friendliness, approachability and empathy of staff. Staff were happy with the caring approach displayed and working practices adopted by the provider. People were well supported through times of discomfort, fear or distress. People were involved in making decisions about the care and support that they received and staff communicated well with them. People were supported to maintain relationships with people who were important to them. People had access to services which provided support and counselling with regards to their emotional, spiritual and religious needs. People were enabled to be as independent as possible and were treated with dignity and respect in all aspects of the support staff provided. Information people needed was made available to them in the format that suited them best was made available to people.

People received the care and treatment they needed when they needed it and which met their individual needs. People were supported to make advanced plans for their future care, including their preferred place of death. A wide range of therapies that were additional to medical and nursing care were available to support peoples’ relaxation and general wellbeing. Staff were creative and proactive in ensuring that peoples’ wishes were met. People had access to outdoor space and were supported through the services provided to socialise and get involved in activities. The provider offered pre and post bereavement counselling and advice about the practicalities of losing a loved one. Staff provided personalised care, spending time with people to discuss a management plan for their symptoms. The provider was keen to meet the local needs of people as well as the wider community, through identifying areas where gaps in provision or service existed and working with others to reduce these. People living with dementia were being supported to maintain their independence by being cared for in an environment that met their needs more effectively. The provider was keen to learn and develop the service it provided from complaints made.

The provider listened to peoples’ concerns and acted on them to improve the experience for all its users. There was a comprehensive program of in-house regular audits such as the incidents and complaints and results were fed into committees and board meetings for consideration and scrutiny. There were effective governance systems in place which ensured that the service people received met their needs and was of good quality. Staff understood the management and leadership structure within the organisation and they were clear about their own roles and responsibilities. People and their families had positive experiences to share with us about the quality of care provided and the values of the service. Staff were fully supported, listened to and involved in the future development of the hospice.