Archived: Phyllis Tuckwell Hospice

Updated 19 October 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.

We inspected Phyllis Tuckwell Hospice on 19 and 20 July 2016. The inspection was unannounced which meant that staff and the provider had not been informed about our visit.

The inspection team consisted of three members: an adult social care inspector, a pharmacist inspector and a specialist advisor. A specialist advisor is someone who has up-to-date knowledge and experience of working in a specific field. The specialist advisor who participated in this inspection had extensive knowledge and experience in palliative care. Palliative care is a holistic, multi-disciplinary approach to providing patients with relief from the symptoms of a life-limiting illness such as pain and stress. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.

Before the inspection, the provider had 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. We reviewed the PIR and other information we held about the service prior to our inspection. This included the notifications we had received from the provider about significant issues such as safeguarding, deaths and serious injuries. The provider is legally obliged to send us this information within required timescales. The PIR was used as a prompt to follow up specific areas at the inspection and to support our findings.

During the inspection we observed how staff interacted with people using the service. We spoke with five people who were provided with care and support by the service, and one relative. We spoke with in-patient and out-patient staff, including the registered manager, two human resources officers, five nurses, five health care assistants, one housekeeping manager, one domiciliary staff member and two volunteers.

We looked at six care files for people who use the service. We also looked at documentation concerning medicine handling, such as medicine charts and administration records. We observed a handover meeting at which medical and nursing staff exchanged information and planned treatment for people using the service.

We looked at a selection of documentation relating to the management and running of the service. These included four staff recruitment files, the training matrix, staff rotas, minutes of meetings with staff, surveys, quality assurance audits and record relating to maintenance of equipment. We were present at a Multidisciplinary Team Meeting (MDT). An MDT is a meeting of a group of health and social care professionals from different clinical disciplines who together make decisions regarding the recommended treatment of people.

We completed a tour of the building to look at how hygiene and cleanliness were maintained.

Updated 19 October 2016

This inspection took place on 19 and 20 July 2016 and was unannounced. The last comprehensive inspection of Phyllis Tuckwell Hospice had taken place in November 2013 and was followed by a focused desk-based inspection in July 2014. During the inspection in 2013 we had found out that not all of staff caring for people had been supported to deliver care and treatment safely and to an appropriate standard. At the inspection in 2014 we found out that the provider had addressed our concerns and met all the required standards.

Phyllis Tuckwell Hospice provides palliative and end-of-life care, advice and clinical support for adults with life-limiting illnesses, their families and carers. The hospice delivers physical, emotional and holistic care with the aid of teams of nurses, doctors, counsellors, chaplains and other professionals including therapists. The hospice runs an 18 beds in-patient unit and accepts admissions for end-of-life care, symptom control and respite care. At the time of our inspection 17 people were in the unit. The hospice also provides community services designed to support people in their own homes. The hospice’s day service welcomes up to approximately 42 people per week and was being used by 10 people during our inspection.

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.

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. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm.

People and their relatives told us they were very satisfied with the care. We saw that people were treated with dignity, respect and compassion. People were involved in the planning of their care which meant their care preferences and choices were identified so that they could be met by staff.

Accidents and incidents were recorded and monitored to identify how the risks of their recurrence could be prevented.

Medicines were safely stored and those requiring refrigeration were stored within their recommended temperature range. Nurses recorded the administration of medicines on prescription charts including prescribed creams applied by care workers. Staff had the skills to effectively manage people's medicines so these were available and administered safely to people.

Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people's individual needs and to respond flexibly to changes.

People were supported by sufficient numbers of staff to provide care and support in accordance with the individual needs of people. There was a flexible approach to adjusting the levels of staff required. People who were receiving care in the in-patient unit told us the staffing numbers were appropriate and assistance was provided promptly when requested.

Staff received the training and support they needed and were highly motivated to undertake their roles and deliver sustained high quality care. People were extremely confident and positive about the abilities of staff to meet their individual needs.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes, hospitals and hospices are called the Deprivation of Liberty Safeguards (DoLS). The service manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had made applications under DoLS to ensure that people were not deprived of their liberty unlawfully.

Staff provided meals that were in sufficient quantities and met people's needs and choices. People and their relatives praised the food they received and they enjoyed their meal times.

Peoples' right to privacy was fully protected and they were always treated with dignity and respect by all staff and volunteers. People told us they were extremely satisfied with staff’s approach and about the way their care and treatment was delivered. We observed staff were kind, compassionate and forward thinking in meeting people's needs. Staff knew how to meet the changing needs of people with progressive, life limiting conditions.

Staff were highly motivated and committed to providing people with the best possible palliative and end-of-life care. The service had received a large number of compliments concerning the kind, compassionate and caring manner of the staff team. People told us staff dedicated their time to listen to people and did not rush them. As people stated, staff did all they could to meet people's individual wishes and requests.

The service had a holistic approach to caring for people at the end stages of life. Supporting the person and their family members was seen as key to their well-being. Family members received support after the death of their loved one through individual or group bereavement counselling. People's spiritual needs were met and there was a range of different complimentary therapies.

People's needs were thoroughly assessed before and at the time of being admitted to the service. The staff team ensured that care and support were offered in a timely way, and services were offered as flexibly as possible depending on people's needs. People's care plans were personalised and contained detailed information about their preferences and advanced decisions in relation to end-of-life care.

Regular multi-disciplinary meetings were undertaken to review and respond accordingly to peoples' changing needs. The management and staff worked closely with other professionals and agencies to ensure peoples' various needs were fully met. Clear information about the service, the facilities, and how to complain was made available to people and visitors. Complaints received were fully investigated and responded to, with evidence of the provider using them as a learning opportunity in order to make improvements to the service.

There was an open culture where people and their relatives were encouraged to share their experience of the service. Staff understood the ethos and values of the service and how to put these into practice. They felt valued, listened to and well supported. This resulted in the staff team being motivated to give a high standard of care to people.

Staff were clear about the leadership structure within the hospice and were fully involved in the hospice’s development. Emphasis was placed on continuous improvement of the service. The managers regularly assessed and monitored the quality of care by completing audits and seeking feedback from people who use the service and their relatives.