We carried out a review of the data available to us about St Michael's Hospice (North Hampshire) on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about St Michael's Hospice (North Hampshire), you can give feedback on this service.
Our rating of this location stayed the same. We rated it as good because:
However:
At the time of the inspection there were six people using the inpatient service and 102 people using the Hospice at Home services. The day services provided in the `Wellbeing Centre` offered a range of services to people diagnosed with life limiting conditions, their carers and families. The service provided specialist advice, courses, complementary therapy sessions and clinics. St Michael’s Hospice also provided a counselling and bereavement service for people and their families if required.
St Michael’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. The registered manager at St Michael's Hospice was the Director of patient Services (DPS)
People were protected from abuse because staff were trained and understood the actions required to keep people safe. Staff had completed the provider’s required safeguarding training and were able to explain their role and responsibility to protect people.
Potential risks to people had been identified and managed appropriately. Risk assessments were completed with the aim of keeping people safe yet supporting them to be as independent as possible. The Hospice at Home staff knew people’s needs and proactively managed risks to people being supported to live with their illness at home, in accordance with their wishes.
The registered manager (DPS) told us department heads completed a weekly staffing analysis to ensure there were sufficient staff available to meet people’s needs. Rosters were completed a month in advance and demonstrated that the required number of staff to meet people’s needs was provided. Staff working within the inpatient unit told us that staffing levels were sufficient to ensure people received their care safely. People and relatives told us they had no concerns regarding the staffing levels.
Staff had undergone robust pre- employment checks as part of their recruitment, which were documented in their records. These included the provision of suitable references in order to obtain satisfactory evidence of the applicants conduct in their previous employment and a Disclosure and Barring Service (DBS) check. People were safe as they were cared for by staff whose suitability for their role had been assessed by the provider.
All staff involved in medicines administration had regular training and had undergone competency checks. Medicines were stored safely and securely. There was a system to check that all medicines were within date and suitable for use. There were medicines available for use in an emergency and these were being checked regularly.
Staff described effective processes for the supply of medicines on discharge from the hospice. We were told by staff that people going on leave were supplied with their medicines in unlabelled dosage boxes. No adverse incidents had been reported in relation to this practice because staff had ensured that people knew all of the information required to manage these medicines safely. The registered manager (DPS) and quality and governance officer ensured this practice ceased before the conclusion of our inspection.
People received effective care, based on best practice, from staff who had the necessary skills and knowledge to do so. The provider had an education and training directory which detailed the mandatory training for all staff which had to be completed annually and was up to date. The provider had enabled experienced nursing staff to take on lead roles in different specialities like Motor Neurones Disease, dementia awareness, infection control and tissue viability (skin and wound care). Clinical staff were effectively supported by the provider with their continued professional development and revalidation of their professional qualifications.
The registered manager (DPS) told us that shortly after their appointment they held a one to one meeting with all staff to introduce themselves, to discuss their expectations and find out what staff thought needed to be improved. All staff confirmed they had a face to face meeting with the new registered manager (DPS) which had been open and honest and made them feel the service was moving in a positive direction.
Staff supported people to make as many decisions as possible. We observed staff seeking people’s consent about their daily care and allowing them time to consider their decisions, in accordance with their care plans.
Staff had received training in relation to the Mental Capacity Act 2005 (MCA) and were able to explain the main principles. Staff understood the importance of giving people choice in the support they received. Staff were able to demonstrate that a process of mental capacity assessment and best interest decisions promoted people’s safety and welfare and protected their human rights.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in hospices are called the Deprivation of Liberty Safeguards (DoLS).We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of the inspection the service had no applications or authorities in place. However, the registered manager (DPS) knew what action to take if required to ensure people’s human rights were recognised and protected.
People had nutrition and hydration assessments and plans, which were up-to-date and where necessary recording of people’s intake had been completed. Staff were aware of people’ dietary requirements and preferences and people were offered a range of choices to meet their nutritional needs.
People in the inpatient unit had 24 hour clinical support from doctors and nurses, with consultants providing out of hours advice where necessary. People using the Hospice at Home service had access to professional support and advice over a 24 hour period. People told us reassurance and advice provided in relation to pain and symptom management to support people with their condition was invaluable. Complementary therapy sessions were available through a twelve week programme where people had on-going support from physiotherapists, occupational therapists, specialist nurses and other alternative and creative therapists.
People, their relatives and friends were extremely positive about the caring nature of all the staff at St Michael’s Hospice, from the registered manager (DPS) to the volunteers. People told us “From the moment you walk in you are made to feel welcome.” One person told us, “You can feel it in the atmosphere here, it is all about caring and dignity.”
People, or where appropriate their representatives, were involved in making decisions about their own care. People told us that when consultants and doctors thought another course of treatment was appropriate they always sought their views and acted upon them. This made people feel their views really mattered and they were in control of their treatment.
The provider had a policy to promote and maintain people's privacy and dignity. Records confirmed all staff had received dignity in care training, which we observed they implemented in practice whilst delivering people’s care.
People were supported at the end of their life to have a comfortable, dignified and pain free death. Staff knew how to manage, respect and follow people’s choices and wishes for their end of life care as their needs changed.
People had access to information about how to make a complaint, which was provided in an accessible format to meet their needs, before people started to use the service. During the previous year there had been no formal complaints about the service.
The registered manager promoted a blame free culture with an emphasis on “recognising when we get it wrong, apologising where required, and learning from our mistakes.” Staff spoke with passion and pride about the hospice and the people they supported. They told us their job was very challenging but exceptionally rewarding. All staff recognised there was a good team spirit amongst their peers, the management team and the different departments.
People, their relatives and staff told us the management team provided clear and direct leadership and were highly visible throughout the service. The registered manager was determined to provide the best quality of palliative care possible for people using the service. She told us they had updated the five main values of the service, which were covered by the acronym PRIDE. Staff were expected to be proud of St Michael’s Hospice and the service it provided; to treat people with respect and dignity; to act with integrity; to respect people’s diversity; and to strive for excellence. Without exception people, their relatives, and visiting health professionals told us their experience of the whole service was consistent with these values.
The quality and governance manager effectively operated processes to evaluate the quality of service provision, including regular surveys of people, their families and staff, seeking feedback on their experience of the service.
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The care was good and people were complimentary about the support provided by staff. We found that care records were not as co-ordinated as they could have been and paper and computerised systems were used in parallel to try to ensure that all relevant information was available. People were properly consulted about their care or that of their relative and involved in decision making.
Patients were provided with a varied and nutritious diet and had a range of options at each meal. They could also request individual items if desired. Specialist or adapted diets were provided when necessary.
The majority of staff recruitment records were in accordance with requirements and the manager was going to request a review of records to identify and address any shortfalls.
Staff and volunteers received appropriate training according to their role. An annual programme of core training was provided to all staff. Qualified staff could attend clinical group supervision led by the in house psychologist. Staff could also obtain personal support from the chaplain. Volunteers were provided with a mentor when they started with the organisation.
The provider had a range of management monitoring and audit systems in place and reported regularly to the board of trustees. The views of patients and their families about the service were sought and acted upon.
The facilities provided a safe environment for patients, relatives and staff. The facilities include accommodation for relatives,a quiet room, and a faith area.
Peoples needs were assessed and support plans put in place ensuring that people were provided with safe and effective care. Staff with appropriate qualifications and experience were available during each working day to provide the required level of care and support to people using the service.