The inspection took place on 13 and 14 April and was unannounced. Wisdom Hospice is one of a range of services provided by Medway Community Healthcare. 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 nurses, doctors, counsellors, social workers, occupational therapists, physiotherapists, spiritual leaders and a range of volunteers. The service cares for people in four types of settings: at the hospice in a 15 bedded ‘In-Patient Unit’; in the ‘Hospice day service’; in people’s own homes; and in hospital, where people received care from the hospital palliative care team, based at Medway Foundation Trust. The service was providing services for 392 people in the hospice and the community at the time of the inspection. A registered manager was in post. 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 at ease receiving care from the service and relatives reported that people were in safe hands. Ensuring that staff understood how to safeguard adults and children was central to the running of the service. Staff received training and regular updates throughout the year and demonstrated that they knew how to recognise and report potential abuse.
Assessments of risk were individual to people’s specific needs and identified 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.
People said that there were enough staff available to promptly attend to their needs. The numbers of staff and volunteers available meant that staff had time to give people one to one attention.
Safe systems were in place for the ordering, storage, administration, recording and disposal of medicines.
New staff received a comprehensive induction and received effective support from a mentor. Training was provided which was necessary to their roles and included specialist training in bereavement and end of life care to make sure that they had the right knowledge and skills to meet people’s needs effectively.
People’s health, medical, nutritional and hydration needs were assessed and closely monitored. People’s needs were individually discussed and effectively communicated when the staff team changed on the in patient unit. People were supported by a multi-disciplinary team and referrals were made to other professionals to seek their advice and input when it was required.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes, hospitals and hospices are called the Deprivation of Liberty Safeguards (DoLS). The service manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The service had made applications under DoLS to ensure that people were not deprived of their liberty unlawfully.
The service provided a relaxed, comfortable and clean environment. There were a range of areas available for people and their visitors to sit and for day patients to undertake activities.
The service had received a large number of compliments concerning the kind, compassionate and caring manner of the staff team. Staff spend time listening and talking to people and people said they were treated as individuals.
The service had a holistic approach to caring for people at the end stages of life. Supporting the person and their family members was seen as a key to their well-being. Family members received support after the death of their loved one through individual or group bereavement counselling. People’s spiritual needs were met and there was a range of complimentary therapies which valued the contribution of people with a life threatening illness.
People’s individual wishes with regards to their care were recorded and the staff team advocated for people when necessary to ensure these were met. People and family members were involved in planning their care and treatment and were confident that staff explained everything to them clearly. Care plans were detailed, reviewed and updated on a daily basis.
People’s needs were thoroughly assessed before and at the time of being admitted to the service. The staff team ensured that care and support was offered in a timely way, and services were offered flexibly depending on people’s needs. People’s care plans were personalised and contained detailed information about their preferences and advanced decisions in relation to end of life care.
Peoples’ psychosocial, spiritual and therapeutic needs were catered for. The day hospice offered a creative and innovative programme of activities that ensured people were treated as active and valued members of the community. They were given opportunities to express their feelings and emotions through a variety of outlets including creative writing, art, photography and a quilting project.
The service and the charity which supported it, had built links with other hospices and the local community through offering services and fundraising events. Further improvements were planned for this area of development for the benefit of people.
People were able to make their views known and knew how to make a complaint or raise a concern. People were able to make their concerns know by immediately ‘texting’ them to the service, therefore, making it easier for them to do so. When complaints had been received, these had been investigated and forums held so that lessons were learned to improve the service.
There was an open culture, where people and their relatives were encouraged to share their experience of the service. Staff understood the ethos and values of the service and how to put these into practice. They felt valued, listened to and well supported. This resulted in a staff team who was motivated to give a high standard of care to people who used the service.
The service had a clear management structure and lines of accountability. There was a robust programme of clinical governance and audit to identify any shortfalls. When this occurred action plans were put in place with timescales to address these areas and monitored until completion. Therefore, there was a process of continuous improvement of the service.