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St Nicholas Hospice Outstanding

Inspection Summary

Overall summary & rating


Updated 6 August 2016

This unannounced inspection took place on 19 and 20 April 2016. At previous inspection the hospice had been compliant with regulation and offered a quality service.

St Nicholas Hospice provides day, community and inpatient care and support to people of West Suffolk and into Norfolk. The Sylvan ward in Bury St Edmunds provides palliative and also respite care for up to 12 people. The Orchard Centre in Bury St Edmunds and the Burton centre in Haverhill provide support, care and activities for day patients and their families. The Community Hospice Team provides care, support and advice to patients in their own homes. St Nicholas Hospice also runs a Hospice Neighbours scheme - trained volunteers offer people companionship and practical support. Approximately 500 people were being supported in the community and 150 through the day centres.

There was a registered manager in place and they participated fully in the inspection process. 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.

St Nicholas Hospice is an outstanding service. It is truly focussed on the individual needs of people that they support, giving people support at the time they need it in a way and place that best suits them and their family. People spoke overwhelmingly of the positive support, guidance and healthcare interventions they had received. People were full of praise of the staff in terms of their kindness, compassion and knowledge about end of life matters. People viewed the healthcare clinicians as expert in their knowledge.

People spoke of a service that was tailor-made for them and their families saying that staff truly went the extra mile to offer understanding, empathy and choices that were based upon information and keeping people informed and involved. Informed consent was embodied into all work that was undertaken at the hospice. The various departments within this hospice worked well together so that people had a seamless experience of moving from one department to another as the need arose.

Staff were motivated and keen to convey to inspectors their pride in the service they worked at. Staff were involved, listened to and empowered with training and support to offer excellent end of life healthcare and support.

Management were inclusive and promoted a culture of excellence. They listened to people and involved them in the running and development of the service. They actively sought out people’s views and used criticism as an opportunity to improve and develop the service. There was a kindness and warmth about the management team that made them approachable to everyone and people knew them by their first names and told us they were visible, approachable and solved matters raised. Governance of the service was of a high standard that was benchmarked against similar services and communication was very good. The board of governors and others who needed oversight were appropriately informed of how the hospice operated. The measures of quality in place showed that people were right to have the confidence in this local hospice.

Inspection areas



Updated 6 August 2016

The service was safe.

People felt safe and trusted using this service. Staff had been trained to recognise and respond to any actual or potential abuse. The service had developed systems for reporting and monitoring.

Potential risks to people were assessed and measures put in place to reduce risks. Accidents and incidents were analysed and learning was shared amongst staff to prevent reoccurrence.

There were the right numbers of staff with the appropriate skills and knowledge to meet people`s needs at all times. Staff were able to support at the pace that people wanted and wished for.

Complex medicines were well managed. People received their medicines from staff who were trained and qualified in safe administration of medicines to ensure people received their medicines in time and safely.



Updated 6 August 2016

The service was very effective.

People received support and care from a staff team who were specifically trained to meet their needs. Training was well managed by a dedicated team within the service. Staff were keen to develop and share their knowledge and skills.

Staff understood and followed the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were genuinely informed and involved in making decisions about all aspects of their treatment and care.

People were supported to eat and drink and maintain a balanced diet. People were able to choose from a varied menu of fresh and appetising food. People with a reduced appetite were appropriately supported.

People had consistently good access to the healthcare support they needed. Health clinicians worked well together to ensure the best outcomes for people.



Updated 6 August 2016

The service was very caring. People�s and their relative�s feedback about the caring approach of the service and staff was overwhelmingly positive.

Staff showed kindness and knew how to show empathy when people faced challenging situations. People valued their relationship with the staff team who often performed beyond the scope of their duties to support people.

The service was very flexible and responded quickly to people�s changing needs or wishes. Staff communicated effectively with people and treated them with kindness, compassion and respect.

People were consulted about and fully involved in their care and treatment. The service provided outstanding end of life care and people were enabled to experience a comfortable, dignified and pain-free death.



Updated 6 August 2016

The service was responsive.

People and their families were fully involved in assessing and reviewing their needs and planning how their care should be provided, which included their wishes and priorities regarding their end of life care and preferred place of death.

The service provided person-centred care based on best practice and focussed on continuous improvement. Staff understood and anticipated people`s needs which enhanced the quality of the care people received.

The hospice had innovative and positive approaches to seeking and responding to complaints and concerns to improve the quality of the service and this was closely monitored by the management team.



Updated 6 August 2016

The service was very well-led.

St Nicholas Hospice had a track record of excellence and place in community. The service promoted a positive and open culture and provided a range of opportunities for people who used the service, their relatives and people from the wider community to comment and influence the running of the hospice. The management team were highly visible and approachable for everyone.

The hospice listened to all people involved about their experiences of different aspects of the service to drive the quality of the service on offer. Staff at the hospice were aware of the same shared values and demonstrated these consistently.

The service worked in partnership with other organisations to ensure they followed best practice and provided a high quality service. They participated in national and local research and had developed �champion� roles within the staff group to drive improvements.