This unannounced focused inspection took place on 30 October 2017. The last unannounced comprehensive inspection took place on 17, 18 and 22 August 2017. At that inspection we rated the service as ‘Requires Improvement’ and found one breach of a regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines management. After the comprehensive inspection the provider sent us an action plan and told us they would make the necessary improvements by 6 October 2017. We had also made a recommendation in relation to auditing and monitoring processes. At this inspection we found that action had been taken to address the shortfalls from the last inspection and processes for auditing and monitoring were in place and working effectively.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Harlington Hospice on our website at www.cqc.org.uk.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider's premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of fluid in body tissues). The service is located in welcoming and comfortable premises with a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider did not have any inpatient services and offered three different types of care packages to support people in their own homes. At the time of our inspection there were 12 people receiving care in their own homes.

The 'Homesafe Night Service' provides a maximum of three nights' of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person's needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The 'Home2Assess' service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by healthcare assistants.

The 'End of Life Care at Home Service' is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people's needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people's assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service is required by legislation to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The service had been without a registered manager since January 2017 and was recruiting to this post. The nom

The last inspection took place on 11 October 2016 when we found breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the provider not supporting staff with formal and regular one to one supervision and an annual appraisal, and the provider not demonstrating robust systems to assess and monitor the quality of the service delivered to people. At this inspection we found improvements had been made in these areas. However, shortfalls were identified with medicines management and the monitoring process had not improved sufficiently to have picked this up.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist

community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider's premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of fluid in body tissues). The service is located in welcoming and comfortable premises with a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider does not have any inpatient services and offers three different types of care packages to support people in their own homes. On the first day of inspection 21 people were receiving care in their own homes.

The 'Homesafe Night Service' provides a maximum of three nights' of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person's needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The 'Home2Assess' service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by healthcare assistants.

The 'End of Life Care at Home Service' is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people's needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people's assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service is required by legislation to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 and associated Regulations about how the service is run. The previous registered manager deregistered in January 2017 and recruitment was ongoing for a new manager. The nominated individual was applying to register with the CQC as an interim measure.

Medicine administration records were not always completed fully and records did not always contain an explanation of any omissions of medicines.

Although monitoring and auditing had improved and the findings from the last inspection had been addressed, further improvements to ensure all aspects of the

This inspection took place on 16, 17 and 29 November 2016. The inspection was unannounced on the first day and we informed the provider we were returning for the second and third days.

Harlington Hospice Association Limited is a registered charity which provides a range of specialist community services for people aged 18 and above with life limiting illnesses and end of life care needs. These services include personal care and nursing care for people living in their own homes, counselling and emotional support, and a Lymphoedema therapy service at the provider’s premises. (Lymphoedema is a chronic condition that causes swelling in the body due to an accumulation of lymph fluid in body tissues). The service is located at a welcoming and comfortable premises, which contains a range of facilities including a purpose built day centre and bespoke treatment rooms. There is also a large and tranquil rear garden that overlooks pleasant fields. The provider does not have any inpatient services and offers three different types of care packages to support people in their own homes. Twelve people were receiving nursing or personal care at home on the first and second days of the inspection; however, due to the distinctive nature of the home care schemes there were six people using the service on our final visit. Sixty-six people were using the Lymphoedema therapy service.

The ‘Homesafe Night Service’ provides a maximum of three nights’ of night sitting to support people to safely settle back at home following discharge from hospital. This service is delivered by either a registered nurse or a health care assistant, in accordance with a person’s needs. The provider also offers this service on request from the local rapid response or integrated care team in order to prevent hospital admissions. The ‘Harlington Care’ service provides short-term care packages of four visits a day for up to 10 days, in order to facilitate discharge from hospital and fill the gap between the discharge date and a sustainable care package arranged by social services being operational. This service is mainly delivered by health care assistants. The ‘Palliative Care at Home Service’ is provided for people with an anticipated prognosis of six months or less. This service can offer up to four visits a day to provide personal care and social support. Visits are predominantly provided by health care assistants but sometimes a registered nurse can be supplied if people’s needs determine the necessity for nursing care. A night sitting service can be included if required, which can be delivered by a health care assistant or registered nurse in accordance with people’s assessed needs. The registered nurses are able to offer symptom management and the management of syringe drivers. (These are portable pumps used to provide a continuous dose of medicine through a syringe).

The service had a registered manager in post, who held the Clinical Lead position within the organisation and is a registered general nurse. 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. During the inspection the registered manager informed us that she was due to resign as registered manager and take on another position within the organisation.

People told us they felt safe using hospice services although some practices were not consistently safe. Staff knew how to protect people from the risk of abuse as they understood the provider’s safeguarding policy and had received suitable training. However, we noted that there had been an incident that potentially placed a person at risk that was not reported to the local safeguarding team. People and relatives understood how to make a complaint and the records for complaint

The service had a manager in place who was applying to CQC for registration.

We spoke with five people who use the service, one relative and nine staff. The staff included the nominated individual, the manager, two referral coordinators, two registered nurses and three health care assistants. The people using the service and relative we spoke with were present at the day centre during the inspection.

People were happy with the care and support they received, and said staff listened to them and treated them with dignity and respect. Care was planned to meet people’s needs and wishes and staff understood the care and treatment people required.

People received care from a team of health and social care professionals, so that all their needs could be identified and they could receive appropriate care and treatment. There was communication between staff working for the service and other healthcare professionals to ensure people received continuity of care.

Staff had the knowledge and skills to care for people effectively and undertook training and updates.

There was a complaints procedure in place. People said they would feel confident to raise any concerns, and that these would be addressed.

Comments we received about the service included, “they are just like a family….nothing is too much trouble”, “very welcoming” and “a wonderful place.”

Comments received by the service from relatives of those who had been cared for by staff included, "you are an amazing group of people" and "we could not have managed without them. Their support was invaluable."

We carried out this inspection to check whether the provider was meeting regulation 21 of The Health and Social Care Act 2008 (Regulated Activities) 2010. On 31 October and 1 November 2012 we carried out an inspection and found there were recruitment procedures in place to obtain the information required, however these were not always being followed and so the information was not always available to evidence that people were cared for, or supported by, suitably qualified, skilled and experienced staff.

During this inspection we found that the provider had made improvements and was now meeting the relevant regulation.

We carried out our inspection over two days to speak with people attending the respite centre, which was open one day a week. We spoke with four people using the service, one visitor and eight staff. The registered manager and clinical lead were present during the inspection.

People were assessed so their needs and wishes were identified and care could be planned to meet them. People said staff treated them with respect and maintained their privacy and dignity. Systems were in place to ensure staff had the information they needed to be able to care for people effectively. People were happy with the care provided and enjoyed the companionship provided in the respite centre.

Safeguarding procedures were in place and were being followed. Medicines were administered by registered nurses with the training and knowledge to do so safely. Staff recruitment procedures were in place but were not always being followed. The different areas of care provision within the service were being appropriately staffed and staff had the knowledge and skills to care for people effectively.

Systems for monitoring and quality assurance were in place and work was ongoing so the service would be monitored regularly and action taken to address any issues identified. Surveys had been carried out in March 2012 and the responses were positive. Comments included “treated my relative with utter respect”, “extra caring (staff)” and “we could not have coped without your excellent support”.