St Helena Hospice

Updated 22 June 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection visit took place on 23 and 24 November 2016. The first day of the inspection was unannounced. The inspection team comprised of two inspectors, a specialist nurse in palliative care and a member of the CQC medicines team.

Before the inspection we asked the provider to complete a Provider Information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We also looked at information we held about the service and provider, including notifications the provider had sent us. A notification is information about important events which the provider is required to send us by law.

The first two days of the inspection were spent visiting the hospice site including the inpatient unit, day centre and accompanying staff on two hospice at home visits. During these two days we spoke with seven people who used the hospice services, five relatives and two visitors. In addition we spoke with a total of 20 staff and two volunteers. These staff included the registered manager, the clinical nurse manager, the head of the Inpatient unit, a consultant who was also the medicines management lead and a chief technician. We interviewed five nurses and three support workers. A further two days in February 2017 were used to speak to seven people using the service.

During the inspection we looked at the care and medication records for five people using the inpatient unit. We also looked at the care records for four people using the inpatient unit and two people using the hospice at home service. In addition we reviewed a range of records relating to how the service was managed; these included staff recruitment and training records, quality assurance processes and policies and procedures.

Updated 22 June 2017

This inspection visit took place on 23 and 24 November 2016. The first day of the inspection was unannounced. A further two days in February 2017 were used to speak to seven people using the service. The service was last inspected in April 2014 and was found to be meeting all the regulations we reviewed at that time.

St. Helena Hospice is a charity which provides a range of hospice services for anyone over the age of 16 with a life-limiting illness living in North East Essex and the Colne Valley area of mid Essex. St Helena Hospice provides a range of palliative care services to patients at home, through two day centres [Joan Tomkins in Colchester] and in an inpatient unit that has 15 beds. In addition the hospice offered a 24 hour telephone advice line, a range of complementary therapies, counselling, support for carers and bereavement support groups that was also available to children.

There was a registered manager in place at the time of the inspection. 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 service had a strong person centred approach. People's dignity was supported and staff treated people with respect at all times. Staff were exceptional at helping people to express their views. People and their families who received care, treatment and support from St Helena could not speak highly enough about the staff who supported them. People who were challenged in coming to terms with a life limiting illness or a terminal diagnosis told us repeatedly that they were enabled to manage their condition and their emotional wellbeing because of the excellent care and support received from various departments within St Helena hospice. Staff were exceptionally kind, caring and compassionate. People we spoke with were only too pleased to share their stories of compassionate appropriate care, treatment and support.

The hospice was proactive in reaching out to communities who did not traditionally access their services. Innovative methods had been used to encourage people to access the support available to them. The model of care delivered was one of inclusion and acceptance and promotion of diversity. The ‘Safe Harbour’ project provided hospice services and supported people on the fringes of society, such as those affected by homelessness, alcohol and drugs misuse.

People received excellent care based on best practice from experienced staff with the knowledge, skills and competencies to support their complex health needs. Staff were supported and coached to deliver care and support following best practice guidance. People and families received care from staff and volunteers who developed positive, caring and compassionate relationships with them. Staff worked together as a multidisciplinary team and had excellent links to community based services to provide the care people needed.

Staff had permanent support and guidance from social care professionals employed by the hospice and were trained in how to protect people from abuse and harm. Staff were proactive and knew how to recognise signs of potential abuse and how to put measures in place to overcome safeguarding issues. Risks to people`s well-being were assessed by staff daily and there were measures in place to mitigate risks and keep people safe as they could be. Risk assessments were reflective of people`s changing abilities and needs and measures to ensure people were as safe as possible were implemented accordingly.

People told us they were fully involved in setting their priorities for care. Care plans in regard to all aspects of people`s medical, emotional and spiritual needs were personalised and written in partnership with people. Staff delivered support to people respecting their wishes and preferences.

People who used the various services offered at the day hospice told us the help and support they received was invaluable for them and their family. They valued the support they received from the different activities, courses and clinics which helped them to live with and manage their symptoms to maximise their health and helped them prepare for the future.

People`s consent to their care and treatment was regularly sought. People’s aspirations, preferences and wishes were known by staff. People were asked what was important to them and supported on their journey to make decisions and choices about advanced care plans and desired places of death.

The SinglePoint service was a national award winning telephone advice line which offered support, assessment and advice to people with life limiting condition living in their own homes over 24 hour seven days a week. The support could be accessed via telephone where the calls were triaged and staff could arrange support for people if it was needed. People told us they received the care and support they needed when they wanted it –even in the middle of the night in their own home. People felt very assured by the range of support options.

There were sufficient staff employed in each department to ensure people’s needs were not only met in a timely way, but so that staff could spend meaningful time with people when needed. People appreciated that staff had time for them when needed. Staff were safely recruited. The staff group are well trained and supported. Staff were consulted through surveys and listened to by management. People had opportunities to be involved with the running of the hospice. Volunteers were valued and involved. The management style was inclusive and open.

The registered manager and staff had a strong set of values that placed people at the heart of the service. All staff constantly strived to work towards these values throughout the organisation. There was a culture of openness and taking responsibility with complaints used to drive improvement and quality assurance systems looking at ways to develop practices and make matters better for the benefit of people using the service.