Trinity Hospice and Palliative Care Services Limited

Updated 28 October 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 team consisted of two adult social care inspectors; a specialist advisor, with clinical experience of hospice services and end of life care; and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience for the inspection at Trinity had experience of caring for people who access hospice services.

Prior to our announced inspection on 13 July 2016, we reviewed the information we held about Trinity. This included notifications we had received from the provider, about incidents that affect the health, safety and welfare of people who accessed the service.

Before the inspection, the provider completed 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. The registered manager told us they planned ongoing staff training and support, as well as the development of their new clinical patient record system. They also said they would enhance their recently introduced staffing levels model; their clinical waste processes; and their auditing systems. They highlighted they planned to recruit new staff for additional treatment programmes and to assist with ongoing growth of their community services.

We spoke with a range of individuals about this service. This included twelve people who accessed Trinity, seven relatives, the registered manager, the chief executive, nine staff and two volunteers. We did this to gain an overview of what people experienced accessing the hospice.

We also spent time observing staff interactions with people who accessed the service and looked at records. We checked four individuals’ documentation and five staff files. We reviewed records about staff training and support, as well as those related to the management and safety of the service.

Updated 28 October 2016

The inspection visit at Trinity Hospice and Palliative Care Services Limited was undertaken on 13 July 2016 and was announced. We gave 48 hours’ notice of the inspection because of the sensitive nature of the service provided. We also wanted to ensure people, staff and visitors were available to talk with us.

Trinity provides palliative and end of life care for 33 children and adults with life limiting illnesses. The service supports people and their families, providing spiritual and holistic care. Furthermore, they offer a hospice at home service in the local community to assist individuals living at home. At the time of our inspection, there were eight people inpatient at Trinity. Additionally, the hospice supported approximately 500 individuals in their own homes within the Blackpool and surrounding areas. The service further employed two teams of clinical nurse specialists in the wider community who worked at the local hospital and with community services. They supported people who were inpatient and worked collaboratively with district nurses for those who lived in their own homes. The nurse specialists provided palliative care management, symptom control advice and facilitated complex treatment discussions with people and their families.

Trinity is situated in a residential area close to local amenities. The service supports people in three different units: the main hospice inpatient unit; Brian’s House (the children’s unit); and a day therapy unit. Bedrooms are for single occupancy, spacious and comfortable. Additional facilities include therapy areas, private consultation rooms and extensive gardens.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 20 August 2014, we found the provider was meeting all the requirements of the regulations inspected.

During this inspection, staff, people and visitors said the service was organised to a high standard and had exceptional leadership. The registered manager worked jointly with other agencies to develop best practice and foster excellent partnership relationships. For example, they conducted various research studies with the local hospital that influenced and improved best practice and national care policy-making. We saw this had a major impact upon people’s care, safety and welfare.

We found staff, people and relatives were at the heart of Trinity’s quality assurance programme. The management team set up multiple forums to involve and gain their feedback. One comment we saw stated, “Nothing needs improvement.” A relative fed back, “Fantastic support given by the hospice at home team.” The registered manager had remarkable oversight of care provision, service quality and everyone’s safety. This included multiple auditing systems, a range of different staff-level meetings and various structures to review staff, people and visitor’s views.

We observed staff provided outstanding support that had the person at the centre of their care and treatment. Without exception, people and their relatives spoke extremely highly of staff and their experiences of care. One relative said, “I really cannot praise them enough.”

We found care planning enabled staff to work in a highly personalised and holistic approach. People told us staff were efficient at responding to them and their requirements. End of life care plans were very detailed and relatives told us related support was excellent. One relative fed back, “The memory boxes have been overwhelming since my [family member] passed away.”

People and their representatives said staff worked collaboratively with them to ensure they received high standards of care. One person said staff advised them in ways that helped them to understand and be fully involved in their care. They added, “We were given lots of information to help us prior to and on the day we arrived, like leaflets and booklets.”

We toured the service and found it had an exceptionally tranquil, warm, happy and welcoming atmosphere throughout. One person said, “I hold Trinity in my heart. I didn’t want to leave.” The hospice demonstrated a highly sensitive and compassionate understanding of protecting and respecting people’s human rights. We found staff were passionate about providing a non-discriminatory service.

The registered manager had systems to monitor and manage accidents and incidents to maintain everyone’s safety. We found people had risk assessments to minimise the risk of harm or injury to them. The provider ensured staff received safeguarding training to underpin their roles and responsibilities. One person confirmed, “I feel safe and supported.”

We noted the registered manager had sufficient staffing and skill mixes to meet people’s levels of support. People told us staffing levels were ample to meet their needs. We saw staff had extensive training to underpin their skills in supporting people at Trinity. The management team had not always followed their recruitment procedures, but took immediate action to address this.

People said they received their medication on time and when they required them. We noted two responsible staff administered medicines together without interruption to ensure a methodical and safe approach. Associated records we looked at were up-to-date and completed accurately.

We found the registered manager trained staff in nutritional support to enhance their awareness of associated risks. When we discussed the quality of meals with people and their relatives, they said food was of a good standard. One person told us, “If there’s not something we like they always get something else from the kitchen for us and it’s never too much trouble for them.”

Staff received training about the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards and demonstrated good awareness of related principles. Care records held documented evidence of the person’s agreement to care.