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Inspection Summary


Overall summary & rating

Good

Updated 7 June 2016

St Peter's Hospice is located in Bristol. The service provides care to adults with life limiting illnesses, and their families. As well as caring for people as inpatients, the hospice provides a service to people in their own homes, a day hospice and a support and advice service by telephone. The hospice inpatient unit can care for up to 18 adults who require symptom control or end of life care. The average length of stay is two weeks. At our last inspection in August 2014, no concerns were found.

This inspection was carried out on 16 and 17 March 2016 by two inspectors. One of the inspectors had specialist knowledge around end of life care services. We gave the service 48 hours’ notice of our visit. This was because we wanted people and their families to be able to be prepared in good time to speak with us.

There was a registered manager for the service. 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 were trained and knew how to protect people from the risk of abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns.

Risk assessments were written in a way that was centred on the needs of each individual. Each assessment included clear actions to take to reduce identified risks.

Staff had a good knowledge about each person and about how to meet their specific care and support needs. The staff team all tried hard to go ‘the extra mile’ to ensure people’s needs were met in a person centred way. This included support for people’s partners, their family and friends.

People’s feedback was actively sought and acted on. People and relatives were overwhelmingly positive in their views of the service that they were receiving. They told us they were very satisfied about the staff approach. People also praised how their care and treatment was being planned and delivered.

There was enough staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. Medical staff were available at any time of the day or night to provide medical support when needed.

There were recruitment procedures in place that helped to ensure only suitable staff were employed. These included checking previous conduct as well as suitability from previous employers. This was to ensure staff were suitable to work with vulnerable people at the hospice.

Staff were very kind and compassionate to people. Relatives told us, “The care was exceptional the staff were all so kind and spent so much time with me and asked how I was .” People’s feedback about the caring approach of the service was overwhelmingly positive and they described it as “Exceptional” and “Wonderful.” Staff communicated effectively with people. They responded to their needs attentively and treated them with kindness and positive regard.

People were involved in all aspects of how their care and time at the hospice was planned. People praised the medical staff who they said supported them to make their own decisions about their care and treatment.

The environment was well utilised for the comfort of people. It was welcoming, well maintained and suited people’s needs. The grounds had been well maintained and were accessible for people to enjoy.

Staff went on a range of training based on best practice and research around end of life. They were booked in for regular update courses. Staff were given a wide range of opportunities for further learning specific to the needs of the people they supported on their end of life care journey. The team received regular one to one and group supervision sessions and an annual appraisal. There was also a free to use counselling support line to offer further emotional support to the staff. This ensured they were supported to work to the expected standards.

The Mental Capacity Act 2005 is a legal framework to ensure decisions are made in the best interests of adults who do not have the mental capacity to make decisions themselves. There was guidance available about the Deprivation of Liberty Safeguards (DoLS). This information helped staff if needed to ensure safeguards were put in place to protect people in the least restrictive way. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered in relation to the requirements of the Mental Capacity Act 2005.

Meals were in sufficient quantity and met people’s needs and choices. People praised the food they received. Staff knew and understood people’s dietary preferences. This included restrictions on what people could eat and reduced appetite.

The registered manager was open and transparent in their approach. Staff told us they felt valued and supported by them. They described the registered manager as friendly and caring. People also said that they were someone who people could talk with easily. Relative’s comments about the management of the service were extremely complimentary. A comment made was that the management support was “Wonderful.”

Audits and quality checks were carried out about the way the service was run. This was to identify ways that it could improve. When improvements were needed action was taken to improve the quality of the service and care. The service worked in partnership with other organisations to drive improvements for the benefit of people who at the service.

Inspection areas

Safe

Good

Updated 7 June 2016

The service was safe.

People told us they felt safe at the hospice. There was enough staff to provide people with safe care and treatment.

Staff were recruited only when the checks necessary to show they were suitable to work with people had been completed.

Staff understood safeguarding procedures. They knew what to do to alert the relevant people if there were safeguarding concerns.

Effective

Good

Updated 7 June 2016

The service was effective

Staff ensured people’s needs were met in a personalised way. This included support for people’s family friends and other loved ones.

Staff had been trained to understand the principles of the MCA and DoLS and understood about the requirements of this legislation. This meant staff knew how to protect people’s legal rights if they did not have the capacity to make informed decisions about care and treatment.

People were provided with food and drink in an individualised way depending on their particular needs.

People were referred to healthcare professionals promptly when needed. Staff worked closely with health professionals to ensure people received a well-planned service.

Caring

Good

Updated 7 June 2016

The service was very caring.

People, their relatives, friends, advocates and other people who had contact with the service, were very positive about the way staff treated them.

Care was planned in a way that was individual to each person. People received care and support from staff who knew and valued their history, likes, preferences, needs, hopes and goals

When people were approaching the end of their life they received compassionate and supportive care. They and the, people who mattered to them contributed fully to their plan of care so that staff know their wishes. This was to ensure the person had dignity, comfort and respect at this time.

Responsive

Good

Updated 7 June 2016

The service was responsive

The care people received was very flexible and staff knew how to respond quickly to people’s changing needs or wishes.

People, families, friends and health professionals were able to gain support at any time. People received personalised care from staff with skills and knowledge to meet their needs.

People’s care and support was planned and reviewed in partnership with them, to reflect their individual wishes and what was important to them.

The service had a wide range of ways to involve people and their families, stimulate their engagement and provide support.

The service took an active role in the local community. People, their families and friends were actively encouraged, enabled and supported to engage with events outside of the service.

Well-led

Good

Updated 7 June 2016

The service was well led.

The organisation and the registered manager provided compassionate leadership and support. This showed that the needs of people who used the service were central to how it was run.

People and staff were actively involved in developing the service and their views were used to improve the way the hospice was run.

The service had clear visions and values that included involvement, compassion and respect. Staff understood these values and embedded them into their work.

Governance and quality assurance systems were effective at driving up improvement in the service. There was a culture of openness that encouraged people and staff to question practice.