This inspection took place on the 13, 15 and 16 September 2016 and was unannounced.

St Luke's Hospice Kenton Grange Hospice Harrow & Brent is a registered charity providing specialist palliative and clinical support for people over the age of 18 years with life limiting illnesses irrespective of diagnosis. The services provided included a 12 bed in-patient unit, a day service, outpatients’ service and care in people’s own homes provided by community teams. The hospice also provides support for families, friends and carers of people using its services.

At the time of our inspection there were approximately 760 people using or known to the service. Two of the beds in the inpatient unit were closed to ensure people’s safety whilst there were a number of nurse vacant posts. The number of inpatients varied each day of the inspection.

The service had a registered manager who was the Director of Nursing and Patient Services of the hospice. 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 registered manager was supported in the managing and running of the services by the Chief Executive Officer (CEO), Board of Trustees, Medical Director and other management staff.

People were very positive about the care and support they received from highly motivated staff. They told us staff were very kind, listened to them and respected their wishes and preferences regarding their care and support needs. People received a service which was person centred in meeting each person’s individual needs. People were supported to be fully involved and to take the lead in all decisions about the care and support they received. They told us they felt listened to and were respected by staff.

People received care and support from a multi-disciplinary team [MDT] and volunteers. The staff we spoke with from all the services were very enthusiastic about their jobs and had a good understanding of their role and responsibilities. They showed they cared very much about the people they supported and were committed to deliver a high standard of service to people. Staff treated people with sensitivity and respect and had positive and caring relationships with people using the hospice services, people’s families and others important to them. People’s emotional, spiritual and other individual needs were met by staff who were competent, compassionate and caring.

People received the care, treatment and emotional support they needed as staff and volunteers had the training they needed to develop their skills and provide them with the knowledge and competence to meet people’s individual care needs.

The hospice was committed to promoting high quality end of life care for people by providing education and training for a wide range of health and social care professionals working in the community, hospitals and nursing homes. People with life limiting illnesses and those at the end of their life benefitted by receiving the care and support they needed from skilled and caring staff and were more likely to avoid hospital admission.

The hospice was responsive to people’s feedback and very proactive in working in partnership with an exceptional number of other professionals and organisations to develop best practice and provide people with a range of services that met their individual needs including advice and emotional support.

People received the medicines they needed on time and in a safe manner. People’s pain was monitored closely and managed well.

The hospice provided a 24 hour advice line for people in Harrow that used its services, their families and friends and for health and social care professionals. This service provided a range of advice including management of pain,

St Luke's Hospice Kenton Grange provides care to the people of Harrow and Brent who have illnesses that are no longer curable. On the day we visited six people were using the in- patient hospice service. We saw this had 12 beds, six are single rooms with a toilet and hand basin; one four bedded bay with a shared toilet and hand basin but which is used as single sex accommodation only; a two-bedded bay with toilet, hand basin and shower. There are additional shower and bath facilities within the ward area.

The Hospice also offers a day service where people can be supported in a safe and uplifting environment, this is open every day with a different emphasis daily to meet different people’s needs. Nurses, doctors and a social worker are available each day.

We spoke with three people who were using the hospice and three relatives during our inspection. Overall, people praised the hospice, comments included “It’s a lovely atmosphere here,” “the staff make me feel safe,” and “it’s very peaceful here and welcoming.” Most people we spoke with told us that the hospice provided everything they and their relatives needed.

All the people and relatives we spoke with felt safe at the hospice and said the staff listened to them and responded quickly to their changing needs. They were involved in planning their own care and staff were aware of people’s likes and dislikes and their cultural and religious needs.

We saw that people’s important documents were kept up to date and they, as well as friends and relatives (if requested by the person), were involved in making decisions. We saw that people had the support of professionals and others when making difficult choices.

People said that staff were knowledgeable, kind, caring and approachable. People were able to quickly access doctors and other professionals such as physiotherapy and counselling services.

People had access to range of activities. They said they enjoyed having a massage or attending music or art therapy, we saw that relatives were also offered relaxing treatments.

We saw that the hospice had areas where people and their families could have privacy. People’s rooms had access to a garden and a private patio area. Their beds could be taken outside on to this if they wished. Families and friends were able to say overnight either in the same room as their relatives or in a separate room for family and friends.

