Pilgrims Hospice Ashford

Updated 27 January 2015

The inspection team consisted of three inspectors, one specialist hospice 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. The expert for this inspection had experience of a relative who had used hospice services. This was an unannounced inspection. The previous inspection took place on 19 November 2013, when no issues of concern were found. This inspection was carried out over two days, as the second day was used to visit the company’s head office and view recruitment files.

Prior to the inspection we examined the 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 PIR included comprehensive details as to how the care was provided, and the on-going development of the service. We looked at previous inspection reports; and we reviewed notifications received by the Care Quality Commission during the past year.

We met and talked with 10 in-patients, 8 people attending the day hospice service, and 12 people’s relatives and carers. We talked with a variety of staff, and observed others carrying out their duties. We talked with some visiting health professionals such as a GP; and with nursing staff, physiotherapists and occupational therapists employed by the service. The hospice had a large number of volunteers who assisted with different aspects of the work such as reception duties, gardening, and administration, and we talked with some of these.

On the second day one inspector visited the Human Resources department in Canterbury to view staff recruitment files; and a second inspector made phone calls to talk with patients and carers in the community; and three phone calls to social workers who arranged placements for people.

We observed staff carrying out their duties, such as staff assisting people with reduced mobility to walk short distances; and staff helping people with food and drink. We carried out pathway tracking by reviewing people’s records and speaking to the people concerned.

We reviewed records in paper and electronic formats. These included:  a list of hospice risk assessments, and two of the assessments in detail; eleven maintenance and servicing records; four staff recruitment files and staff training records;  minutes for a User Forum meeting; twelve recently completed patient surveys, and the results of the previous patient surveys; eight care planning and treatment records; one week’s staffing rotas; the complaints procedure; medicines records for individual patients and controlled drugs records; and audits for cleaning, infection control and controlled drugs management.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective?’

The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

Updated 27 January 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 was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to  pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Pilgrims Hospice Ashford is one of three hospices provided by the Company, Pilgrims Hospices in East Kent. It provides specialist palliative care, advice and clinical support for people with life limiting illness, their carers and families. The hospice has a 16 bed in-patient unit and a day therapy hospice with various clinics and drop-in centres.  There is a bereavement counselling service.  Services are provided by health professionals and volunteers. The service was providing services to 336 people in the community and in the hospice at the time of the inspection.

The hospice provides a very relaxed, comfortable, clean and attractive environment. This includes facilities for families to relax in during the day and to stay overnight. There are quiet reflective areas including a chapel; and beautifully maintained gardens for people to spend time in – either helping with the gardening, or wandering quietly in the memorial gardens or wildlife  area. People said it was very important to them that they were able to receive care and support in such a peaceful environment.

The hospice is run by a registered manager, who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

People said that they felt safe receiving care in the hospice. Many commented that they felt safe for the first time “in a long time”, because they “knew that their care and treatment was being managed effectively.” One person said “It only took me ten minutes to realise I was going to be safe and comfortable here.”

All of the staff had been trained in safeguarding vulnerable adults, and received regular refresher courses. Staff gave us clear explanations of the different types of abuse to be aware of; and explained that they knew the action to take in the event of any suspicion of abuse.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager told us that they had not found it necessary to apply for a Deprivation of Liberty Safeguard for anyone to date.  Where people were unable to make complex decisions for themselves the service had considered the person’s capacity under the Mental Capacity Act 2005, and had taken appropriate action to arrange meetings to make a decision within their best interests, if this was applicable.

The hospice had a wide range of risk assessments in place for the environment, and for each individual person who received care. Some people had restricted mobility and we saw that individual risk assessments had been implemented and were in use for different pieces of equipment. General risk assessments were evident for each room or area in the hospice, the gardens, maintenance activities and company vehicles.

Without exception, everyone spoke very highly of the staff, and patient surveys reflected this too. People’s comments included phrases such as “The service has been outstanding”; “The consultation was conducted in an excellent manner”; and “The doctors and staff could not have been more helpful and understanding.”

We saw that staff had a kind and gentle manner with people. They spent time listening to people, did not rush them, and did all they could to meet people’s individual wishes and requests.  The staff had suitable training and experience to meet people’s assessed needs; and always encouraged people to make their own choices and promoted their independence. We found that it was a hallmark of the service that ran through every aspect of the hospice, that people were treated as individuals, and were provided with the support they needed to enable them to meet their ‘wish’ lists.  A visiting health professional told us, “The care here is second to none. The staff really care about people and look after them extremely well.”

Staff files showed there were safe recruitment practices, which included Disclosure and Barring checks. These were included for volunteers who came into contact with patients.

We inspected medicines management and found that there were clear procedures in place to provide safe storage and administration of medicines.

People said that the food provided was “excellent”, and we saw that this included variety, suitable nutritional content, and was in accordance with people’s expressed wishes. The chef and catering staff were innovative in providing specific items requested by people, and in preparing and presenting food in an attractive way.

People told us that they were fully involved in every part of their care planning and treatment, and were confident that staff explained everything to them clearly. Care plans were stored electronically, and those for in-patients were reviewed and updated on a daily basis. The hospice employed their own consultants and doctors, as well as nurses, healthcare assistants, physiotherapists and other therapists to provide on-going treatment and support.

There were robust systems in place to obtain people’s views, which included formal meetings and the use of questionnaires. However, we found that it was a feature of the hospice to ask people for their views in relation to every aspect of their care, so that they were treated as individuals. The manager explained that the staff always tried to pick up on any little frustrations that people expressed and dealt with these immediately, so as to make people feel as comfortable as possible.

Patients, relatives and staff said that the manager was always available, and provided reliable and helpful support with any concerns or difficulties.