The inspection took place on 2 July 2015 and was unannounced.
At our last inspection on 15 October 2013 the provider was meeting all the regulations that were assessed.
Harrogate District Hospice Care Limited provided care and support to more than 2,000 people every year through its hospice and community based services. Services included specialised support at home, hospice care including day therapy and inpatient care, lymphoedema management, support for families and carers, and bereavement support. They are made available to people living in the Harrogate area who are at least 18 years old and there is no charge to people using the services.
This report follows an inspection visit to the 10 bedded inpatient unit known as Saint Michael’s Hospice, which was carried out on 2 July 2015. People are referred to the hospice in agreement with their consultant or GP and may be admitted for care during the last weeks and days of their life, symptom control, assessment and / or respite care. The hospice is located in a large adapted building overlooking Crimple Valley in Harrogate. During their stay people have access to a team of health and social care professionals as well as bereavement counsellors, complementary therapists and chaplains.
There is a registered manager. 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.
We found that Harrogate District Hospice Care Limited provided outstanding care. Effective leadership, management and governance systems were used along with clear strategic planning to critically assess their performance and create a culture of continual improvement, to meet the changing needs of the population.
There was a visible management presence throughout the service, which promoted the hospice vision and values and ensured consistent best practice. Feedback from people using the service, health and social care professionals and visitors was wholly positive. Everyone spoke highly of the care that they or their relative received and people said that staff were highly sensitive to their needs and were compassionate. Hospice staff were extremely proactive in finding out and meeting people’s emotional, spiritual and social needs as well as their physical needs. This meant people approaching end of life or with a life limiting conditions were actively supported to lead a full, active life. People were provided with as much information as they wanted and were encouraged to make their own decisions based on the best therapeutic options.
People spoke positively about all the staff and the catering team was singled out for particular mention. People who used the service and staff said that catering staff were always willing to make special efforts, to tempt people’s appetites with food that they might like or that had been requested. Everyone told us that the food was of an excellent quality and that mealtimes were a social occasion that everyone enjoyed.
There were examples of excellent partnership working and joint planning with commissioners and other providers, to ensure people received the best care. A joint initiative with the Harrogate Hospital Foundation Trust meant that people had the support of specialist care and advice whether they were in the hospice, in residential or nursing care, in hospital or at home. Staff were currently engaging with another care provider to review and better understand palliative care needs for people with a learning disability. This offered staff the opportunity to exchange professional ideas and promote best practice.
Volunteers were used extensively throughout the hospice and in the counselling and befriending services. Those services provided substantial practical care and emotional support during people’s illness and during bereavement. People experiencing emotional distress or poor mental health could also access counselling and support services, which operated alongside the bereavement support service. The award of a social action end of life project grant meant that the home care service was set to expand still further and thus enable people living with any terminal illness to benefit.
An extensive range of educational development programmes, meetings and support was provided to external organisations. This benefitted people living in the Harrogate district area through the dissemination of best practice and enhanced communication between partner agencies. Health and social care professionals endorsed the training they had undertaken and were positive about the benefits to their own work.
Effective management arrangements were in place to safeguard people and to promote their wellbeing. Safe recruitment practice was followed for both paid staff and volunteers, which minimised the risk of appointing someone unsuitable. All staff and volunteers received training appropriate to their role within the hospice. Staff were knowledgeable and had the right skills, knowledge and experience to provide people with safe, consistent care. Clinical supervision and counselling promoted staff self-awareness, professional accountability and emotional wellbeing, which further enhanced patient care.
There was a high level of expertise in the way people’s symptoms were managed and clinical care was delivered. Prescription charts were clear and the times medicines were administered conscientiously recorded and medicines due outside of normal medicine rounds were flagged to ensure they were not forgotten. Whilst practice issues regarding medicines management were discussed immediate action was taken once these matters were brought to the manager’s attention. The governance arrangement around the management of medicines including controlled drugs was good. Incidents including medicines errors were logged and reviewed by the manager quarterly to look for trends and to learn from what had happened.
People’s care plans gave a good overview of people’s individual needs and the assistance they required. They contained detailed information to instruct staff what action they should take to make sure people received appropriate care, treatment and specialist support. People were supported to attend healthcare appointments and hospice staff liaised with other healthcare professionals, to meet people’s holistic care needs.
A high value was placed on dignity and respect and the wishes of the person who was ill. Staff were aware of the requirements of the Mental Capacity Act (MCA) 2005 and Deprivations of Liberty safeguards (DoLS) and had applied their knowledge appropriately to ensure people’s rights and freedoms were upheld. Where people were unable to make complex decisions for themselves the service had considered the person’s capacity under the MCA and had taken action to arrange meetings to make a decision within their best interests.