St Gemma's Hospice - Leeds

St Gemma’s Hospice (in patient unit) provides specialist palliative and end of life care to a maximum number of 32 people. The service also supports around 200 people in the community. At the time of our inspection visit there were 26 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.

People told us there were enough staff to meet their needs and keep them safe. Staff had the extensive knowledge, information and support to ensure people were kept safe from abuse. Staff told us they would report any concerns to the nurse in charge or the registered manager. There was a ‘no blame’ culture with staff encouraged to report any clinical incidents or accidents. These were fully investigated and used as a learning tool to drive improvements in the delivery of care and safeguard people from harm.

Staff understood people’s individual needs and the support they and their family members required. Staff were passionate about their roles and placed people at the heart of their work. We saw that care was provided with the utmost kindness, respect and compassion. People who used the service and relatives spoke very highly about the care and service they received. People said their right to privacy was fully protected within the hospice .Families of people told us the end of life care their relatives had received was excellent. People had their wishes documented in their care plans and there was clear evidence that these wishes had been carried out. One member of staff told us, “One gentleman wanted to die in Scotland this was in his care plan. We had to make so many calls to find somewhere who could continue his care, but we did it. A nurse flew up to Scotland with him to ensure he was settled in the hospice and we were proud to know he got his last wish.” The hospice provided excellent family support, counselling and bereavement support within and outside the hospice.

Meals were produced specifically for each individual to their own taste. People could have meals when they wished and could request anything they wanted to eat. People’s cultural and religious needs were taken into account when preparing any meals. Staff told us meals were so important to people that they tailored them to what people wanted. Comments included: “The menus are extensive and there are no set meal times, you eat when you want to.” “The food is superb, you can have whatever you choose and at whatever time you feel like eating.” Nutritional assessments were undertaken to identify risks associated with eating and drinking. Referrals were made to the appropriate professionals.

People received care from a multi-disciplinary staff team who were qualified to a high standard and supported and trained to meet their individual needs. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate the required knowledge and skills to meet people’s needs effectively. Staff received supervision and support.

A well-established pharmacy team provided good clinical services to ensure people’s medicines were managed safely. The team regularly attended clinical meetings to discuss people’s individual pain management requirements and ensure good clinical practice was followed. One relative told us, “They really understand non-verbal cues about pain; they saw when he wasn’t quite right even when we didn’t notice. They’d change his medication until they were sure he was comfortable.”

There was a holistic approach to people’s care with the physical, psychological, social and spiritual needs of each person given equal importance, together with the needs of those closest to them. Staff respected people’s cultural and spiritual needs and people told us they received the religious and spiritual support they wanted and needed from a multi-faith chaplaincy team.

The rights of people who were unable to make important decisions about their health or wellbeing were protected. Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

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.

There were very few complaints and concerns raised. The provider had a positive and open approach to using complaints and concerns to improve the quality of the service. Each complaint was assessed to establish the lessons learned and where necessary, appropriate action taken to improve the service provision for everyone using the services at the hospice.

The management structure showed clear lines of responsibility and authority for decision making and leadership in the operation and direction of the hospice and its services. The management team demonstrated a strong commitment to providing people and those closest to them with a safe, high quality and caring service and promoted high standards.

Staff worked closely and in partnership with external health and social care professionals and other national organisations to improve the service within the hospice and health provision in the local community and nationally.

"I can't praise this place high enough.'

"From day one care has been superb.'

People said the meals were good and food, snacks and drinks were available at any time of day for them. Comments we received included:

'Fares pretty well.'

'The meals are superb.'

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, "Never had any staff we've not taken to." Another said, "All have been kind, caring and considerate.'

We saw there were effective recruitment procedures in place.

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

People's comments included:

'Lovely bedside manner from all staff, everything always explained really well.'

'Couldn't come to a better place.'

'Treated like royalty here.'

'Can't fault the care and attention from all staff.'

We saw that people who used the service were responded to promptly when they asked for any support or assistance

We saw that people received care and support in an environment that was safe and well maintained to a very high standard. People who used the service were very complimentary about the environment. One person said, 'It's so lovely here and so clean, they are always cleaning and making it nice.'

People who used the service said there were enough staff. They were also very complimentary about the staff. Their comments included: 'Excellent staff' and 'The staff are so kind and caring.'

People told us they would speak to staff if they had any concerns. They said they felt confident and comfortable to do so.