We carried out this inspection on 20, 25 and 28 July 2017. This was an unannounced inspection.

Sue Ryder – Wheatfields Hospice is a specialist palliative care service. It provides inpatient care for up to 18 people. The service also supports 321 people in the community whose care needs are triaged and recieved medical advice. At the time of our inspection visit there were 12 people who used the in patient service.

The service currently had no registered manager although we checked the manager in post application had been received and was being processed by the CQC. 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.

The services provided included counselling and bereavement support, day hospice care, family support, spiritual support, out-patient clinics, occupational therapy, physiotherapy, complementary therapies and a lymphedema service (for people who may experience swellings and /or inflammation following cancer treatment).

People were kept safe by staff who were trained in the safeguarding of adults and health and safety. They were able to fully describe their responsibilities with regard to keeping people in their care, safe from all forms of abuse and harm. There were safe systems in place to manage and administer medicines to people. Medicines were prescribed, recorded, stored, administered and disposed of in safe and appropriate ways. People received their medicines in a timely manner and in line with their preferences.

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 to make sure people were protected from harm.

Recruitment practices were safe and ensured staff employed were safe and appropriately skilled to care for people using the hospice.

Systems were in place to ensure records related to accidents and incidents captured the relevant information and this was considered and analysed without delay. Appropriate remedial actions were taken following such occurrences and action was taken to minimise any immediate or future risks to people.

Staffing was at a level which allowed staff to meet people's needs in a safe, timely and personalised manner.

Staff were well supported with the provision of a wide range of support in the form of training, a comprehensive induction, ongoing supervision and appraisal along with practice reflection. Learning within the service including adopting and sharing best practice was highly prioritised.

People were supported to access the nutrition they needed and were monitored for any changes in their dietary needs.

Management and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and supported people in line with these principles. Staff established consent from people before providing care and supported people to access independent advice and support when necessary.

Staff were very caring and showed people and their families kindness. Staff demonstrated they were both motivated and passionate about their work and had a clear commitment to providing the best quality care in a compassionate way. People were encouraged to remain as independent as possible by staff. Staff acted in a way that maintained people's privacy and dignity.

People were fully involved in decisions about their care, including when identifying their preferred place of death. They benefitted from the environment within the hospice which was homely and had been designed and equipped in a way that was clearly comforting to people using the service.

People were fully involved in the planning of their care, from symptom and pain management to their end of life

We inspected Wheatfield’s Hospice on 17 and 19 May 2016. Both inspection days were unannounced which meant that the staff and registered provider did not know we would be visiting. At the last inspection in December 2013 the service was meeting the regulations we looked at.

Wheatfield’s Hospice (in patient unit) provides specialist palliative and end of life care to a maximum number of 18 people. The service also supports around 321 people in the community. At the time of our inspection visit there were 15 people who used the (in patient service).

The hospice had a registered manager in place. 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.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However in people’s care plans there was no evidence to support this. We spoke to the Head of Clinical Services who told us new care plans were starting within the next few days through an online system. The registered manager told us they had recognised short falls in their care plans and this new documentation would rectify this.

Staff understood people’s individual needs and the support they and their family members required. We saw that care was provided with the upmost kindness, respect and compassion. People who used the service and relatives spoke extremely highly about the care and service received. People said their right to privacy was fully protected. People told us the service they received were excellent. The hospice provided very good family support, counselling, a befriending service and bereavement support within and outside the hospice.

People and relatives spoke very highly of the complimentary therapies that were available to both people who used the service and their relatives.

There were very good staffing levels which allowed staff to meet people’s care and treatment needs in a safe, timely and personalised manner. The service had recruitment procedures in place. Staff and volunteers had robust recruitment checks, which helped to make sure they were suitable to provide people’s care and support.

Risks to people’s safety were appropriately assessed, managed and reviewed. Care records contained risk assessments specific to the needs of the people we looked at.

There were systems and processes in place to protect people from the risk of harm. Staff told us about different types of abuse and the action they would take if abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

The management of medicines was safe and people told us their pain was well managed. However, pain recording charts were not completed in the care plans we looked at.

Checks of the building and equipment were completed to make sure it was safe. The service had a comprehensive maintenance file which included any outstanding actions and completion dates throughout.

People told us the food provided was very good. Nutritional assessments were undertaken to identify risks associated with poor nutrition and hydration. The chef took time to speak to all people before the meals were given to ensure they received the choice and meal they wanted at the time.

People’s individual views and preferences had been taken into account when their care or treatment plan had been developed. However, care plans were not person centred. The registered manager tol

People who used the service said they were happy with their care, treatment and support. Comments included:

“I have been offered all the help I need.”

“Beautiful people here, it’s like a five star hotel, anything you request and it’s done.”

“They cannot do enough for you, always asking if there’s anything else you need.”

People said the meals were very good and food, snacks and drinks were available at any time of day for them. People also spoke highly of the catering staff and how helpful they were. Comments we received included:

“The food is very reasonable, very nice porridge and excellent desserts.”

“I really enjoyed a full English breakfast this morning.”

We saw that people who used the service were responded to promptly when they asked for any support or assistance. People who used the service said there were enough staff. They were also very complimentary about the staff. One person said, “The staff are so friendly, you see the doctor every day and they explain everything

so well.” Another said, “Always enough staff on, they come as soon as you press the buzzer, without fail.”

People were protected from unsafe or unsuitable equipment because the provider had systems in place to make sure equipment was properly maintained, suitable for its purpose and used correctly. Staff and people who used the service said they had all the equipment they needed.

There were systems in place to ensure people were protected because accurate and appropriate records were maintained.

People who used the service were involved in decisions about their care and treatment and had their consent recorded. People had the opportunity to record how they would like to be cared for in the future if their health deteriorated. We spoke with two people who used the service. One person said “they always explain things to me.” Another said that the staff “Discuss everything with me.”

People were cared for in a way which met their needs and protected their rights. Each person had their own individual care plan which contained information specific to them. The staff showed a pride in the quality of care provided and a genuine concern for the welfare of people using the service. We saw staff interacting with patients in a warm and supportive manner. We saw people being treated with respect and courtesy.

People were cared for in a well maintained and clean environment. The provider had sought to create welcoming and comfortable facilities for patients and their families. There were effective systems in place to prevent and control the risk of infection.

People were cared for by suitably qualified, skilled and trained staff. Appropriate checks had been undertaken before staff began work. These included a record of professional registration, references and Criminal Records Bureau checks.

People were provided with information on how to make a complaint. The provider invited people to make comments or suggestions. We saw that these were recorded and acted upon.

During the visit we spoke to two people using the service and their relatives. They told us they were very happy with the care and treatment they received at Wheatfields. They said they were involved in decisions about their care and treatment and any questions they had were answered. People told all the staff were kind and attentive, they said when they called for help staff responded quickly. People said they the food was very good and snacks were available at any time.