Queenscourt Hospice

Updated 16 July 2016

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 31 May, 1 & 2 June 2016 and was announced.

The inspection team consisted of an adult social care inspector, a specialist advisor (SPA) Pharmacist and an SPA with experience in end of life care.

The provider submitted a Provider Information Return (PIR) prior to the inspection. A PIR 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. Before our inspection we reviewed the information we held about the service. We looked at notifications and other information the Care Quality Commission (CQC) had received about the service. We contacted the commissioners of the service to obtain their views.

During the inspection we spent time with four people on the in-patient ward. We spoke with the registered manager, Chaplain for Southport and Ormskirk Trust, a volunteer, therapy staff, two nurses, a unit manager, two members of the care team, two clinical service managers, a quality services manager, the Medical and Education Director (MED) who held the position of consultant in palliative medicine, a doctor and the hospice lead for the transform team. The transform team’s remit is to up-skill staff with the knowledge and support for people in the last 12 months of life, both in the community and acute setting. We also spoke with two relatives during the visit.

We viewed a range of records including, four care documents for people who used the service, four staff personnel files, medicine records, records relating to the running of the service and a number of the provider’s policies and procedures.

Updated 16 July 2016

This announced inspection of Queenscourt Hospice took place on 31 May and 1 & 2 June 2016.

Queenscourt Hospice is a local charity that provides ten beds for acute specialist palliative care and support for the people of Southport, Formby and West Lancs. At the time of our inspection nine people were receiving specialist palliative care and support as an in-patient. The service also provides support for families, friends and carers of people using the services of the hospice. Palliative care means the hospice cares for people with serious illnesses, enabling them to achieve the best possible quality of life at each new stage. The in-patient unit had two wards (Woodside and Lakeside) and two single en-suite rooms. The service provision included Queenscourt at Home service, an in-patient unit and Queenscourt Connect. Queenscourt Connect provides day care and also a therapy service.

There was 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’.

The organisational structure included the director of clinical services (DCS) who was also the registered manager, the medical and education director (MED) who held the position of consultant in palliative medicine and there was a director of non-clinical services (DNCS). The organisation had a responsible individual who was the main point of contact with us, the Care Quality Commission, (CQC).

People we spoke with, family members and staff spoke positively regarding the overall management of the hospice and the leadership qualities of the senior management team. A person told us, "The staff team are brilliant."

Family and carers’ support was seen as important part of the overall care provision and feedback from relatives we spoke with was very positive. A relative said, “The support we have all had has been wonderful, I could not ask for more.” Formal feedback included the provision of surveys and feedback was very positive across all hospice departments.

The quality of the service was assessed and monitored regularly by a series of audits (checks) on the service provision to help monitor standards and drive forward improvements. We saw there was emphasis on working in partnership with external organisations, including other hospices and taking part in research based work and projects to evidence best possible outcomes for people who need end of life care.

Staff had a good knowledge of what constituted abuse and how they would report an alleged incident. Safeguarding policies and procedures were in place along with local authority guidelines for staff to follow.

People using the services of the hospice were protected against the risks associated with the use and management of medicines. Medicines were audited (checked) to ensure they were managed safely. Symptom control including pain management was seen as a priority.

Risk assessments were in place to ensure people’s health and safety. The risk assessments helped to help mitigate those risks and to protect them from unnecessary harm. There was a robust system in place to assess and monitor accidents and incidents. Incidents were analysed to minimise the risk of re-occurrence.

People were supported by sufficient numbers of staff to provide care and support in accordance with individual need. There was a flexible approach to adjusting the levels of staff required. People who were receiving care on the in-patient unit told us the staffing numbers were very good and assistance was provided promptly when requested.

Staff sought advice and support from health professionals to ensure people received the support they needed it and when requested to optimise their health. Hospice staff included doctors, nurses, physiotherapists, occupations therapists, complementary therapists, social worker, pastoral support, housekeeping and catering team.

Volunteers worked alongside hospice staff. They helped run fund raising events and supported the staff in various roles.

The hospice provides a very relaxed, comfortable and attractive environment which was designed to provide maximum privacy for people on the in-patient unit. The hospice had facilities for families and this included an overnight room and a house for people to stay in. The hospice grounds were landscaped and provided a tranquil setting for people to enjoy the peaceful surroundings.

A high standard of cleanliness was maintained at the hospice. Systems and processes were in place to monitor standards of hygiene and control of infection.

Recruitment procedures were robust to ensure staff and volunteers were suitable to work with vulnerable people.

Systems were in place to maintain the safety of the hospice. This included fire prevention, health and safety checks of equipment and the building and general maintenance.

We saw staff had access to a good training programme and support with their job role. The formal training programme for staff included palliative and end of life qualifications as part of their professional learning and development. A staff member said, “The training programme provides us with good learning opportunities.”

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Staff were trained in the principles of the Mental Capacity Act 2005 (MCA) and the DoLS and were knowledgeable in the main principles of the MCA that they applied in practice. They assessed people's mental capacity when necessary and when applicable they held meetings to make decisions on their behalf and in their best interest. This meant that people's rights were protected and respected. People’s consent was documented electronically to evidence their inclusion around their care and treatment.

Feedback about the meals was very good and emphasis was placed on accommodating people’s dietary needs and preferences so that the dining experience was enjoyable. People said, “The meals are so nicely served and so much choice” and “It’s like hotel food in all respects.” People had access to a menu which offered a good choice of hot and cold meals. Refreshments were available twenty four hours a day.

Staff were very caring, supportive and polite when helping people. Staff had time to listen and to spend time with people throughout the day so that they go to know them well. A person said, "Everyone makes so much time for you, it does help so much."

People told us they were involved with their care and treatment and everything was fully explained to them. People told us they had time to ask questions, had confidence in the staff team’s ability to care for them.

We saw people had a plan of care which provided information about their medical, physical, emotional and social care and specific wishes were recorded in advance care plans (ACPs). Care plans were stored electronically, and we saw those for in-patients were reviewed and updated on a daily basis.

People and their families were given plenty of information about the hospice and leaflets were available regarding support services/organisations and also medical conditions and symptoms people may experience.