Archived: Phyllis Tuckwell Hospice

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.

Patients and their family members demonstrated a high level of satisfaction with the care provided. One relative told us 'This place is wonderful. I can't imagine anywhere better. X is really well cared for and so are we.' Family members talked about being involved in all aspects of their relatives care. One said. 'My family and I have been kept updated with any changes in X's health. Staff are really kind and considerate and nothing is too much trouble.'

Staff at the hospice worked in collaboration with other providers to ensure that patients received continuity of care. Infection control measures were in place and patients were protected from the risk of infection.

Some of the staff were not properly supported to undertake their roles because the arrangements in place for staff supervision and appraisal were inadequate.

Relatives told us that staff were very kind to their family member, they said " nothing is too much trouble for the staff, they are so kind to us" Another relative told us "the staff always treated their family member with the utmost dignity and respect" and " the care could not be bettered"

Patients spoken with told us they were involved in any and all decisions about their treatment and care. People commented they were always part of the discussion, staff always asked me what I thought. Others told us they liked attending the day hospice and enjoyed the recreational activities provided.

People spoken with told us they felt safe and they would speak to staff if they had concerns. One person said " I was given the choice of going to hospital or the hospice, no comparison really, the hospice is wonderful and I know I will get first class care, I am so lucky"