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Inspection carried out on 16 March 2016

During a routine inspection

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 carried out on 06/05/2014

During a routine inspection

St. Peter’s Hospice provides care for adults with life limiting illnesses. They provide physical, psychological and spiritual care for patients in their own homes as well as at the hospice. At the time of our inspection they provided care for approximately 700 people living in Bristol, South Gloucestershire, North Somerset and part of Bath and North East Somerset.

They provide a range of services which include hospice at home, services in the community, a day hospice, a 24hr helpline, a spiritual care coordinator and an in-patient unit. As well as the work they do with patients and families they have an education centre with trainers who work with those who advise and care for patients away from St Peter’s Hospice such as GPs and care home workers.

When we visited there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The people who used the service and their relatives were full of praise for the highly considerate and personalised and professional approach of staff. Patients felt they were listened to and that their needs and requests were acted upon in a way that made them feel they mattered.

Staff we spoke with and observed were sensitive to the emotional needs of patients and offered appropriate and effective support as needed.

In consultation with patients the inpatient unit of nurses and a consultant led team of doctors worked together in the care planning process to provide specialist, intensive symptom control for patients. Depending on the specific risks and needs of the patient the care planning process was updated regularly, in many cases daily. The information was documented and communicated to the team. This ensured the staff had the most up-to-date information relevant to the individual.

There were also various non-medical approaches to pain and symptom control. Staff explained these were not an alternative to medical care but an enhancement of care whereby complementary therapies worked alongside medical treatments. These included emotional and spiritual support, developing coping strategies, relaxation and distraction techniques.

In some cases it was agreed by the patient that advance care planning would be appropriate. This process involved discussions between a patient and their health care professionals about future needs. The discussions established the patient’s priorities regarding their end of life care and enabled them to plan their future and prepare for their death whilst maintaining control over their wishes and preferences.

Staff we spoke with felt well supported in their role by the registered manager. There was an emphasis on support and an open dialogue was encouraged.

The service placed a strong emphasis on education of its staff and to other health professionals who cared for dying people in other settings, such as the community. The Education Department is an established centre for the provision of palliative care (management of pain and other aspects of long term illness) education. They provide education that is aimed at developing clinical practice and to improve care.

We identified that there were robust support arrangements in place which monitored and reviewed members of staff involved in delivering care, treatment and support in end of life care.

We found the service worked with key organisations, including the local authority and the national charity, Help the Hospices, to support local and national hospice care provision and service development.

Where people did not have the mental capacity to make their own decisions there was a process to be followed in considering a patient’s best interests. Staff we spoke with told us they practised best interest’s decisions for those people who did not have capacity. All clinical staff had received training in the Mental Capacity Act 2005.

We found the service was currently meeting the requirements of the Deprivation of Liberty Safeguards.

Inspection carried out on 8 September 2013

During a routine inspection

During our inspection we spoke with four people who were using the in patient service and five relatives of people who used services. People consented to their care and treatment and staff informed them of the effects and benefits of their treatment. One person said “staff tell me what every tablet they give me is and explains what the medication does”. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements.

People told us that they were pleased with the care and treatment they received. One person said “you can’t fault the place, the staff are excellent and can’t do enough for you”.

People’s needs were assessed and care plans developed to meet these needs were up to date.

People told us that the food at the hospice was very good and they were able to have their choice of food when they required it.

Systems were in place to ensure cleanliness and infection control was monitored effectively. People and visitors told us that the service was always very clean and tidy. We observed staff using personal protective equipment appropriately.

Staff told us they received regular training and support which allowed them to carry out their roles effectively.

The service had effective systems in place to monitor the quality of the service provided. This included gaining feedback from people who used the service and their relatives. We found that this feedback was monitored and acted on to improve the service.

Inspection carried out on 15 May 2012

During a routine inspection

We spoke with patients and relatives on the in-patient unit. One person told us that they could not wish for anywhere better for their relative and that staff were "fantastic". Another person told us that staff were "brilliant".

One person that we spoke with had just received a hand massage. She told us that staff were "very nice".

We were not able to speak with people who receive care in the community. However, we looked at surveys carried out in relation to the 'hospice at home' service and saw a number of positive comments. One person wrote 'the nurses were most helpful and always happy in their job. I will always be grateful for the service they gave'.

Reports under our old system of regulation (including those from before CQC was created)