Oakhaven Hospice

Updated 22 March 2017

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 8 and 9 August 2016 and was unannounced.

The inspection was carried out by an adult social care inspector, a pharmacy inspector, a specialist advisor and an expert by experience. A specialist advisor is someone who has recognised clinical experience and knowledge in a particular field. In this case the specialist advisor had expertise, skills and knowledge in relation to palliative end of life care in a hospice environment. The expert by experience was a person who had personal experience of having used a similar service and had cared for someone who had used a similar type of care service.

Before the inspection we read all of the notifications received about the service. Providers have to tell us about important and significant events relating to the service they provide using a notification. We reviewed the Provider Information Return (PIR) about the service. 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 also looked at the provider’s website to identify their values and details of the care and services they provided.

We spoke with 12 people who used the in-patient unit (IPU), hospice at home and day care service, eight of their relatives and two friends.

We spoke with 30 staff, including two charge nurses who managed the inpatient service, the hospice at home sister, three clinical nurse specialists, the physiotherapy lead, 16 nurses and care staff, the two housekeepers, two chefs, the chaplain, two service administrators and 10 volunteers.

We also spoke with the provider’s registered manager (also known as the head of clinical services), the chair of the board of trustees, lead consultant in palliative medicine, head of nursing, the Senior Physiotherapist (who is the quality lead for the organisation), head of human resources and volunteers, two doctors specialising in palliative care and ten volunteers.

We used a range of different methods to help us understand the experiences of people using the service who were not always able to tell us personally. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual. We pathway tracked the care of three people using the IPU service and one using the hospice at home service. Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered.

We looked at twelve staff recruitment files, and reviewed the provider’s training records. We reviewed the provider’s policies, procedures and records relating to the management of the service. We considered how comments from people, staff and others, as well as quality assurance audits, were used to drive improvements in the service. We looked at a selection of six medicine records to check medicines were managed safely.

The service was last inspected on 14 February 2014 during which no concerns were identified.

Updated 22 March 2017

This inspection of Oakhaven Hospice took place on 8 and 9 August, 2016. The hospice is a charitable organisation owned by Oakhaven Hospice Trust, which is a specialist palliative care service providing care to people in The New Forest and Waterside area who have been referred by a health care professional. Oakhaven Hospice provides specialist care to people, carers and families who are facing complex physical, emotional and practical difficulties arising from advanced progressive life limiting illness. This may be cancer or other diseases. The service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an inpatient unit (IPU), outpatient day service, a hospice at home service and The Coates Centre. The Coates Centre provides information and support for anyone in the local community who feel their lives have been impacted by illness.

At the time of the inspection there were eight people using the inpatient service. The day services provided offered a range of services to people diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and clinics. Oakhaven Hospice provided a counselling and bereavement service for people and their families if required.

Oakhaven Hospice 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. The registered manager at Oakhaven Hospice was also known as the Head of Clinical Services.

Staff had been trained in relation to safeguarding vulnerable people and knew how to protect people from abuse and harm to keep them safe.

Potential risks to people had been identified and managed appropriately. 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.

There were effective health and safety systems to protect people from harm within the inpatient unit and Day Services. Regular audits and daily checks by nominated staff ensured that the environment and equipment used was safe and fit for purpose.

The service provided support for people in the community through a specialised equipment loan system. This system has recently been improved based on a recent audit to ensure all equipment is safety checked and decontaminated after each use.

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

People were supported by sufficient numbers of staff to provide care and support in accordance with the individual needs of people. 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 had undergone robust pre- employment checks as part of their recruitment, which were documented in their records. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.

People’s medicines were managed effectively to ensure they received them safely. People and relatives told us people had their medicine when they needed it and staff were quick to respond to any needs they had. Staff involved in medicines administration had regular training and had undergone competency checks to ensure their knowledge and practice remained up to date.

People received effective care, based on best practice, from staff who had the necessary skills and knowledge to do so. Staff received effective training and supervision to fulfil their roles and responsibilities. Staff 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.

People were supported to make as many decisions as possible. We observed staff seeking people’s consent about their daily care and allowing them time to consider their decisions, in accordance with their care plans.

Staff understood the relevance of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) and consent issues which related to the people in their care. Staff were able to demonstrate that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare and protected their human rights. Staff understood the importance of giving people choice in the support they received.

People had nutrition and hydration assessments and plans, which were up-to-date and where necessary recording of people’s intake had been completed. Staff were aware of people’ dietary requirements and preferences and people were offered a range of choices to meet their nutritional needs. People and their relatives praised the food they received and enjoyed their meal times.

People were provided with clear information and explanations by staff in terms they understood about their healthcare, treatment options and their likely outcome. Staff made referrals quickly when required to relevant healthcare services when people’s needs changed.

People were involved in making decisions about their own care. People told us that when consultants and doctors thought another course of treatment was appropriate they always sought their views and acted upon them. This made people feel their views really mattered and they were in control of their treatment.

People told us that staff were kind and considerate, not only to them, but their family and friends. Staff had developed positive caring relationships with people. We observed staff engage people in conversations about things which interested them, that did not just focus on the person’s support needs. Staff supported people to express their views and encouraged them to be actively involved in decisions about their care and treatment.

People were supported to maintain relationships with people who were important to them. People told us that their friends and relatives visited regularly and were welcomed to the hospice at any time.

Staff had completed training to ensure they understood how to respect people’s privacy, dignity and human rights, which we observed being delivered in practice.

Staff respected and followed people’s choices and wishes for their end of life care as their needs changed. People were supported at the end of their life to have a comfortable, dignified and pain free death.

People’s wishes were at the centre of their care planning. Staff were aware of people’s care plans and were mindful of people’s likes, dislikes and preferences. People`s constantly changing needs were assessed and discussed by staff on a daily basis or more frequently in order to address them appropriately. Staff attended thorough handover meetings at the beginning of their shift. Each person was discussed in depth including care needs, changes to treatment, care plans and medication requirements.

The provider delivered considerate and person-centred care and support that had a positive effect on people. People were asked about their needs and preferences by the staff. Staff were able to demonstrate their understanding of how to give people personalised care. The care given to people followed the guidance in their care plan, for example; detailed information about the person’s pain and plans to manage the symptoms.

The provider sought feedback from people, their relatives, staff and community professionals using various different methods, which was overwhelmingly positive. People told us staff were quick to respond especially if their needs changed, which we observed in practice. We observed all staff working together to ensure people’s requests for attention were answered as quickly as possible.

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.

People had access to information about how to make a complaint, which was provided in an accessible format to meet their needs, before people started to use the service. During the previous year there had been no formal complaints about the service. Where people had raised concerns these were used as an opportunity for learning or driving improvement in the service.

There was a clear management structure at the service and staff were aware of the individual roles and responsibilities of the management team. All the managers demonstrated an excellent understanding of all aspects of palliative and end of life care, which we observed in practice. The registered manager who had been in post for almost 10 years and senior staff had created an open and transparent, blame free culture within the service, which encouraged learning from mistakes.

Staff spoke with passion and pride about the hospice and the people they supported. Staff told us there was an ‘unequalled team spirit’ at Oakhaven which had been driven by a stable management team who were totally committed to people using the service and their staff.

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 provide high quality care to people.

The Senior Physiotherapist, who is the quality lead for the organisation, effectively operated processes to evaluate the quality of service provision, including regular surveys of people, their families and staff, seeking feedback on their exper