The Norfolk Hospice Tapping House

Updated 5 July 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 visit took place on 16 May 2017 and was announced. We gave the provider 48 hours` notice to make sure the manager and staff were available to talk to us. The inspection was carried out by one inspector.

Before our inspection we reviewed information that the provider had sent to us which included notifications of significant events that affect the health and safety of people who used the service.

We spoke with eight people who used the service, three relatives, one volunteer, two nursing staff, two care staff, the hospice at home manager, the director of operations, the director of care and the chief executive officer (CEO) who was also the registered manager. We also talked to a group of 14 staff who were employed for the in-patient unit and were on induction and we received feedback from three health care professionals.

We reviewed five people’s care plans to see how their support was planned and delivered. We also looked at a range of policies and procedures, quality assurance and clinical audits and meeting minutes for different departments.

Updated 5 July 2017

This inspection took place on 16 May 2017 and was announced. We also contacted people, their relatives and professionals for feedback about the service after the inspection visit.

The Norfolk Hospice Tapping House is registered to provide specialist palliative care, advice and support for adults with life limiting illness and their families in their own homes. They deliver physical, emotional and holistic care through teams of nurses, care assistants, counsellors, a specialist doctor in palliative care and other professionals including therapists. The hospice also operated a Day Service. However, the only service which involved an activity the provider was registered for with the Care Quality Commission was the hospice at home service.

At the time of the inspection there were 80 people using this service. The service provided specialist advice with regards to symptom control and worked in partnership with health care professionals, Macmillan nurses and the district nurse team to ensure that people received the best possible support in their own homes. There was a counselling, pre- bereavement and bereavement support service offered to families and relatives.

The Norfolk Hospice Tapping House 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. The hospice employed a social worker who was also the safeguarding lead in the hospice. Staff assessed the risks involved in delivering a service to people in their own homes. Staff communicated any risks to people`s health and well-being to all health and social care professionals involved in people’s care They followed up and reviewed risks regularly to ensure these were appropriately managed and mitigated.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. Plans in regard to all aspects of their medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so that these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of reoccurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. There were sufficient numbers of staff to ensure people received support when they needed it. There were plans to open an in-patient unit at the hospice in June 2017 and staff had been recruited and trained before the opening date.

People who used the day services told us that this service enabled them to meet the staff and form relationships before their condition progressed to a stage when they would use the hospice at home service. They appreciated the opportunity 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 gave them reassurance and made them feel safe. Staff told us they undertook training which enabled them to provide good quality care to people in their own homes.

People’s medicines were not managed by the hospice staff. People had their medicines prescribed by their own GPs and on rare occasions, staff from the hospice administered medicines as and when required. However, staff were trained and qualified in medicine administration and the use of syringe drivers. Any changes in people`s medication were discussed with health care professionals in a weekly multi-disciplinary meeting to ensure people’s symptoms and pain management was efficient.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and were dedicated in their approach to supporting people to make informed decisions about their care.

People and relatives were very positive about the caring and compassionate attitude of the staff delivering the service. They told us they were completely satisfied with their care and thought highly about staff and management. 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.

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 registered manager was committed to improve and broaden the services the hospice offered. They recognised the importance of the hospice services in their catchment area where there were no other similar specialist palliative care services available.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the management team. Action plans were comprehensive in detailing actions taken, time frames and the responsible person for the actions.