Harlington Hospice

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harlington Hospice on our website at www.cqc.org.uk.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider's premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of fluid in body tissues). The service is located in welcoming and comfortable premises with a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider did not have any inpatient services and offered three different types of care packages to support people in their own homes. At the time of our inspection there were 12 people receiving care in their own homes.

The 'Homesafe Night Service' provides a maximum of three nights' of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person's needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The 'Home2Assess' service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by healthcare assistants.

The 'End of Life Care at Home Service' is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people's needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people's assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service is required by legislation to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The service had been without a registered manager since January 2017 and was recruiting to this post. The nominated individual had recently applied to the CQC to become the registered manager for the service until a new manager was appointed.

Improvements had been made with the medicines management for people using the service and medicine administration records were being correctly completed and monitored. Auditing and monitoring processes had improved to ensure each aspect of the service was being monitored and action taken to address any shortfalls identified.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist

community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider's premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of fluid in body tissues). The service is located in welcoming and comfortable premises with a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider does not have any inpatient services and offers three different types of care packages to support people in their own homes. On the first day of inspection 21 people were receiving care in their own homes.

The 'Homesafe Night Service' provides a maximum of three nights' of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person's needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The 'Home2Assess' service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by healthcare assistants.

The 'End of Life Care at Home Service' is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people's needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people's assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service is required by legislation to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The previous registered manager deregistered in January 2017 and recruitment was ongoing for a new manager. The nominated individual was applying to register with the CQC as an interim measure.

Medicine administration records were not always completed fully and records did not always contain an explanation of any omissions of medicines.

Although monitoring and auditing had improved and the findings from the last inspection had been addressed, further improvements to ensure all aspects of the service were captured within the monitoring processes were required. We have made a recommendation relating to this. The nominated individual was aware of this and work was ongoing to ensure monitoring processes were made robust.

Procedures were in place to safeguard people against the risk of abuse. Staff understood what constituted abuse and knew to report any concerns. There was a complaints procedure in place and complaints were thoroughly investigated and responded to so they were robustly managed.

Procedures were being followed to ensure only staff suitable to work with people were recruited. Staff were available to meet the needs of people using the service and people received their care in a timely way. Risks to individuals had been assessed and plans were in place to mitigate any risks identified.

Staff received the training they needed to provide them with the skills and knowledge to care for people effectively. Supervision had been taking place and staff received individual and group supervisions to support their learning and development. Staff respected people’s rights to make choices about the care and support they received and knew to report if a person’s mental capacity deteriorated.

Where required staff provided people with assistance with food and drink to help meet their nutritional and hydration needs. The service worked with other health care professionals to ensure people’s health needs were being met.

People confirmed staff treated them with respect and were friendly and kind. Staff took the time that was needed to meet people’s care and support needs. Staff knew the importance of treating people well and providing kind and compassionate care.

Staff respected people’s right to receive the care they wanted in a person-centred way so their individual needs were met. Care records were not always personalised and work was ongoing to address this.

The service sought the opinions of people, relatives and stakeholders about the service so they could take action to improve. Action was taken to address any areas identified for improvement. Regular staff meetings were held and provided staff with the opportunity to meet and discuss good practices and learning and identify any areas for work.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of medicines management. You can see what action we told the provider to take at the back of the full version of the report.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider’s premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of lymph fluid in body tissues). The service is located at a welcoming and comfortable premises, which contains a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider does not have any inpatient services and offers three different types of care packages to support people in their own homes. Twelve people were receiving nursing or personal care at home on the first and second days of the inspection; however, due to the distinctive nature of the home care schemes there were six people using the service on our final visit. Sixty-six people were using the Lymphoedema therapy service.

The ‘Homesafe Night Service’ provides a maximum of three nights’ of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person’s needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The ‘Harlington Care’ service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by health care assistants. The ‘Palliative Care at Home Service’ is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people’s needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people’s assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service had a registered manager in post, who held the Clinical Lead position within the organisation and is a registered general nurse. 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. During the inspection the registered manager informed us that she was due to resign as registered manager and take on another position within the organisation.

