Severn Hospice Apley Site

Severn Hospice Apley Site is operated by Severn Hospice Limited. The hospital has 10 beds. The service had seven open beds at the time of the inspection. Facilities include a day unit, spiritual room, indoor and outdoor relaxation spaces and a mortuary.

The service provides hospice care for adults. We inspected hospice services for adults during this inspection.

We inspected this service using our comprehensive inspection methodology. We carried out an unannounced inspection on Tuesday 22 October 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

We found areas of outstanding practice in relation to hospice care for adults:

• Staff consistently treated patients and those close to them with compassion and kindness. There was a strong, visible person-centred culture. Staff were highly motivated to offer care that promoted people’s dignity and respected patient’s entire holistic needs.
• Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs. Staff recognised the impact of small gestures in supporting patients and those close to them. Staff went above and beyond to ensure patients and those close to them had the emotional support throughout the hospice journey.
• Patients and those close to them were fully involved in their care. Staff consistently empowered people who used the service to have a voice and to realise their potential. Staff were fully committed to working in partnership with people and making this a reality for each patient.
• People’s individual needs and preferences were central to the delivery of tailored services. The service had innovative ways to provide integrated person-centred pathways. Services were flexible to patient’s needs.
• The service had a proactive approach to understanding and meeting the needs and preferences of different groups of people. Staff made reasonable adjustments to meet the needs of patients, including those with protected characteristics. Staff understood how to support people’s sexuality and gender identity whilst receiving care. The service coordinated care across services.
• Leaders had the skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. Leaders at all levels had the skills, experience and capacity to deliver excellent and sustainable care.
• Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. There was a strong culture of teamwork and support across all levels of the service. Staff shared a common goal to improve the quality and safety of care and people’s experiences.

We found good practice in hospice care for adults:

• The service provided mandatory training in key skills to all staff and made sure everyone completed it.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. However, policies did not consistently support staff to safeguard patients.
• The service controlled infection risk well. Staff used control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.
• The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.
• Staff completed and updated risk assessments for each patient and removed or minimised risks. Risk assessments considered patients who were deteriorating and in the last days or hours of their life.
• The service had enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers reviewed and adjusted staffing levels and skill mix.
• The service had enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.
• Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.
• The service used systems and processes to safely prescribe, administer, record and store medicines.
• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.
• The service did not use the safety thermometer, but did monitor safety information to help improve patient safety.
• The hospice provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance.
• Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.
• Staff assessed and monitored patients regularly to see if they were in pain, and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.
• Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients.
• The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.
• Doctors, nurses, other healthcare professionals and non-healthcare staff worked together as a team to benefit patients. They supported each other to provide good care.
• Key services were available seven days a week to support timely patient care.
• Staff gave patients practical support to help them live well until they died.
• Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions.
• People could access the service when they needed it and received the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were monitored.
• It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.
• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.
• Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.
• Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.
• The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.
• Leaders and staff actively and openly engaged with patients, staff, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.
• All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

• The provider should review the complaints policy to ensure it is reflective of the full complaints process.
• The provider should review the use of friends and relatives to translate information to patients.

Heidi Smoult

Chief Inspector of Hospitals