LOROS The Leicestershire & Rutland Hospice

Leicestershire & Rutland Organisation for the Relief of Suffering Limited (LOROS) is registered to provide care and support to people in relation to symptom control, pain relief, assessment and end of life care

LOROS in-patient facility caters for up to 31 people, accommodated within four bedded bays or an individual room. The hospice service provides specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, psychological, social and spiritual care through teams of nurses, doctors, counsellors, chaplains and other professionals including therapists and social workers. The service has a team of community specialist palliative care nurses who care for people and their families within the community providing specialist advice as regards symptom control and psychological support along with other health care professionals.

The services provided include counselling and bereavement support, home visiting, chaplaincy, out-patient clinics, occupational therapy, physiotherapy, dietetics, and complementary therapies.

LOROS 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.

People told us that they felt safe at the service. The service was committed to promoting people’s safety across all levels of staff within the organisation and included advising the Board of Trustees of safeguarding concerns and ensuring staff at all levels, including volunteers received training on protecting people from potential abuse or avoidable harm.

Risks to people were assessed and where potential risks had been identified these were minimised in consultation with the person. Where accidents or incidents occurred there was a no blame culture within the service. This ensured staff reported any concerns so that they could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.

People’s physical, psychological, emotional and spiritual needs were met as the service employed sufficient staff from a range of disciplines to provide holistic care. People’s needs were regularly reviewed by staff from a range of health and social care disciplines and included staff that provided spiritual support and complementary therapies.

The service supported people within the community providing psychological and practical support. People in some instances accessed the day therapy facility, which offered clinics where people could review their health, which included symptom and pain management along with complementary therapies, creative therapies and social activities. People told us that the day therapy facility enabled them 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 created a welcoming and relaxed atmosphere. Staff told us that they undertook training which enabled them to provide good quality care, which supported a holistic approach to care. Reflective practice sessions were used to enable staff to discuss issues associated with their work and their welfare was supported by the chaplaincy team who provided one to one and group support.

People’s medication needs both within the hospice and the community were discussed by health professionals to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs. A pharmacy team including a specialist pharmacist and pharmacy technicians from a local hospital provided a clinical, and medicines supply, service to the hospice to ensure people received their medicines in a safe and timely manner.

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.

All of the food was freshly prepared and the meals provided catered for a range of specialist diets. People were supported to eat and drink when required. People could ask for what they wanted to eat at any time. Dieticians were involved in people’s nutritional welfare and had worked collaboratively with the chef to develop a range of milkshakes and other drinks to encourage those with a poor or low appetite to eat.

People, friends and relatives were consistently very positive about the caring and compassionate attitude of the staff. They told us they were completely satisfied with their care. They spoke of excellent relationships with staff who understood their needs and preferences. 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.

People and the service were supported by volunteers who played an important part in the day to day running of the service.

Staff respected people’s cultural and spiritual needs and people told us they received the religious and spiritual support they wanted and needed. Relatives told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. Bereavement support was available to people and their families and friends. This provided emotional and practical support to those who required it.

People were fully involved in assessing their care and treatment needs and their wishes and preferences were incorporated in planning how those needs were to be met. Regular reviews of people’s care were held and people were involved in discussions about their health to ensure their wishes were known. Community services and the lymphoedema clinic worked with health care professionals within the wider health community to promote good practice to improve the care and treatment available to people.

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 Board of Trustees and the management team demonstrated a strong commitment to providing people and those closest to them with a safe, high quality and caring service and promoted high standards. The service actively encouraged and provided a range of differing methods and opportunities for people who used the service and their relatives to provide feedback and comment about the service in order that they could influence the service and continue to drive improvement. The service has plans to improve the range of services it provides within the community and their accessibility to those living within rural locations.

The service is open and transparent providing a range of information within the service and on its website, which includes the outcome of surveys and audits undertaken and their response to improving the service. There are systems in place to enable people to make comments and ask questions about LOROS, which include completing comment cards and the use of social media.

Staff worked closely and in partnership with external health and social care professionals and other national organisations to improve the service within the hospice and health provision in the local community and nationally. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure the best possible outcomes for people with life-limiting conditions and those closest to them.

People we spoke with were happy with the meals provided and told us they received the support they needed, which included support where they were unable to eat or drink and received nutrition in a different way. People's comments included: 'There's a good choice and it's always really tasty.' 'The food is excellent, you get asked what you like and the choices are excellent. The drinks trolley regularly comes round and there's always a jug of water by your bed.'

Staff we spoke with told us they receive the support they need from within their individual teams and through the provider. Staff told us that support came in many forms which included clinical supervision and annual appraisals. The provider encouraged staff to access services to support them which included attending reflexology sessions as well as being given information about external counselling services. Staff we spoke with told us they have good access to training and developmental sessions.

People who use the service are asked for their views about the service they receive within days of their admission to the hospice. In addition, annual surveys are also completed as part of the annual quality assurance process in place at the service. Groups involving people who use the service had been set up and met regularly to talk about their views and experiences and we saw that the outcome of these meetings was used to develop the services provided by LOROS. The provider had a robust quality assurance system in place which produced an annual report which is available on the LOROS website.

We spoke with patients and patient relatives who told us they had been provided with information about the service provided. Patients and relatives told us they were involved in all aspects of their care and treatment and that staff spent time talking and explaining to them their options. Patients and relatives said they were very happy with the service provided and their comments included: - 'coming in here is fantastic. It's like walking into a snowball and someone puts a big fluffy blanket around you and looks after you.' 'Metaphorically embraces you.' 'The professionalism of all the staff and their cheerfulness cannot be sufficiently highlighted.' 'I can't fault the doctors and the nurses, everything is explained to you and everyone has time for you.'

People we spoke with were able to tell us about the day to day running of the service and how they involved patients and their relatives in reviewing the service and how they listened and made changes based on the feedback they received. We looked at a range of records. All recording systems were up to date and effectively used to monitor the service.