Katharine House Hospice

Updated 21 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 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 the 11 May 2016 and was unannounced and we returned on the 12 and 20 May 2016.

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

We reviewed information the provider had sent to us which included notifications of significant events that affect the health and safety of people who used the service.

We sought the views of health and social care professionals within the wider community who work in collaboration with the hospice and its staff.

We spoke with nine people who used the service and five relatives who were visiting.

We spoke with the Director of Care Services [registered manager], the Matron, the Chief Executive, PA to the registered manager, advanced nurse practitioner for day therapies, community services manager, occupational therapist, social worker, voluntary services officer, Sister of the in-patient unit, the medical director, head of human resources, the Chaplain and the facilities health and safety manager. We spoke with clinical staff, which included, nurses and health care assistants. We spoke with people who had lead responsibility for infection control and tissue viability.

We reviewed three people’s care plans to see how their support was planned and delivered. We looked at a six people’s medication records to check medicines were managed safely. We spent time observing staff interacting with people and their relatives.

We also looked at the recruitment files of three members of staff, a range of policies and procedures, maintenance records of equipment and the building, quality assurance and clinical audits and the minutes of meetings.

Updated 21 July 2016

This inspection took place on the 11, 12 and 20 May 2016 and was unannounced.

Katharine House Hospice is registered to provide care and support to people in relation to symptom control, pain relief, assessment and end of life care.

Katharine House Hospice in-patient facility caters for up to 10 people, accommodated within two four bedded bays or an individual room. The hospice service provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, psychological, social and spiritual care through teams of nurses, doctors, counsellors, chaplains and other professionals including therapists and social workers.

Katharine House Hospice provides a Hospice at Home Service, which provides palliative care within people’s own homes, which is provided by health care assistants.

Katharine House Hospice has a day therapy service, which provides an opportunity for people to meet and take part in a range of activities. The day therapy service in additions provides facilities for counselling and bereavement support, chaplaincy services, occupational therapy physiotherapy and complementary therapies.

Katharine House Hospice had 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.

People told us that they felt safe at the service and that they had confidence in the staff. The service was committed to promoting people’s safety across all levels of staff within the organisation and included advising the Board of Trustees of safeguarding concerns and ensuring staff at all levels, including volunteers and administration staff received training on protecting people from potential abuse or avoidable harm.

Risks to people were assessed and where potential risks had been identified these were minimised in consultation with the person. The provider promoted people and their relatives’ safety by providing leaflets and opportunities to take part in groups where information could be shared to reduce risk, for example in falls prevention.

The provider had robust systems to monitor risk which was facilitated by staff within the service with specific roles, such as infection control and tissue viability that undertook audits and reported the outcome to the Board of Trustees, where recommendations were considered and acted upon. The provider had a system to ensure that the premises of the hospice and its equipment were maintained to ensure peoples safety and any issues identified acted upon in a timely manner.

People’s medication needs were discussed by health professionals to manage and support people’s symptoms and pain management. And information in the form of a leaflet was provided to people, which included information when medicines were not being used for their usual indications. Medicines were regularly reviewed and audited to ensure they met people’s needs. A community pharmacist and pharmacy technician provided a medicines supply service and medicines advice to staff or people using the service, to ensure people received their medicines in a safe and timely manner.

People and their relatives were confident in the knowledge and skills of the staff that provided their care and support. Staff told us that they had access to training which enabled them to understand the needs of people and provide effective care and support. Staff said that they received planned and proactive support that enabled them to deal with the difficulties and challenges in providing care to people and their relatives with life limiting conditions and who required end of life care.

There were effective systems in place for all those involved in people’s support and care to share and communicate well, both within the hospice and community services, which included the hospice at home service. Regular meetings were held involving health and social care professionals to promote the effectiveness of people’s care by working collaboratively.

The staff of the service supported people within the community through services which included the hospice at home service, which provided respite care to people and their relatives. Volunteers provided psychological and social support to ensure a positive and open relationship between the hospice services was maintained when people were at home and so that changes to people’s needs could be identified and responded to.

People in some instances accessed the day therapy facility. People told us that the day therapy facility enabled them to meet with people in similar circumstances and found the service to provide social support. The day therapy facility included services for people and their relatives, to promote people’s well-being and independence. These included to complementary therapies and an environment where physiotherapist and occupational therapists could assess and support people.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care. People and their relatives told us they were fully informed about their care and support and were involved in all decisions as to their treatment.

All of the food was freshly prepared and the meals provided catered specialist diets where required. People within the in-patient unit and day therapy service spoke positively about the quality of the meals and how any individual requests for food and drink were met.

People and their relatives were consistently very positive about the caring and compassionate attitude of the staff. They told us they were satisfied with the care, which they said they would not in their view be able to manage without. We found staff to be very motivated and enthusiastic and demonstrated a commitment to providing the best quality and end of life care in a compassionate way. People’s wishes for their final days were respected and staff told us how they continued to care for people following their death.

People and their relatives were supported by a range of individual and group services provided by the hospice staff and volunteers. People spoke of the benefits of these groups in providing practical information along with emotional support.

Staff respected people’s spiritual needs and people told us they received the religious and spiritual support they wanted and needed. Relatives told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. Bereavement support was available to people and their families and friends. This provided emotional and practical support to those who required it.

People were fully involved in assessing their care and treatment needs and their wishes and preferences were incorporated in planning how those needs were to be met. Regular reviews of people’s care were held and people and their relatives were involved in discussions about their health to ensure their wishes were known. The hospice at home service worked in a range of individual ways to support people and their relatives when at home, this included support by telephone and social support provided by volunteers. In addition staff worked with health care professionals within the wider health community to provide care to enable people to remain within their own home as per their wishes.

The management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. The Board of Trustees and the management team demonstrated a strong commitment to providing people and those closest to them with a safe, high quality and caring service and promoted high standards. The service actively encouraged and provided a range of differing methods and opportunities for people who used the service and their relatives to provide feedback and comment about the service in order that they could influence the service and continue to drive improvement.

The service is open and transparent providing a range of information within the service and on its website, which includes the outcome of surveys and audits undertaken and their response to improving the service. There are systems in place to enable people to make comments and ask questions about Katharine House Hospice, which includes the use of social media.

Staff worked closely and in partnership with external health and social care professionals and other national organisations to improve the service within the hospice and health provision in the local community and nationally.

The Board of Trustees is committed to the development of the service and takes an active part and interest in all aspects of service provision through regular meetings, participation in audits and the reviewing of reports provided by managerial staff within the hospice.