People told us they felt safe using hospice services although some practices were not consistently safe. Staff knew how to protect people from the risk of abuse as they understood the provider’s safeguarding policy and had received suitable training. However, we noted that there had been an incident that potentially placed a person at risk that was not reported to the local safeguarding team. People and relatives understood how to make a complaint and the records for complaints investigations showed that the provider appropriately responded to complaints, which included monitoring staff performance and disciplinary action where required.

Comments from people and relatives showed they were happy with the reliability of staff and they felt staff were properly trained and supported to carry out their roles. Although the provider was able to demonstrate that staff were safely recruited on the final day of the inspection, we found the filing system for staff personnel records was disorganised and essential information to verify the rigorousness of recruitment practices was not available when we first checked how staff recruitment was conducted. Records showed that staff attended a range of relevant training; however, there were no formal systems in place to demonstrate that staff received regular one to one supervision, and annual appraisals of their performance and learning and development needs.

Staff had received medicines training; however the provider had not obtained written evidence for all nursing staff to show they had completed syringe driver training and an annual assessment of their competency to manage syringe drivers.

People using the home care services were protected as risks were identified and managed. However risk assessments written by district nurses were not consistently read by the provider to ensure their staff understood these risks and the required actions to take to mitigate the risks. The provider had not developed risk assessments where necessary for people who used the day centre services at the hospice.

People’s human and legal rights were understood and respected by staff, who were familiar with their responsibilities in regards to the Mental Capacity Act (MCA) 2005. The provider had developed positive relationships with local health and social services and supported people where necessary to meet their health care and nutritional needs. People were consulted by staff as part of the care planning for the Palliative Care at Home Service, the care and support plans for people using the Homesafe Night Service and Harlington Care were developed by the district nursing service.

The provider had systems in place to regularly seek people’s feedback about the quality of the service, which had been very positive. The registered manager supported staff in the community and carried out risk assessments for the Palliative Care at Home Service, and accompanied staff to visit people if there were complex issues to discuss. However, we found there were noticeable environmental issues at the premises and a lack of monitoring of care practices that needed to be addressed in order to promote people’s safety and wellbeing. The provider had already created innovative projects to support local people and was engaged in strategic planning with other voluntary sector organisations in order to broaden its scope of services.

We have found two breaches of Regulations in relation to the provider not supporting staff with formal and regular one to one supervision and an annual appraisal, and the provider not demonstrating robust systems to assess and monitor the quality of the service delivered to people.

You can see what actions we told the provider to take at the back of the full version of the report.

We spoke with five people who use the service, one relative and nine staff. The staff included the nominated individual, the manager, two referral coordinators, two registered nurses and three health care assistants. The people using the service and relative we spoke with were present at the day centre during the inspection.

People were happy with the care and support they received, and said staff listened to them and treated them with dignity and respect. Care was planned to meet people's needs and wishes and staff understood the care and treatment people required.

People received care from a team of health and social care professionals, so that all their needs could be identified and they could receive appropriate care and treatment. There was communication between staff working for the service and other healthcare professionals to ensure people received continuity of care.

Staff had the knowledge and skills to care for people effectively and undertook training and updates.

There was a complaints procedure in place. People said they would feel confident to raise any concerns, and that these would be addressed.

Comments we received about the service included, 'they are just like a family'.nothing is too much trouble', 'very welcoming' and 'a wonderful place.'

Comments received by the service from relatives of those who had been cared for by staff included, "you are an amazing group of people" and "we could not have managed without them. Their support was invaluable."

During this inspection we found that the provider had made improvements and was now meeting the relevant regulation.

People were assessed so their needs and wishes were identified and care could be planned to meet them. People said staff treated them with respect and maintained their privacy and dignity. Systems were in place to ensure staff had the information they needed to be able to care for people effectively. People were happy with the care provided and enjoyed the companionship provided in the respite centre.

Safeguarding procedures were in place and were being followed. Medicines were administered by registered nurses with the training and knowledge to do so safely. Staff recruitment procedures were in place but were not always being followed. The different areas of care provision within the service were being appropriately staffed and staff had the knowledge and skills to care for people effectively.

Systems for monitoring and quality assurance were in place and work was ongoing so the service would be monitored regularly and action taken to address any issues identified. Surveys had been carried out in March 2012 and the responses were positive. Comments included 'treated my relative with utter respect', 'extra caring (staff)' and 'we could not have coped without your excellent support'.