Archived: The Martlets Hospice

Updated 19 February 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 carried out 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 was carried out on 21 and 22 December 2015 and was unannounced. The inspection team consisted of three inspectors and two pharmacist inspectors.

Before our inspection we looked at records that were sent to us by the registered manager and the local authority to inform us of significant changes and events. The registered manager had not been asked by the CQC to provide a current Provider Information Return (PIR) at the time of our visit. 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. However we collected the relevant information which we looked at during our inspection.

We looked at the premises and equipment. We looked at 15 sets of records that related to people’s care and examined three people’s medicines charts. We looked at people’s assessments of needs and care plans and observed to check that their care and treatment was delivered consistently with these records. We consulted documentation that related to staff recruitment, training and management, and records relevant to the storage, ordering and administration of medicines. We looked at checks that were carried out concerning the monitoring of the safety and quality of the service. We observed a ‘ward round’ and the administration of medicines. We sampled the services’ policies and procedures.

We spoke with six people who stayed in the In-Patients Unit, eleven of their relatives and six volunteers. We also spoke with relatives of four people who received support from Hospice at Home in the community.

We spoke with the registered manager, the medical director, the nurse who was the development and quality lead, the counselling and bereavement manager, a social worker, six members of nursing staff, four care workers, the chef and kitchen staff, two members of learning and development staff, and a team leader in the Hospice at Home team. We spoke with the Partnership Service manager who was working in the service, employed by the NHS Community Trust. We also spoke with three managers of care homes where the Hospice at Home team was providing support and advice, and three district nurses who oversaw people’s care in the community. We obtained their feedback about their experience of the service.

At our last inspection on 25 September 2013 no concerns were found.

Updated 19 February 2016

The Martlets Hospice is a local charity that provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families in the Brighton, Hove and Havens area.

They deliver physical, emotional and holistic care through teams of doctors, nurses, counsellors, chaplains and other professionals including therapists and social workers. The service cares for people in two types of settings: at the hospice in an 18 beds ‘In-Patient Unit’, or in their ‘Hospice at Home’ service where a team of nurses and nursing auxiliaries offer specialist, short term end of life nursing care for people in the comfort of their own home. In addition, The Martlets Day Services provide therapeutic support for patients and their carers who are living at home, and aim to maximise their independence and quality of life. Services are free to people and the Martlets Hospice is largely dependent on donations and fund-raising by volunteers in the community.

This inspection was carried out on 21 and 22 December 2015 by three inspectors and two pharmacist inspectors. It was an unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run. The registered manager was also the director of clinical services and oversaw the running of the service. They were part of a leadership team that included a chief executive officer, a medical director, a director of human resources, a finance director and an income generation director.

The services provided include counselling and bereavement support; outpatient clinics; occupational therapy, physiotherapy, chaplaincy and volunteer services that include approximately 500 volunteers.

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 or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

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 according to their individual plans.

The environment was well designed, welcoming, well maintained and suited people’s needs.

Staff had received essential training including end of life care and were scheduled for refresher courses. Staff had received further training specific to the needs of the people they supported. All members of care staff received regular one to one supervision sessions and an annual appraisal. This ensured they were supported to work to the expected standards.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People praised the food they received and they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences, restrictions and reduced appetite.

People’s feedback was actively sought and acted on. People and relatives were very positive about the quality of service they received. They told us they were very satisfied about the staff approach and about how their care and treatment was delivered.

Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people’s individual communication needs and treated them with genuine kindness and respect.

Staff approach was kind, compassionate and pro-active. They often went beyond the scope of their duties to meet people and their families’ needs. People’s testimonies included, “Anything big or small they will do it for you” and, “Being here has been an enjoyable experience for me even in these circumstances because the staff are so fantastic”. A relative said, “There are no adequate words to describe how wonderful all the staff are in this place, they have become our friends in times of great need.”

Clear information about the service, the facilities, and how to complain was provided to people and visitors. People’s privacy was respected and people were assisted in a way that respected their dignity. Staff sought and respected people’s consent or refusal before they supported them.

The registered manager was open and transparent in their approach. They held a vision for the service that included, “Helping our patients make the most of whatever time they have left; providing person-centred care.” They told us, “We are all very passionate about ensuring everyone has a dignified death, has their wishes respected and their families are well supported through the process.”

Comprehensive audits were carried out about every aspect of the service to identify how it could improve. When needs for improvement were identified, remedial action was taken to improve the quality of the service and care. The service worked in partnership with other organisations to drive improvements.