Pilgrims Hospice Thanet

Updated 16 August 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 carried out 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 was carried out on 15 and 16 June 2017 and was unannounced. The inspection team consisted of three inspectors, one pharmacist inspectors and an expert by experience. The expert by experience who supported this inspection had experience in palliative care.

The registered manager had completed a Provider Information Return (PIR) at the time of our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. Before our inspection we looked at the information provided in the PIR; records that were sent to us by the provider, the registered manager and the local authority to inform us of significant changes and events; the provider’s action plan; and our previous inspection reports.

We made a tour of the premises and equipment. We looked at twelve sets of records that related to people’s care and examined people’s medicines charts. This included people’s assessments of needs and care plans, and observations to check that their care and treatment was delivered consistently with these records. We consulted documentation that related to staff recruitment, training and management, maintenance and safety of the premises, and records relevant to the storage, ordering and administration of medicines. We path-tracked a planned discharge which had involved all members of the multidisciplinary team, including doctors, nurses, a physiotherapist and social services. We looked at audits, checks and surveys concerning the monitoring of the safety and quality of the service. We observed a multi-disciplinary meeting and the administration of medicines. We sampled the services’ policies and procedures.

We spoke with the chief executive officer (CEO), the registered manager, the palliative specialist nurse community lead, the medical director (who is also the palliative care consultant), the hospice services manager, the director of HR and workforce development, and the director of income generation and marketing. We also spoke with the senior nurse manager, a team leader for the Hospice at Home service, the volunteer services manager, a community fundraising officer, the head chef, eight members of nursing and care staff and an occupational therapist assistant.

We consulted four people who stayed in the IPU, four of their relatives, four visitors and four volunteers. We also spoke with four people who attended the hospice day centre, and two relatives of people who had received support in their own home from the Hospice at Home team. We spoke with district nurses who provided care for people in the community alongside the hospice team, and two managers of nursing care homes that were supported by the hospice, to obtain their feedback.

Updated 16 August 2017

Pilgrim Hospice Thanet is one of three hospice locations for the provider, Pilgrim Hospices in East Kent. The hospice offers specialist palliative care, advice and clinical support for adults with life limiting illness and their families. They deliver physical, emotional and holistic care through a multi-disciplinary team of doctors, nurses, occupational therapists, physiotherapist, social workers, counsellors, spiritual leaders and a range of volunteers. The location has a day centre and capacity for 18 persons in their In-patient unit (IPU). At the time of our inspection, nine people were using the service as in-patients. The community team provides services for people in their own homes and at an outreach clinic in Deal. There is a rapid response service that provides personal care to people in the community and is available the same day it is needed. The Hospice at Home service supported people in the last days when they approached end of their life. Support groups for carers are available and advice is available 24hours a day. The service was providing services to approximately 400 people in the community and in the hospice at the time of our inspection.

There was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. The registered manager was also the director of nursing and care services.

At our last inspection on June 2016, we found that medicines were not properly and safely managed; staff had not received the appropriate supervision to enable them to carry out their roles; we issued two requirement notices in relation to these two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the service was not always effective in protecting staff from rude and bullying behaviour. The registered provider sent an action plan to us detailing the improvements they would make. They confirmed they would be meeting the requirements of the regulations by October 2016 and that new systems would be embedded and sustained over time. They kept us informed of their progress.

This inspection was carried out on 15 and 16 June 2017 to follow up on compliance with these notices and check whether new systems were embedded in practice. At this inspection we found that the registered provider had met the requirements detailed in the requirement notices and had made significant improvements to medicines management, the support provided to staff and the culture of the service.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns in regard to people’s safety. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Improvements had been made in regard to the management of medicines. People received medicines that were stored, documented, administered and disposed of appropriately by competent staff.

People received care from staff who were appropriately supported, skilled and appropriately trained. All staff received regular one to one supervision sessions to support them in their role. There were members of staff who took the lead in a speciality, offering guidance to other staff so people could be confident about staff particular expertise. There were sufficient staff on duty to meet people’s needs across the service. Robust recruitment systems ensured staff were suitable to work with people.

People were fully involved in the planning and review of their care, treatment and support while in the Inpatient Unit (IPU) and while receiving support in the community. Staff delivered care and support to people according to their individual plans.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. A system was in place to submit appropriate applications to restrict people’s freedom when necessary after the least restrictive options were considered, in accordance with the Mental Capacity Act 2005 requirements.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People were very complimentary about the food provided and told us they enjoyed their meal times. Staff knew about and provided for people’s dietary preferences, restrictions and reduced appetite.

Staff knew each person well and understood how people may feel when they were unwell or approached the end of their life. They responded to people’s individual communication needs and treated them with genuine kindness and respect.

Staff were caring, empathetic and compassionate. Staff approach was kind and pro-active; they were skilled at giving people the information and explanations they needed in a sensitive manner.

Clear information about the service, the facilities, and how to complain was provided to people and visitors. People’s privacy was respected and people were assisted in a way that respected their dignity. Staff sought and respected people’s consent or refusal before they supported them.

People and relatives told us they were very satisfied about the staff approach and about how their care and treatment was delivered. People’s feedback was sought, valued and acted on.

A robust quality assurance system was implemented and embedded in practice. A range of audits and checks were carried out throughout the service to identify how the service could improve and action was planned and taken as a result.