Pilgrim Hospice Thanet is one of three hospice locations for the provider, Pilgrim Hospices in East Kent. 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 doctors, nurses, occupational therapists, physiotherapist, social workers, counsellors, spiritual leaders and a range of volunteers. The location has a day centre and capacity for 18 persons in their In-patient unit (IPU). At the time of our inspection, nine people were using the service as in-patients. The community team provides services for people in their own homes and at an outreach clinic in Deal. There is a rapid response service that provides personal care to people in the community and is available the same day it is needed. The Hospice at Home service supported people in the last days when they approached end of their life. Support groups for carers are available and advice is available 24hours a day. The service was providing services to approximately 400 people in the community and in the hospice at the time of our inspection.

There was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run. The registered manager was also the director of nursing and care services.

At our last inspection on June 2016, we found that medicines were not properly and safely managed; staff had not received the appropriate supervision to enable them to carry out their roles; we issued two requirement notices in relation to these two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the service was not always effective in protecting staff from rude and bullying behaviour. The registered provider sent an action plan to us detailing the improvements they would make. They confirmed they would be meeting the requirements of the regulations by October 2016 and that new systems would be embedded and sustained over time. They kept us informed of their progress.

This inspection was carried out on 15 and 16 June 2017 to follow up on compliance with these notices and check whether new systems were embedded in practice. At this inspection we found that the registered provider had met the requirements detailed in the requirement notices and had made significant improvements to medicines management, the support provided to staff and the culture of the service.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns in regard to people’s safety. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Improvements had been made in regard to the management of medicines. People received medicines that were stored, documented, administered and disposed of appropriately by competent staff.

People received care from staff who were appropriately supported, skilled and appropriately trained. All staff received regular one to one supervision sessions to support them in their role. There were members of staff who took the lead in a speciality, offering guidance to other staff so people could be confident about staff particular expertise. There were sufficient staff on duty to meet people’s needs across the service. Robust recruitment systems ensured staff were suitable to work with people.

People were fully involved in the planning and review of their care, treatment and support while in the Inpatient Unit (IPU) and while receiving support in the communi

The inspection took place on 15, 16 and 17 June and was unannounced. Pilgrims Hospice Thanet is one of three hospice locations for the provider, Pilgrims Hospices in East Kent. 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 location has a day centre and capacity for 18 in-patients. At the time of our inspection up to 12 people were using the service as in patients. The community team provide services for people in their own homes and at an outreach clinic in Deal. There is a Rapid Response Service that provides personal care to people in the community and is available on the same day it is needed. Support groups for carers are available and there is a 24 hour advice. The service was providing services to 349 people in the community and in the hospice 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.

Safe systems were in place for the ordering and administration of medicines. However, medicines which had passed their expiry date were stored with current medicines. This was not safe practice. Guidance was not in place for the use of prescribed creams nor if people were able to self-administer their medicines.

The service had not followed its policy in providing staff with regular supervision which offers staff support and learning to help with their development. Opportunities for staff to reflect on their practice and to learn what they were doing well and what they could improve in supporting people, had not been formalised throughout the service.

There had been a lack of consistency in leadership at the service and not all staff had not been protected from bullying and harassment. The staff team had not felt valued, listened to or supported for a number of years. Even though some staff morale was low, all staff continued to give a high standard of care for people who used the service. The new management team was aware of staff’s feelings and that it took a long time to change the culture of a service. They had put in a range of initiatives to engage with staff.

Staff understood how to safeguard adults and children and this was central to the running of the service. Staff received training in safeguarding and demonstrated they knew how to recognise and report potential abuse.

Potential risks to people had been assessed and action and guidance was in place which identified how they 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 to identify any patterns or trends. The service was clean and infection control guidance was followed to help minimise the spread of any infection if it should occur.

Checks were carried out on all staff at the service, to ensure that they were fit and suitable for their role. Staffing levels were flexible so staff could support people in the part of the service where there was the greatest need.

New staff received a comprehensive induction and were provided with the training necessary to their roles. This 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 monitor

People told us that they were happy with the care and treatment that they and their relatives received at the hospice. They told us that they were fully involved in decisions about their treatment and plan of care. We found that people’s individual needs were assessed and care given in accordance with their and their families’ wishes.

People told us that the staff were attentive to their needs. One relative told us "they really can’t do enough for you.”

The manager and staff took care to ensure that people’s views were taken into account.

We spoke to two patients and three relatives of patients. All the people we spoke to said that they were happy with the care given and none had any concerns. One told us that "you can’t fault the treatment."

People told us that they were happy with the care and support that both they and their relatives received. They told us that their needs were being met in all areas. They said that staff treated them with respect and that they communicated with them about their treatment and plan of care. People told us that they would be happy to raise any concerns with staff should they need to.

People told us that the staff responded to their needs quickly when they used the buzzer system. One relative told us “they are very good with the call buzzer – they are very quick”.

We spoke to four of the sixteen patients. All four patients that we spoke to said that they were happy with the care given and none had any concerns. One told us that “staff are amazing” and another said “care has been excellent – I could never have had better”.