We saw that people had well-co-ordinated care when they moved from different services. The hospice had good relationships with other services, such as the Clinical Nurse Specialist (CNS) based at the local hospitals, which ensured people received effective care and support.

People had their comments and complaints listened to and acted on. There was an effective complaints system in use In the hospice. We saw that complaints were reviewed by the manager, the senior leadership team and well as the board of trustees.

The hospice promoted a positive culture that was person-centred, open inclusive and empowering. People spoke positively about the approach of staff and managers. Staff we spoke with were aware of their roles and responsibilities. There was a consistency between what the managers, staff and board of trustees said were the key challenges, achievements and risks at the hospice.

The hospice had a registered manager who had the day to day support of the Chief Executive Officer (CEO) and an active board of trustees. They demonstrated good leadership of the hospice and it was evident that the manager was well known to the staff.

We looked at the prescribing of medicines, medicines storage and supplies and administration systems for medicines. We saw medication was kept securely. However, we could not be assured of safe practice with recording of prescriptions and prescribing of some medicines which could have led to medication being administered incorrectly.

We saw medicines were being kept securely and only accessible to staff authorised to handle medicines. Medicines were being kept in a locked drug trolley or in a locked treatment room. Controlled drugs were being appropriately stored.

However, we could not be assured of safe practice in the recording of prescriptions for controlled drugs and other prescriptions that were being used at the hospice. We saw that these were not being recorded in a way that that would assure that they were being used appropriate.

When syringe drivers were being prescribed, (these are used to give medication continuously under the skin, often used for managing people’s pain) the prescription did not specify how long the medicines should be administered over. This could lead to medicines being administered over an incorrect time period and puts people at risk of receiving too much or too little medicine.

These problems were evidence of a breach of a health and social care regulation. You can see what action we have asked the provider to take at the back of this report.

We spoke to two visitors, a patient and twelve staff including healthcare assistants, nurses, housekeeping staff, chef, education facilitator, Senior Nurse Manager and the Chief Executive. We also looked at recorded feedback from patients and visitors. A patient told us that they felt safe and received the care they needed and wanted, and was very positive about the staff who supported them.

Feedback from the 2012 satisfaction survey showed us and a patient told us that staff were approachable, suitably skilled, treated them with courtesy and respect, listened to them and acted on their views and preferences.

Patient’s health, safety and welfare were protected as they received the advice and support that they needed from a range of health and social care professionals. Records showed us and a patient confirmed that patients who used the service were asked for their consent to the examination, care, treatment and support that they received.

Staff received the training that they needed, knew about their roles and responsibilities in meeting the needs of patients and they supported them in a friendly and respectful manner. Staff told us that they were well supported by senior staff.

Patients each had a plan of care that had been regularly reviewed and included information about the individual support and care that the patient needed.

Patients we spoke with were very complimentary about the service. They told us that the staff were competent and very kind, and they were very happy with the care they received. They said they could choose their meals and have something to eat and drink whenever they wanted. They told us staff always consulted them and involved them in making decisions about their care and support needs.

Comments from patients included “I feel involved deeply, these people are a class above, their attitude and understanding proves to me this is the right place”, “I feel the staff understand my needs” and “you are not just a number, but a person”.

Patients confirmed that staff provided them with choices, listened to them and explained clearly all care and support options. They told us that they were offered a choice of activities which they could participate in if they wanted to or choose not to and their decision was always respected. Patients provided us with examples of activities that they enjoyed.

Patients told us that staff protected their privacy and dignity. They told us that they felt safe as a patient cared for by the hospice and knew who to talk to if they had a worry or concern.

During our visit we saw staff interact with people in a respectful and sensitive manner. Staff spoke of enjoying their job supporting and caring for people in the hospice. They told us there was good staff teamwork and they felt well supported by the manager and by other staff.

The hospice had monitoring systems in place to ensure that the service provided to people was always a quality service.

We carried out an unannounced comprehensive inspection of this service on 08 April 2014. A breach of a legal requirements was found. As a result we undertook a focused inspection on13 January 2015 to follow up whether action had been taken to deal with the breach.

You can read a summary of our findings from both inspections below.

