Mountbatten IW

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 was carried out by three inspectors and a pharmacist inspector on 30 and 31 January 2017 and was unannounced. We had previously inspected the service in May 2013 and found no concerns.

Before the inspection, the provider 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, previous inspection reports, notifications and all contacts we had about the service. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with nine people who used the service, five relatives and one visitor. We spoke with the registered manager (who is the Chief Executive and the Governance lead), the Head of clinical quality and patient experience and the Service development lead. We spoke with the head of housekeeping, the catering manager, a GP trainee, the Medical Director, the Care at Home team leader, a physiotherapist, the Social worker, the Admiral nurse, a Lymphoedema nurse, the Clinical Psychologist, nine nurses, a student nurse and eight health care assistants.

We attended the weekly multi- professional team (MDT) meeting and the Quality and Governance Committee. We viewed a range of records including care documents for eleven people who used the service, six personnel files and records relating to the running of the service

Updated 22 March 2017

This inspection was carried out by four inspectors on 30 and 31 January 2017 and was announced to ensure the Hospice at Home staff we needed to speak with would be available.

Earl Mountbatten Hospice (EMH) serves the adult population of the Isle of Wight (IOW). Services are provided from the In-Patient Unit (IPU) and the local hospital. Day Services and Out-Patient appointments are provided from the John Cheverton Centre (JJC). People are supported in their own homes by the Rapid discharge and the Hospice Care at Home team. The hospice also offered a range of other bespoke services to people and their families including psychological support, creative and complementary therapies and a bereavement service. The hospice has a large multi-professional team consisting of medical staff, nurses, a psychologist, social worker, therapists and chaplaincy supported by people facing volunteers.

There was a registered manager in place. 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 Earl Mountbatten Hospice provided an outstanding service that creatively enabled people to choose where they wanted to receive end of life care (EOL) and responded promptly to clinical deterioration in times of need. People spoke of a service that was tailor-made for them, highly personalised and focussed on their individual needs and that of their families. EMH had developed their range of services innovatively with local agencies to ensure their local population would receive the support they needed at the time they needed it and in a way and place that best suited them.

The hospice worked innovatively with their local hospital and was highly responsive to ensure people were discharged from hospital in a timely manner so that they could receive EOL care at home when this was their preference. Through this joint working people who would not traditionally access hospice care had also been given the choice to receive their EOL care in a hospice. The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose.

People, their relatives and staff spoke overwhelmingly of the positive support, guidance and healthcare interventions people had received. They were full of praise for the staff in terms of their exceptional kindness, compassion and knowledge about end of life matters. Staff went out of their way to support the needs of their wider community which included providing care and support to children and people living with dementia at the end of their life.

The Day Services used their Schools Project creatively to support people’s desire to remain useful and contribute to society till the end of their lives. Through this project people had an open and honest dialogue with their local young people about palliative care and their end of life experiences. People told us this how this had made them feel valued and they were proud to be able to teach others through their life stories.

Managers showed outstanding leadership and they recognised, promoted and implemented innovative ways of working in order to provide a high-quality service. This forward thinking approach had resulted in service commissioning arrangements that ensured people received high quality integrated community care to support their preference to receive end of their life care at home.

The management team promoted a culture of openness, reflection and excellence. Staff were involved in the development of the values and vision of the service. An outstanding example of enabling staff to contribute to personal and hospice development was the bespoke ‘Well-led: Leading from the Middle programme designed for middle managers across the organisation. We saw this project had empowered staff to work on operational challenges and creatively deliver tangible outcomes for the hospice. Governance of the service was of a high standard and robust quality assurance systems were in place that showed people were right to have confidence in this local hospice.

The hospice offered end of life care training opportunities for their staff and other health and social care professionals. Through this training and other service developments the hospice had enabled people to receive end of life care closer to home and reduced the need for hospital admissions. Staff were involved in the development of working practice, listened to and supported to offer high quality end of life healthcare and support.

People's informed consent was embodied into all work that was undertaken at the hospice and people who did not have capacity to consent to their care and treatment had their rights protected under the Mental Capacity Act (MCA) 2005.

People were protected from harm and abuse and robust staff recruitment procedures were followed to keep people safe. There were sufficient staff to meet people's individual needs and to respond flexibly to changes and unforeseen emergencies. Systems were effective to manage known risks associated with people's care and treatment needs such as falls, pressure sores, poor nutrition and hospice acquired infections.

Guidance was provided to ensure people were supported to eat and drink sufficiently and adjustments were made to ensure people at risk of choking could eat and drink safely. Regular reviews took place of people's symptoms and changes were made as required to ensure people's pain would be well managed.

The service listened to people, families and staff, involving them in the running and development of the service. They actively sought out their views and used feedback as an opportunity to improve and develop the service. There was a kindness and warmth about the management team that made them approachable to everyone and people knew them by their first names and told us they were visible and solved matters when they were raised.