All of the people referred to Hospice at Home West Cumbria have ongoing involvement in their care from a range of community services which include Macmillan nurses and community nursing teams. Hospice staff worked from their own documented risk assessment/care plan but also have access to the community nursing notes which are kept in the person’s home. All treatment was prescribed by either a GP or a member of the palliative care specialist team.

We looked at the responses from the relative and carer survey and the patient survey for the latter part of 2013. We saw that all responses were positive about the care and support they received from the Hospice at Home West Cumbria staff. Comments included, “Hospice at Home was an excellent service – I couldn’t have managed without them.” All respondents confirmed that they were regularly kept up to date with the details of who would be providing care and that people were treated with dignity and respect by staff. There were also positive comments regarding the support carers received with one person stating, “It was good to be able to talk things out with someone who was supportive of us, but was unbiased.” Another person wrote, “Dignity and respect for the patient and carer was given at all times.”

All medication for people who received support from the service was prescribed either by the person’s own GP, Cumbria Health on Call (CHOC) or members from the palliative care team. All medication was kept in the person’s own home and remained their property. In the event of death, all drugs were the responsibility of the family and staff advised them to return these to the local pharmacy.

The provider could demonstrate that suitable arrangements were in place to ensure that staff employed in the service were appropriately trained in relation to their job role. All staff we spoke to confirmed to us that they felt very well supported. One person told us, “There is very good morale amongst all staff and we all receive very good support. I receive good updates, it’s the best training I have ever had.” Another told us, “The buddy system works really well. There are sometimes problems in trying to arrange meetings but we always manage it.”

The Hospice at Home West Cumbria was able to show us that they monitored the quality of the service they provided to people. They gathered information about safety and the quality of their services from all relevant sources which included feedback from people using the service, audits, investigations, complaints and compliments and any other information they received.

We did not ask for the views of people who use services as part of this follow up inspection

This inspection of the Hospice at Home West Cumbria took place over three days 18, 19, 20 August 2015. We last inspected this service in January 2014. At that inspection we found the service was meeting all the regulations assessed.

Hospice at Home West Cumbria (the service) is a registered charity providing 24 hour nursing care with personal care interventions as appropriate to need and a lymphoedema assessment and treatment service. The service will also support people living in residential or nursing homes or in the acute hospital and community hospital and operates from an office based at Workington Community Hospital. The service aims to help both people and their carers during the last few months, weeks or days of their lives. The care and support supplements that given by community doctors and nurses.

The Hospice at Home West Cumbria provides a specialist Lymphoedema service through its clinics and home visits. [Lymphoedema is a chronic condition where excess fluid is retained in the tissues causing a painful swelling]. There is also a patient, family and bereavement support service available before and following bereavement. All services are provided free of charge.

At the time of our inspection the service had 12 people using the home nursing service. Six people were being visited at home by the Lymphoedema nursing team as their condition did not allow them to attend the service’s clinics. In addition the service provided Lymphoedema clinics and also made home visits if needed.

The service also offers bereavement support to patients, carers and families (including children as part of the family unit) and complimentary therapies. The complimentary therapies provided included therapeutic massage, Reflexology, Reiki and breathing and relaxation techniques. [Complimentary or ‘holistic’ therapies are therapies that aim to treat the whole person, not just the symptoms of disease].

The service had a registered manager 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.

Everyone we spoke to whose relatives were or had received care from the service had only positive things to say about their experiences. Comments included, “They are so caring” and “A real community asset” and “So professional”. Staff were proud to be part of the organisation and set themselves high standards to deliver.

We found that the service was well run and had measurable and verifiable processes in place to thoroughly monitor and assess the effectiveness of the care and support services it provided. Systems were also in place to ensure that training and development and research activity were given the time and resources needed to promote the continuous improvement of the service. This approach placed the voices and preferences of the people using the service at its centre. The service also took its expertise out into the broader community through training and educational initiatives. Staff were enthusiastic and showed a deep commitment to providing a high standard of care and expertise.

The staff and management team used reflection and incident analysis to help them make changes to improve the care and support they gave so that they responded quickly to a person’s needs. Forward thinking planning and strategic business planning was very clear and accessible to address the diverse and changing care needs of the local population.

The service worked closely with the hospital palliative care team, GPs, the Macmillan team, community nursing services and external agencies such as social services and mental health team. This helped to make sure smooth cross service working to provide appropriate care to meet people’s different physical, psychological and emotional needs.

There were systems in place to assess and to grade and manage risk. For example, to protect people from the risks associated with medicines, falls, pressure sores and moving and handling. For staff the lone worker procedures and risk assessments for work place stress and specific training needs helped keep staff safe as well.

People who used the services told us how much they valued it and the high standard of caring and understanding displayed by staff about their needs. They told us that they were involved in planning how they wanted to be cared for and were frequently asked for their views and experiences of the service and were listened to. A relative told us “They give us all the care and support they possibly can, they’re so very good”.

Everyone we spoke with who worked for the service was very clear about their aims and objectives and their sense of commitment to the people they supported was evident in their enthusiasm and pride in their service.

All staff and volunteers received induction, training and support relevant to their roles and had been tailored to their personal training needs. Training was given a high priority and staff were encouraged to realise their potential and develop their skills and knowledge to take the service forward and provide care that reflected best practice.

Staff had received training on safeguarding and all felt they could raise and concerns about safety or practice with the management team and would be well supported. Effective systems were in place for the recruitment of staff and there were regular registration and security checks to make sure all staff were still suitable to work with people in their homes.