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Inspection carried out on 14 December 2016

During a routine inspection

This inspection took place on 14 December 2016 and was unannounced. Following the inspection we received feedback from family members of the people who used the service, volunteers and other services working in partnership with St Luke`s Hospice.

St Luke`s Hospice is registered to provide specialist palliative care, advice and clinical support for adults with life limiting illness and their families. The service delivers physical, emotional, spiritual and holistic care through teams of nurses, doctors, counsellors and other professionals including therapists. The service provides care for people through an In-Patient Unit, Day Service and Out- Patient Care. St Luke`s Hospice contracted with a registered nursing care provider to run a ‘hospice at home service’. The hospice at home service and a fast response team called ‘One Response’ were based and had their offices in St Luke`s Hospice and offered a service for people with palliative care needs living in the community.

The 'One Response' service was an innovative fast response service which offered support, assessment and advice to people with life limiting condition living in their own homes over 24 hour seven days a week. The support could be accessed via telephone where the call was triaged and staff could arrange specialist visits to people within two hours. This service was run in conjunction with Macmillan nurses, Marie Curie nurses and end of life specialists. At the time of our inspection the service was supporting approximately 300 people either with direct care or by telephone support.

At the time of the inspection there were three people using the inpatient service and around 500 people using day services. The day services offered a range of services to people recently diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and outpatient clinics. It aimed to empower people to be in control of their condition and achieve what was important to them.

St Luke`s Hospice 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.

Staff had permanent support and guidance from a social care professional employed by the hospice and were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns they had. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.

People received care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. The service promoted a culture that was caring and person centred. Staff worked together as a multidisciplinary team to provide the care people wanted and needed.

People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

People who used the various services offered at the day hospice told us the help and support they received was invaluable for them and their family. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future. They also appreciated the opportunity to meet with people in similar conditions and the social aspect of the services provided.

People told us that staff understood their individual care needs and were compassionate and understanding. Staff told us they undertook training which enabled them to provide good quality care to people in the inpatient unit, in the community and in the day hospice.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Staff reported any concerns so these could be reviewed and discussed to identify if lessons could be learnt to reduce the likelihood of recurrence.

Recruitment procedures were robust and ensured that staff working at the service were qualified and skilled to meet people`s complex needs. Staff told us they worked and trained towards their personal development plans and were happy with the support from their managers. There were sufficient numbers of staff to ensure people received support when they needed it.

People’s medicines were administered by trained and qualified staff who had their competency to give medicines safely assessed regularly by their manager. Any changes in people`s medication were discussed by the medical team, nurses and pharmacist to manage and support people’s symptoms and pain management. Medicines were regularly reviewed and audited to ensure they met people’s needs.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care.

The registered manager was committed to improve and broaden the services the hospice offered. They established seamless working relationships with other organisations to be able to reach out to as many people with complex needs as possible. They were constantly involved in research and development of new services together with partner organisations and promoted coordinated personalised care for people in the community. The services provided by the hospice had the support of volunteers who were closely involved in every aspect and department the hospice operated.

The service actively encouraged and provided a range of opportunities for people who used the service and their relatives to provide feedback and comment upon the service in order to continue to drive improvement.

There was a comprehensive auditing programme for all the services the hospice provided carried out by the quality and education service team. Action plans were comprehensive in detailing actions taken, time frames and the person responsible for the actions.

Inspection carried out on 5 June 2013

During a routine inspection

When we visited St. Luke's Hospice we found that there was detailed information for people to help them understand the care and treatment that was available. Leaflets were displayed in the main entrance area and these outlined the services offered and they were very informative. These included in-patient or day care, counselling services for friends and relatives and information about the various support groups that had been organised.

When we spoke with relatives and service users we were told that the care was excellent. One person said, "They are so kind and caring here and explained all the treatments before I received them." We found that the care plans were very detailed, personalised and contained all the information required to enable staff to provide the most appropriate care and treatment.

Medicines were stored in line with current regulations and a robust management system was in place that included accurate recording, administering and disposal procedures.

We looked at the numbers of staff on duty and their skills and qualifications and this included those who volunteered at the hospice. We found that all staff were trained to be able to deal with the needs of the people using the service. Staff we spoke with were happy with the levels and frequency of their training and when we viewed training records we found that all training was in date and relevant to the people receiving treatment there.

Inspection carried out on 26 November 2012

During a routine inspection

People with whom we spoke told us that the care provided in the day unit and inpatient unit at St Luke's hospice was of a high standard. One person said “I look forward to coming to the day centre each week, it makes me feel better”. Another person told us that “the staff and volunteers are so caring and nothing was too much trouble”. We saw that people experienced care, treatment and support that met their needs and protected their rights. They were protected from the risk of infection because appropriate guidance had been followed.

Staff told us they were supported to deliver care and treatment safely and to an appropriate standard and we could see that the provider had an effective system to regularly assess and monitor the quality of service that people receive. Everyone we spoke with was positive about the quality of services at St Luke's Hospice and also told us that they would not be worried about raising concerns if necessary because the attitude of staff was open and welcoming.

Inspection carried out on 12, 13 April 2011

During a routine inspection

People with whom we spoke were very happy with the services provided by St Lukes hospice and felt well informed and fully involved in their care and treatment. They were knowledgeable about the different services available and aware of the written information available to all. People told us that privacy and dignity was respected at all times.

People told us that they were fully consulted about all aspects of their care and treatment. They were confident that no decisions would be made without the full involvement of the person receiving the care or their family members where appropriate. One person due for discharge told us they had discussed the planning for discharge with members of the team and knew what was being arranged for their discharge.

People said “Continuity of care was good”. Two people said that some times there were too many visitors.

People were very happy with the food provided and told us they were always given choices about what they wanted to eat and drink. They praised the chef and staff in the good presentation of food which they said made it more appetising. They felt well supported by all staff including, the hospice at home team and the Macmillan nurses. They said that there was good communication between the hospice and their consultants and the hospital palliative care teams.

People told us they feel safe and secure within the hospice and that if any concerns were raised, that the staff would take them seriously and would not tolerate any form of abuse. They said the hospice was very clean and that the standards of hygiene were good. They saw staff washing their hands properly and did not feel they were at risk from any poor infection control practices.

People with whom we spoke told us that the staff are very helpful if they have any queries about their medication and that the doctor is very supportive if they need a review of their medicines to help symptom control. They told us that the environment both in the day centre and the in patient unit was calming and restful. They were impressed with the gardens and new therapy rooms.

Everyone with whom we spoke said that the staff at the hospice were very good. People told us that there are always adequate amounts of staff available to help them when needed. They also told us that all staff were knowledgeable about their needs. People told us that staff were kind and caring and that, "Nothing was ever too much trouble". We were also told “The staff are so friendly you could ask them anything”. Everyone we spoke with said they would have no concerns about raising a complaint if necessary and that they were confident it would be handled properly without discrimination.

People with whom we spoke said that they were aware that records were kept about them and trusted the staff with this aspect of the service.