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Inspection carried out on 30 March 2016

During a routine inspection

This inspection took place on 30 and 31 March 2016 and was unannounced.

St Michael’s Hospice provides care and treatment to people using the 20 bedded inpatient unit, day service, community nurses and hospice at home service and outpatient clinics. People may also receive support from the hospice’s transport and a telephone triage service. All these services provide specialist palliative and end of life care to people over the age of 18 with life limiting illnesses. At the time of our inspection eleven people were using the hospice inpatient service.

There was a registered manager in post who was also known as the director of care. 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 were protected from harm and abuse due to the arrangements in place to make sure risks to people were reduced. Where people were at risk due to their health and physical needs these had been identified with measures put in place to help people to manage and reduce any known risks. Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people’s individual needs and to respond flexibly to changes.

Staff received the training and support they needed and were highly motivated to do their roles and deliver sustained high quality care. This included staff having the skills to effectively manage people’s medicines so these were available and administered safely to people. People were extremely confident and positive about the abilities of staff to meet their individual needs.

Staff worked closely and in partnership with external health and social care professionals and providers and health commissioners. They also worked with educators and national organisations concerned with palliative and end of life care. This helped to ensure people received the right care at the right time and that knowledge was appropriately shared and used to influence best practice for people’s care.

People told us they were supported with their nutritional needs with the assistance of the chef. They checked people’s choices with them as they served meals which were both nutritious and presented in a way which met people’s needs so that they could enjoy their meals comfortably.

Staff treated people with care and compassion and were highly motivated and committed to providing people with the best possible palliative and end of life care. Staff were kind and thoughtful to people. People told us staff spent time listening to them, did not rush them, and did all they could to meet people’s individual wishes and requests. People’s individual needs were assessed and staff always encouraged people to make their own choices about their care and treatment. Where this was not possible issues of consent and decisions were made in people’s best interests by people who had the authority to do this.

People received care that was tailored to their individual needs. Both people who used the service and family members were highly complementary and satisfied with the care provided, which they often described as excellent. People and family members felt they mattered and their views were taken seriously and acted on. Staff worked alongside people to enable them to live as full a life as possible and supported people in achieving their wishes with key comments from staff who believed they went the extra mile. People were supported to receive end of life care which met with their needs and wishes to achieve a private, dignified and pain free death. People, their families and staff were provided with the emotional and bereavement support they needed.

People were placed at the heart of the services they received by the strong values held by the management and staff team around supporting people to have quality of end of life care which was responsive to enable people to live their lives as they wished until their died. There was a strong sense of commitment within the management and staff team to source new initiatives and find creative ways of responding to the varied needs of the local population. Education, research and working in partnership was actively encouraged and supported to provide not only care and treatment but therapeutic benefits to people.

People and their family members, staff, board of trustees were actively informed and involved in developing the service. Their views were used to continuously inform service improvements and development and to influence the services people received so that these remained innovative, effective and raised quality where needed. The management team were continuing to make improvements and develop the hospice services further to ensure people received safe and effective palliative and end of life care.

Inspection carried out on 6 January 2014

During a routine inspection

We talked with a number of the patients who were using the hospice. All were very positive about the care and treatment they had received. For example, one patient described the standard of care as "wonderful", whilst another person referred to the service as “excellent”.

Patients and relatives were given appropriate information and support and felt listened to. One person commented “They are very good to me; staff are very kind.”

Admission assessments reflected people's individual care needs which helped staff to offer the support that people required in ways that they preferred. Care plans were detailed and covered the spiritual and social as well as physical aspects of care and treatment. This helped ensure that patients’ needs were met.

The hospice had suitable arrangements for the safe storage, handling, administration and disposal of medication. This ensured people got the right medication at the right times.

There was a system in place for assessing and monitoring the quality of the service. This ensured patients received a service which was of high quality and met their needs.

Inspection carried out on 15 January 2013

During a routine inspection

We spent time at the hospice, talking with people who were using the service and watching staff as they supported people. We spoke with three people who were using the service, three members of staff and the registered manager (the Head of Nursing). Later on, we spoke by telephone with a relative of a person who had been cared for at the hospice.

We saw that staff were kind and attentive to people's needs. People told us that the staff were, "really wonderful" and said, "I can't speak highly enough of them". People said that they received the care and treatment that they needed. One person said, "there's nothing that they could do better here".

Records showed that staff worked together as a team to ensure that people's needs were met. Staff told us that communication between colleagues was effective and helped to ensure that all staff had the information they needed.

People told us that they felt safe at the hospice. They said they would feel comfortable raising any concerns. They were confident that staff would listen to them and take any necessary action.

The hospice had effective recruitment procedures, which helped to ensure that only suitable staff were employed. Staff received a range of training to give them the skills and knowledge they needed to provide care and support for people.

There were effective systems in place for monitoring the quality of the service.

Inspection carried out on 8 November 2011

During an inspection to make sure that the improvements required had been made

We did this review because when we visited the service in June 2011 we found that some aspects of the records needed to be developed to ensure staff had the information they needed to give the correct care. The areas this related to were pressure area care, moving and handling, falls and the use of bedrails. These were therefore the areas we looked at most closely when checking records during this visit.

We spoke with two people and members of their families. They were all positive and complimentary about the care and support provided not only to patients but to families and friends as well.

One patient told us “this is a wonderful place”. They described the approach of staff as caring and considerate and the person told us “they make me feel like an individual”. They told us that the staff kept them involved in making decisions and asked for their views.

Another person we spoke with also gave us a positive view of the care they were being given and the support for them and their family from all of the staff. They told us that staff were polite and that the call bell was answered promptly if they used it.

The person’s family told us they could not speak highly enough of the care provided or of the kindness and support given to the whole family. They told us that the attention to detail was excellent and that staff frequently go into their relative’s room to check how they were and whether they needed anything.

They told us that “staff awareness is wonderful – all the staff remember our names and whose family we are”.

Inspection carried out on 1, 15 June 2011

During a routine inspection

When we visited we met people who were using the service and their relatives. We asked people about the care they had experienced and they told us it was “absolutely fantastic”; they “could not fault it”. “Without them I would not be here today”. “Nothing is too much trouble”. They “will do what I need at any time of the day or night”. People said, “I feel I can talk to anybody, they understand and listen”.

People told us how staff maintained their privacy and dignity by drawing the curtains around them whilst giving personal care as they were in a small ward with three other people of the same sex. They told us staff always spoke quietly to ensure the other people did not overhear information they talked about.

People told us staff were “very friendly, very supportive, you can’t fault them”. There was “never a time when staff appeared rushed”. Staff were “superb” and there were “always plenty of staff”. A relative told us “staff are good to me, and support me, very good to X (name removed) too which helps me”. A person told us the family “had ‘googled’ the hospice before X (name removed) had come into the hospice". They told us they were “happy to see the feedback and all the good comments about the place. They had found this to be true – wonderful staff, and a very nice place”.

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