Sue Ryder - Wheatfields Hospice

Updated 12 September 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.

The inspection took place on 20, 25 and 28 July 2017 and the inspection was unannounced. We last inspected Sue Ryder Wheatfields Hospice in May 2016. At that inspection we rated the service ‘requires improvement’ overall.

The inspection team consisted of two adult social care inspectors.

Before the inspection we reviewed the information we held about the service. This included speaking with the local authority contracts and safeguarding teams and reviewing information received from the service, such as notifications. We asked the provider to complete 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 looked at how people were supported throughout the day with their daily routines and activities. We reviewed a range of records about people’s care and how the service was managed. We looked at three care records for people that used the inpatient unit and six records of people who were out patients. We spoke with 11 people, three relatives and one visitor. We spoke with one registrar in palliative medicine, one speciality doctor in palliative medicine, a pharmacist, two inpatient nurses, two community specialist nurses, a nursing assistant, the head chef, a physiotherapist, the spiritual care coordinator, two palliative care social workers, family support team leader, ward clerk and a medical secretary as well as the registered manager and provider. We looked at quality monitoring arrangements, rotas and other staff support documents including supervision records, team meeting minutes and individual training records.

Updated 12 September 2017

We carried out this inspection on 20, 25 and 28 July 2017. This was an unannounced inspection.

Sue Ryder – Wheatfields Hospice is a specialist palliative care service. It provides inpatient care for up to 18 people. The service also supports 321 people in the community whose care needs are triaged and recieved medical advice. At the time of our inspection visit there were 12 people who used the in patient service.

The service currently had no registered manager although we checked the manager in post application had been received and was being processed by the CQC. 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 services provided included counselling and bereavement support, day hospice care, family support, spiritual support, out-patient clinics, occupational therapy, physiotherapy, complementary therapies and a lymphedema service (for people who may experience swellings and /or inflammation following cancer treatment).

People were kept safe by staff who were trained in the safeguarding of adults and health and safety. They were able to fully describe their responsibilities with regard to keeping people in their care, safe from all forms of abuse and harm. There were safe systems in place to manage and administer medicines to people. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways. People received their medicines in a timely manner and in line with their preferences.

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.

Recruitment practices were safe and ensured staff employed were safe and appropriately skilled to care for people using the hospice.

Systems were in place to ensure records related to accidents and incidents captured the relevant information and this was considered and analysed without delay. Appropriate remedial actions were taken following such occurrences and action was taken to minimise any immediate or future risks to people.

Staffing was at a level which allowed staff to meet people's needs in a safe, timely and personalised manner.

Staff were well supported with the provision of a wide range of support in the form of training, a comprehensive induction, ongoing supervision and appraisal along with practice reflection. Learning within the service including adopting and sharing best practice was highly prioritised.

People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and supported people in line with these principles. Staff established consent from people before providing care and supported people to access independent advice and support when necessary.

Staff were very caring and showed people and their families kindness. Staff demonstrated they were both motivated and passionate about their work and had a clear commitment to providing the best quality care in a compassionate way. People were encouraged to remain as independent as possible by staff. Staff acted in a way that maintained people's privacy and dignity.

People were fully involved in decisions about their care, including when identifying their preferred place of death. They benefitted from the environment within the hospice which was homely and had been designed and equipped in a way that was clearly comforting to people using the service.

People were fully involved in the planning of their care, from symptom and pain management to their end of life care. They took part in discussions with staff to express their views, preferences and wishes in regard to their care, support and treatment, and were invited to take part in developing advance care plans.

The staff team demonstrated through their input at clinical and multi-disciplinary meetings that they knew people well and understood their individual needs. People's progress including pain management, spiritual needs, emotional and psychological well-being and social support were all considered on a daily basis.

All aspects of care and treatment were assessed and discussed with the person and their family. The whole staff team could access the most up to date information about a person's treatment including changes in people's health and about how to respond when people experienced changes in their symptoms or pain levels. People spoke positively about how their care had been tailored to meet their needs and preferences.

Families were included in all aspects of the person’s stay, where this was an expressed wish of the individual person. People and staff felt comfortable about sharing any concerns, complaints and ideas for improvements with management.

The manager was open and transparent. They consistently notified the Care Quality Commission of any significant events that affected people or the service. Regular ward and management meetings took place to discuss every aspect of the service, including staff training, incidents, service policy and development reviews.

Staff praised the provider and the leadership team for their approach and consistent, effective support. The provider had a well-defined management structure that provided strong, effective and innovative leadership. There was an extensive programme of clinical audits to check that quality of care and best practice were maintained.