Archived: Grove House

Updated 1 June 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 20 and 21 April 2016 and was unannounced.

The inspection was carried out by one inspector, a pharmacy inspector, a specialist advisor and an expert by experience. The specialist advisor had the experience working as a nurse within the community and within the field of palliative care. The expert by experience is a person who has personal experience of having used a similar service or who has cared 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. We also reviewed information that 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 spoke with five people who used the service, four relatives, two volunteers, four nursing staff, two care staff, two service managers, the clinical audit lead and the director of nursing and clinical services who was also the registered manager for Grove House.

We reviewed five people’s care plans to see how their support was planned and delivered. We looked at a selection of medication records to check medicines were managed safely. We looked at a range of policies and procedures, quality assurance and clinical audits and meeting minutes for different departments.

Updated 1 June 2016

This inspection took place on 20 April 2016 and was unannounced. We contacted people and their relatives for feedback about the service on 21 April 2016.

Grove House is registered to provide specialist palliative care, advice and support for adults with life limiting illness and their families in their own homes. They deliver physical, emotional and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The hospice also operated a Day Service however the only service which involved an activity the provider was registered for with the Care Quality Commission was the hospice at home service.

At the time of the inspection there were 55 people using this service. The service provided specialist advice with regards to symptom control and worked in partnership with health care professionals to ensure that people received the best possible support in their own homes. There was a counselling, pre- bereavement and bereavement support offered to families and relatives.

Grove House 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.

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. Staff assessed the risks involved in delivering a service in people`s own homes. Staff communicated any risks to people`s health and well-being to health and social care professionals. They followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. There were sufficient numbers of staff to ensure people received support when they needed it.

The service operated a 24 hour service and on-call system to ensure people received the same support and advice during the day as during the night. This gave people great confidence and comfort. People told us they valued this service and they felt reassured to know they could talk to a member of staff any time during day and night.

People who used the Day Service told us that this service enabled them to meet the staff and form relationships before their condition progressed to a stage when they will use Hospice at Home service. They appreciated the opportunity to meet with people in similar circumstances and was a welcome part of the community support.

People told us that staff understood their individual care needs and were compassionate and understanding and that their cheerful and friendly approach gave them reassurance and made them feel safe. Staff told us they undertook training which enabled them to provide good quality care to people in their own homes.

People’s medicines were administered by trained and qualified staff who had their competency assessed regularly by their manager. Any changes in people`s medication were discussed with health care professionals to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.

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 relatives were very positive about the caring and compassionate attitude of the staff delivering the service. They told us they were completely satisfied with their care and thought highly about staff and management. Staff were very motivated and demonstrated a commitment to providing the best quality end of life care in a compassionate way. People’s wishes for their final days were respected.

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 registered manager was committed to improve and broaden the services the hospice offered.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.