Willow Wood Hospice

Updated 29 November 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.

The provider was given 48 hours’ notice because we did not wish to impact on the day to day running of the service and wanted to enable nursing staff to be available to speak with us.

On the day of the inspection there were two adult social care inspectors, a specialist advisor in end of life and palliative care and an expert by experience who had experience of caring for someone at the end of their life.

Before the inspection, the provider 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. Before the inspection we reviewed the information in the PIR as well as all the information we held about the service, this included notifications of significant changes or events.

Prior to the inspection we contacted external health care professionals and commissioners of the service from the Clinical Commissioning Group (CCG) by email. We did not receive any responses to our requests.

At the time of our inspection visit there were eight people who used the in-patient service and there were people using the day hospice on a sessional basis. We attended the daily multi-disciplinary team meeting with medical staff, nurses and other heads of department.

During the visits we spoke with 11 staff, this included the chief executive, the registered manager, the medical director, human resources manager, the head of house-keeping, the chef, the lead for day services, nurses, and health care assistants. We also spoke with two in patients, three relatives, three patients who used the day service and four volunteers.

During the inspection we reviewed a range of records. This included people’s electronic care records, including care planning documentation and medication records. We also looked at staff files, including staff recruitment and training records, records relating to the management of the hospice and a variety of policies and procedures developed and implemented by the registered provider.

Updated 29 November 2016

Willow Wood Hospice provides in-patient hospice care and a day hospice from one site. The hospice holds condition specific clinics, has a bereavement support service, therapy services, a fundraising department and a team of volunteers all based on-site. The hospice delivers physical, emotional, spiritual and social holistic care through teams of nurses, doctors, counsellors, a chaplaincy/ spiritual care team and complementary therapists.

The inpatient facility accommodated up to twelve people and provided 8 single rooms and 2 double rooms. At the time of the inspection there were eight people using this service. The service also had its START day clinic where people could attend for a variety of therapies and activities.

The service is a registered charity with a board of trustees. Day to day the service was run by a management team drawn from all departments within the hospice.

There was a registered manager employed for this service. 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. The registered manager was experienced in providing palliative care and worked for the organisation for a number of years.

People and professionals spoke highly of the complementary therapies that were available to both people who used the service and their relatives. The hospice provided family support, counselling and bereavement support. We also saw the service helped people carry out specific wishes such as helping someone get married and providing a wedding dress from one of their hospice charity shops to ensure people and their relatives could achieve their wishes.

People told us that staff were caring, compassionate and listened to them. People we spoke with who received personal care felt the staff were knowledgeable, skilled and their care and support met their needs. We found during the inspection that the people using the hospice services were placed at its centre and were treated very much as individuals and with respect and compassion. People and their relatives told us staff understood their specific needs.

Care plans in regard to all aspects of people’s medical, emotional and spiritual needs were personalised and written in partnership with people so their preferences were made clear. Staff delivered support to people respecting these wishes and preferences about their care and life choices.

People’s health care needs were met by the in-house medical team. This included consultants, GP’s with a special interest in palliative care, an occupational therapy team and a physiotherapy team. We saw the service’s medical team had established links with international services in relation to sharing knowledge and experiences about palliative care and regularly published research in the field.

Care plans were personalised to include people’s wishes and views. People and relatives told us they were consulted about their care and treatment and that they regularly had the opportunity to speak to medical and nursing staff. Care plans were regularly reviewed in a multi-disciplinary framework. We observed staff caring for patients in a way that respected their individual choices and beliefs. We did feedback to the service that information about the hospice for people of different faiths and ethnicity could be displayed more prominently.

Staff recruitment processes were followed with the appropriate checks being carried out. There were sufficient staff on duty to meet people’s needs. We were told by some patients that they sometimes had to wait longer for pain relief or support at night time. Staff we spoke with told they felt there were enough staff and that the registered manager would step in if needed. The hospice had a bank of staff who they could contact if they needed additional staff. Staff and volunteers received a thorough induction and regular training to ensure they had the knowledge and skills to deliver high quality care and support.

Staff followed risk assessments and guidance in management plans when providing care and support for people in order to maintain people’s safety.

People were protected by the service’s approach to safeguarding and whistle blowing. People who used the service told us that they were safe, could raise concerns if they needed to and were listened to by staff. Staff were aware of safeguarding procedures, could describe what they would do if they thought somebody was being mistreated and everyone knew who the safeguarding lead was within the service.

Staff told us they were very supported by their direct line management and could get help and support if they needed it at any time. Staff received regular group supervision and appraisals, but feedback told us the group supervision called ‘well-being meetings’ could be more structured. Staff members told us they felt part of a caring team and were proud to work for the hospice.

Staff worked within the principles of the Mental Capacity Act where appropriate and explained to us the process for making any best interests decisions with people. People had choices about their care and their consent was sought by staff.

People were supported to receive a nutritious diet at the service. Their appetite was assessed through talking to them which led to staff being able to give the person the type and amount of food they would be able to eat. There was a choice of menu on the day we inspected and drinks and snacks were available at any time. The service also provided a café for people, families and staff to enjoy a drink or snack.

The staff undertook the management of medicines safely and in line with people’s care plans. The service had health and safety related procedures, including systems for reporting and recording accidents and incidents. The care records we looked at included risk assessments, which had been completed to identify any risks associated with delivering the person’s care and their environment.

The registered provider had a system in place for responding to people’s concerns and complaints. People and families were asked for their views and were involved in a group that considered ideas and developments at the service.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the in-patient unit had a very positive culture and the registered manager who was called the matron was very approachable and supportive. Feedback we received from in-patient staff indicated relationships could be improved in relation to communication with senior hospice management.