Farleigh Hospice

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We did not look at this key question during this assessment. The score below is based on the previous rating for this key question.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

Patients told us they felt safe, staff knew them well and they felt confident to raise any concerns. Patients and their loved ones told us they were involved in planning and reviewing their care and staff asked them for feedback regularly. Comments included: “Staff were kind, caring and treated them as individuals and in line with their personal needs”, "We were kept involved throughout. Mum has had outstanding person-centred care", "We had been kept informed every step of the way”, “My stay has made me feel supported, loved, safe and cared for in a sympathetic and compassionate way. Nothing is too much for the staff who create a perfect atmosphere, and I am so grateful for that". "On behalf of Dad we would like to thank all the team, both IPU and Community for everything. It has been a difficult journey and without the Farleigh Team I don't know what we would have done. Thank you." A specific question on transition of care was not included on the current service user questionnaire, however leaders informed us that can be included on future patient surveys. “Staff are very responsive when concerns are raised, and they are dealt with promptly.” "Exemplary care. I feel well looked after and safe in hospice, staff have had truthful conversations with relatives.”

Staff told us that they had access to and are supported with all the training they need to deliver safe care to patients and had a good understanding of how to protect their patients from harm. A staff member talked about the culture within the service with inclusion and diverse work, and collaboration with leaders from other services and the staff training days had been provided. Staff we spoke to had regular mandatory training; leaders monitored compliance in line with training target. Staff we spoke to had received training in safeguarding, dementia, learning difficulties and mental health training. They used the central reporting system to raise concerns. This would be reviewed at the daily MDT meetings and local risk meetings. Escalations are made via Clinical Quality Group to the Clinical Governance Committee. Staff believed important information would be filtered down from senior managers. Staff told us managers meet regularly with external partners, Hospitals, Ambulance Services and GPs to ensure continuity of safe care. Staff followed an admission policy, which laid out set criteria for admission and use of community services. We spoke to staff there were clear pathways into the service. There were options for patients and relatives to self-refer via the providers online referral system. The community teams ran an 8am to 8pm , 7 days a week service. Registration was carried out and patients were triaged according to need. Red represented the need for the same day response, amber represented the need for a response within 24 hours and green represented a non-urgent review. They held MDT meetings every morning to discuss case load and patients, raise any issues or concerns and address safeguarding. They also had daily calls with District Nurses.

Positive feedback was received from partners with evidence of examples of collaborative and proactive team working. The service worked closely with partners including faith leaders. Partners reported weekly meetings demonstrated a positive collaborative approach which built a trusting working relationship. The hospice collaborative group was implemented in 2021 which led to a clearer understanding of patient’s personalised needs and promoted effective working across the network.

Patient survey feedback reviewed from 87 respondents from the in- patient unit and community teams showed that 100% of the patients asked had felt that they were treated with kindness, compassion and respect and given emotional support when needed. From the same patient survey, all patients asked felt their privacy and dignity was respected, felt staff were aware of their personal needs and their views were always taken into consideration. All patients involved on the survey felt supported in expressing their views and being involved in making decisions about their care and treatment. The service told us of actions they had taken to improve information sharing with patients and those close to them, after receiving feedback that 1.7 % of patients reported that staff did not adequately inform them about the services available to them. The team have a clear safeguarding structure, with operational safeguarding meetings monthly, strategic meetings and escalations to the Clinical Governance Committee as required. The Team attend the Local Operational Group for all-age safeguarding and the Mid Essex Quality Group for external support and learning.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service made sure they had enough qualified, skilled, and experienced staff, who received training to be effective, supportive and received regular supervision and development as identified. The staff work well together to provide safe care that meet individual patient needs. Patient’s related that there were enough staff for them to be able to express their individual needs, emotions and support them in making memories with their friends and family members. Patient’s commented that they received excellent care, with someone always there for support. All care was delivered in an attentive manner from all staff and agency nurses. Patients said they were supported well in the community and had experienced continuity of care when admitted into the hospice as an in-patient. Individual needs were identified and attended to as required, for example, a younger family member was given counselling when staff recognised additional support was required when they had difficulties with dealing with their loved one was admitted into the hospice.

Staff told us there was a consistent team to support people. Staff felt valued, respected and treated equally. Staff felt the service supported them with a comprehensive induction, buddy support and supervision meetings. Staff engaged and communicated well with people providing guidance, support, and encouragement. Managers regularly reviewed and adjusted staffing levels and skill mix according to patient needs. In line with national challenges, leaders confirmed that it had been difficult to fill all nursing establishment, so had sought other alternatives to support the population with their palliative care needs. They had developed trainee HCA’s and nurtured their own staff for development. The hospice commenced an innovative Virtual Clinical Nurse Specialist role, and then developed a Trainee Clinical Nurse Specialist Pathway. These workforce solutions were presented nationally at the Hospice UK conference in 2023. Leaders had worked with the local NHS hospital to develop a preceptorship programme to support newly qualified staff. The service had a robust interview process and systems in place to assess competency of all staff. The service had won the Hospice UK award for innovation around workforce planning and training. The vacancy rate for the in-patient unit (IPU) was at 20% Registered Nurse (RN) and 40% for Health Care Assistant (HCA). Capacity for the community team had recently been reviewed with the increased numbers of patient’s remaining within their own homes. The Hospice Escalation Acuity Tool (HEIT) had been rolled out in the IPU and across the community. Volunteers supported between Monday to Friday. The service held regular debriefs for staff and volunteers to be more responsive. The hospice was committed to training and developing it’s staff members through a bespoke pathway enabling staff to progress their career. Professional registration checks were audited, as per Nursing and Midwifery Council regulations and Royal Colleges guidance.

Staff schedules and rotas showed there were appropriate staffing levels in place to meet people's needs. These were monitored to ensure staff unplanned and planned leave was covered. Agency staff were used to provide additional support when required. Staff were deployed around the service effectively. Staff had completed training relevant to their roles and there were systems in place for the provider to identify and monitor staff training requirements. Staff told us about the training they had as part of their job roles and were knowledgeable about the topics they were trained in. The provider recruited new staff in line with legislation to help ensure they were suitable for their job roles. Managers adjusted staffing levels to meet the needs of patients. If minimal staffing levels could not be achieved, then consideration was given to reduce admissions to ensure safety of those using the service. The service holds regular debriefs for staff and volunteers to be more responsive to their emotional and psychological needs. Professional registration checks for staff are audited, staff are reminded to complete revalidation as per Nursing and Midwifery Council regulations and Royal College guidance.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.