Pilgrims Hospice Canterbury

Updated 30 March 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 took place on 21 January 2015 and was unannounced. The inspection team consisted of two inspectors, a pharmacist, a specialist nurse 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.

Prior to the inspection we looked at previous inspection reports and notifications about important events that had taken place at the service. Before the inspection, we asked the provider to complete 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 provider returned a PIR within the set time scale. We also obtained feedback from questionnaires sent to people who use services, relatives and friends, community professionals, and care, nursing and medical staff.

We spoke to nine people receiving day or in-patient care, five relatives/visitors, and 15 staff. Including nursing staff, care staff, the pharmacist, a community nurse, chef, and office based staff responsible for human resources and quality assurance. We also spoke to a visiting minister. The registered manager was present on the day and supported us with the inspection.

We observed staff helping people with food and drink at lunchtime, assisting people with their needs and talking with people during the day. We saw the in-patient ward, patient lounge, chapel, and gym and day services. We also looked at three people’s care plans and spoke to staff about their care needs. This was to track how their care was planned and delivered.

During the inspection we viewed a number of records including three staff recruitment records; the staff training programme; medicine records; medicines, safeguarding, complaints and infection control policies and procedures; environment and health and safety records; risk assessments and audits; user group and health and safety minutes; menus, compliments and complaints logs and quality assurance questionnaires.

Updated 30 March 2015

The inspection was unannounced. At the previous inspection in December 2013, we found that there were no breaches of legal requirements.

Pilgrims Hospice Canterbury is one of three hospice locations for the provider, Pilgrims Hospices in East Kent. It provides specialist end of life care and care to people with life limiting illnesses, their carers and families. Pilgrims Hospice Canterbury has a 16 bed in-patient unit and provides day therapy and bereavement counselling. The service also provides services for people in the community including hospice services for people at home, outreach clinics in Faversham, Whitstable and Dover, support groups and 24 hour advice. Services are provided by a multidisciplinary team of health and social care professionals and volunteers. The service was providing services to 393 people in the community and in the hospice at the time of the inspection.

The hospice is run by a registered manager, who was present on the day of the inspection. 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.

People said that they felt safe receiving care from the hospice. Staff had been trained in safeguarding adults and received regular refresher courses. Staff gave clear explanations of the different types of abuse to be aware of and demonstrated that they knew the action to take in the event of any suspicion of abuse.

Risks to people’s safety were assessed and managed appropriately. Assessments identified people’s specific needs, and showed how risks could be minimised. Environmental and health and safety checks were carried out to ensure that the environment was safe and that equipment was in good working order. There were systems in place to review accidents and incidents and make any relevant improvements.

Checks were carried out on all staff at the service, to ensure that they were fit and suitable for their role. This included interviewing applicants and undertaking criminal record/barring checks and character references.

People said that there were enough staff available to promptly attend to their needs. Staff did not rush people and had time to give people and their family member’s individual time and support. Staffing levels were flexible and based on people’s individual needs.

Safe systems were in place for the ordering, storage, administration, recording and disposal of medicines.

The hospice provided a relaxed, comfortable, clean and attractive environment. This included facilities for families to relax in during the day and to stay overnight. There was a quiet reflective area in the chapel and well maintained gardens for people to spend time in.

People said that staff had the skills and knowledge to support them. They said that staff always explained what they were going to do, and sought their consent, before supporting them with their care needs. New staff received a comprehensive induction, which included training in areas necessary to their roles and also completed a wide variety of additional specialist training to make sure that they had the right knowledge and skills to meet people’s needs effectively.

People said that the quality of the food provided was “excellent”. They were offered a variety of choices, which took into consideration people’s dietary, health and individual needs and preferences. The chef and catering staff provided specific items requested by people, and in preparing and presenting food in an attractive way.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had not needed to make an application under DoLS to ensure that people were not deprived of their liberty unnecessarily.

Everyone commented on the kind, compassionate and caring manner of the staff team. People said that they were always treated with dignity and respect, and were encouraged to continue to do tasks that they were able to do and be involved in making day to day decisions.

The hospice had a holistic approach to caring for people at the end stages of life, and for providing expert care and advice to people needing symptom management, or other support with life limiting illnesses. They supported the person to continue relationships with their family, to support their spiritual needs, achieve end of life wishes and offered complementary therapies. People’s families were supported by the caring nature of the staff team, and in addition by support groups and bereavement counselling if they wished.

People’s needs were thoroughly assessed before they were offered services at the hospice and once a referral had been made. The staff team ensured that care and support was offered in a timely way, and services were offered flexibly depending on peoples needs. People’s care plans were personalised and contained detailed information about their preferences and advanced decisions in relation to end of life care.

People said that they were involved in planning their care and treatment and were confident that staff explained everything to them clearly. Care plans were stored electronically and were reviewed and updated on a daily basis.

The service viewed complaints as a way to learn and to improve the service. People knew how to make a complaint and the service was effective in responding to any complaint or concern that was raised.

The registered manager and senior staff were available and provided reliable and helpful support for people, relatives and staff. Staff understood the ethos and values of the service and how to put these into practice. Staff were motivated and said that there was good team working and communication, which enabled them to give good care to people who used the service.

There were systems in place to review all aspects of the service and assess if the hospice provided quality care for the people who used it. The service was proactive in education, research and local community projects to improve end of life care and care for people with life limiting illnesses and their families. Feedback from people who used the service was sought and acted upon.