Sue Ryder - Leckhampton Court

The hospice at Leckhampton Court has a 16-bed in-patient unit, a day service and a hospice at home team. It provides support for people over the age of 18 who have life limiting conditions such as cancer, heart failure, lung disease and degenerative neurological illnesses. The hospice at home team helps people to stay at home longer or to die at home if this is their preferred place of death. The service also offered respite for carers. The expert care team included doctors, nurses, health care assistants, physiotherapist, occupational and complementary therapist, social workers, bereavement support workers, volunteer befrienders and spiritual care workers. The various services provided by the hospice worked in conjunction with people’s own GP, community district nurses, and other health and social care professionals.

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.

A hospice service was provided for end of life care in the last couple of weeks, symptom control, emotional and physical crisis. From the in-patient unit 50 percent of people would go home after a short stay and may return at a later date and 50 percent would die in the hospice. The hospice at home service was mainly provided for people in the last two months of life, however this service had helped people with degenerative neurological conditions for longer periods.

All staff including volunteers received safeguarding adults training and nurses and care staff received safeguarding children training. This meant they would be able to recognise if people and children they came into contact with were being harmed and would know what to do to report those concerns.

The nurses and health care assistants were trained on how to use equipment correctly to safely move and transfer people from one place to another. Any risks were identified and management plans put in place. Any other risks to people’s health and welfare were identified during the assessment of care needs and were then well managed. Safe recruitment procedures were followed to ensure that only suitable staff were employed. The service had the appropriate procedures in place to protect people from being harmed.

The numbers of staff on duty in the in-patient unit were determined by the number of people who were receiving care and support and the complexity of their needs. The hospice at home team had a flexible workforce (bank staff) in order to be able to increase capacity and accommodate the demand for their service. The team endeavoured to always meet any referrals for a service and would pull out all the stops to support those in need.

All staff had a programme of mandatory training to complete. This enabled them to carry out their roles and responsibilities effectively. Volunteers also had to complete some of these training sessions. There was a comprehensive induction training programme for all new staff plus a programme of refresher training for all other staff. This ensured they had the required skills and qualities to provide a compassionate and caring service to people and their families. .

On admission to the in-patient unit people’s capacity to make decisions was assessed and where possible they were supported to make their own choices and decisions. Staff received training regarding the principles of the Mental Capacity Act (2005) and these were understood. They ensured consent was given prior to providing any care and support. Where people lacked the capacity to make decisions because of their condition or were unconscious they worked within assumed consent but checked with healthcare professionals and family members before providing care and support.

People in the in-patient unit were provided with a well-balanced and nutritious diet. Alternatives were always available in order to meet people’s specific needs and an out of hours menu was available for those who needed to eat, outside of planned meal times. People in their own homes were assisted to eat and drink where this was required.

Health and social care professionals referred people to the hospice service when they needed in- patient care, and provided an overview of their medical and nursing care needs. Hospice at home staff received referrals for their service from the district nurses and the person’s GP and liaised with them as and when needed whilst they were providing a service. Staff worked in partnership with healthcare professionals and families to be supportive and provide an effective service.

All staff who worked for the hospice had the qualities and skills required to provide sensitive and compassionate care and support to the people they were looking after. The staff developed close working relationships with the people they looked after and their families. The hospice received glowing feedback from families post bereavement and examples of these are detailed in the main body of the report. The hospice service not only cared for the people they looked after but also looked after the staff. Staff were emotionally well supported by their colleagues and the managers.

People’s care and support needs were assessed and they were provided with person-centred care. Regular reviews of people’s needs ensured their care plans were revised as often as necessary. People were involved in making decisions about how they were looked after and in the case of the hospice at home service, the support their family would find beneficial. There were secure communication systems in place for the hospice at home staff so that changes in people’s health status was reported back to the team and to the district nursing services.

The service was well led. There was a team of experienced managers and heads of department in post, all committed to providing a high quality service that was safe, effective, caring and met people’s needs. The prevalence of any events such as accidents, incidents and complaints were monitored and analysed to identify trends and enable the service to prevent a reoccurrence. Where things had not gone as expected by families and an individual experienced contentious or complex issues at end of life, the staff looked at the reasons why and looked for lessons they could learn for the future. There was a continual programme of audits in place to drive forward any service improvements needed.

Feedback from people who used the in- patient service, the day therapy service and the hospice at home service was gathered and used to measure how people felt about the care and support they received. All feedback was used to drive forward any improvements. A service user group was set up 18 months ago and feedback gathered from this group had led to a number of changes being implemented. These are listed in the main body of the report,

The service worked in partnership with other hospice care providers, took part and led on research projects. The partnership arrangements enabled the service to share good practice with other care providers and improve medical and nursing standards of care for people who were at the end of their lives or living with a life limiting condition.

People's care was provided according to their assessed needs and risk assessments were reviewed regularly. We found that communication between different shifts and staff groups was effective. Working practices, including handover at the bedside and checking medication charts, contributed to maintaining safety and people's welfare. Appropriate information was obtained from other providers including GP's and hospital services before people's care and treatment started. This meant that the most appropriate service could be offered for each person.

Everyone we spoke with felt that the staffing numbers were right and that there were enough staff to meet people's needs. People told us that generally they did not have to wait for assistance from staff and staff did not appear rushed while working. One person said, 'If I ask for something it's no problem'. Another person said, 'Very, very special people work here'.

Quality improvement and assurance processes were robust. These systems had identified where improvements were needed, for example in care plan documentation. Plans were in place to address the identified shortfalls.

We spoke to six people. They all gave us very positive comments including 'The care and staff are excellent, I can't fault it', 'this place is inspirational', 'it's superb, the staff and service is very good', 'I know the staff and they know how to look after me'. Monthly surveys from relatives also gave a very positive impression of the care, facilities and staff.