Comprehensive Inspection of 08 April 2014

St Luke's Hospice Kenton Grange provides care to the people of Harrow and Brent who have illnesses that are no longer curable. On the day we visited six people were using the in- patient hospice service. We saw this had 12 beds, six are single rooms with a toilet and hand basin; one four bedded bay with a shared toilet and hand basin but which is used as single sex accommodation only; a two-bedded bay with toilet, hand basin and shower. There are additional shower and bath facilities within the ward area.

The Hospice also offers a day service where people can be supported in a safe and uplifting environment, this is open every day with a different emphasis daily to meet different people’s needs. Nurses, doctors and a social worker are available each day.

We spoke with three people who were using the hospice and three relatives during our inspection. Overall, people praised the hospice, comments included “It’s a lovely atmosphere here,”  “the staff make me feel safe,” and “it’s very peaceful here and welcoming.” Most people we spoke with told us that the hospice provided everything they and their relatives needed.

All the people and relatives we spoke with felt safe at the hospice and said the staff listened to them and responded quickly to their changing needs. They were involved in planning their own care and staff were aware of people’s likes and dislikes and their cultural and religious needs.

We saw that people’s important documents were kept up to date and they, as well as friends and relatives (if requested by the person), were involved in making decisions. We saw that people had the support of professionals and others when making difficult choices.

People said that staff were knowledgeable, kind, caring and approachable. People were able to quickly access doctors and other professionals such as physiotherapy and counselling services.

People had access to range of activities. They said they enjoyed having a massage or attending music or art therapy, we saw that relatives were also offered relaxing treatments.

We saw that the hospice had areas where people and their families could have privacy. People’s rooms had access to a garden and a private patio area. Their beds could be taken outside on to this if they wished. Families and friends were able to say overnight either in the same room as their relatives or in a separate room for family and friends.

We saw that people had well-co-ordinated care when they moved from different services. The hospice had good relationships with other services, such as the Clinical Nurse Specialist (CNS) based at the local hospitals, which ensured people received effective care and support.

People had their comments and complaints listened to and acted on. There was an effective complaints system in use In the hospice. We saw that complaints were reviewed by the manager, the senior leadership team and well as the board of trustees.

The hospice promoted a positive culture that was person-centred, open inclusive and empowering. People spoke positively about the approach of staff and managers. Staff we spoke with were aware of their roles and responsibilities. There was a consistency between what the managers, staff and board of trustees said were the key challenges, achievements and risks at the hospice.  

The hospice had a registered manager who had the day to day support of the Chief Executive Officer (CEO) and an active board of trustees. They demonstrated good leadership of the hospice and it was evident that the manager was well known to the staff.

We looked at the prescribing of medicines, medicines storage and supplies and administration systems for medicines. We saw medication was kept securely. However, we could not be assured of safe practice with recording of prescriptions and prescribing of some medicines which could have led to medication being administered incorrectly.

We saw medicines were being kept securely and only accessible to staff authorised to handle medicines. Medicines were being kept in a locked drug trolley or in a locked treatment room. Controlled drugs were being appropriately stored.

However, we could not be assured of safe practice in the recording of prescriptions for controlled drugs and other prescriptions that were being used at the hospice. We saw that these were not being recorded in a way that that would assure that they were being used appropriate.

When syringe drivers were being prescribed, (these are used to give medication continuously under the skin, often used for managing people’s pain) the prescription did not specify how long the medicines should be administered over. This could lead to medicines being administered over an incorrect time period and puts people at risk of receiving too much or too little medicine.

These problems were evidence of a breach of a health and social care regulation. You can see what action we have asked the provider to take at the back of this report.

Focused inspection 13 January 2015

After our inspection of 08 April 2014 the provider wrote to us to say what they would do to meet the legal requirements for the breach relating to aspects of the management of medicines.

We undertook this unannounced focused inspection to check they had followed their plan and to confirm that they now met legal requirements. We found the provider had followed their plan in relation to this regulation. This means legal requirements for the management of medicines had been met.

Improved arrangements were in place for the recording of prescriptions [FP10 and FP10CDF] used in the service. A new prescription and medication administration record was in use along with additional records for the application of medicines supplied as patches. A clear competency database was maintained for all nurses training relating to medicines handling.

We also found improvements had been made with the recording of Do Not Attempt Resuscitation [DNAR] orders. They showed that cardiopulmonary resuscitation (CPR) had been discussed with the person using the service who had then made the decision whether or not they wished to be resuscitated, and this decision was recorded.