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Archived: St Margaret's Somerset Hospice -Yeovil Outstanding

Inspection Summary

Overall summary & rating


Updated 19 July 2018

This comprehensive inspection took place on 9, 10 and 12 April 2018. The first day was unannounced.

We previously inspected the service on 22 August; 5 and 7 September 2016 and 6 October 2016. At the last inspection the service was rated as ‘requires improvement’ overall and requires improvement in three key questions; safe; effective and well-led. One breach of regulation was found at the last inspection relating to regulation 12, safe care and treatment. This was because people who used the service and others were not always protected against the risks associated with smoking and oxygen use.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe; effective and well-led to at least good.” At this inspection we found the provider had followed their action plan and improvements had been made to ensure people were safe when using oxygen.

St Margaret’s Somerset Hospice is a charity which provides a range of hospice services for adult patients with life-limiting illnesses or advanced progressive conditions and support for their families and carers. They provide a service for people with a range of conditions including cancer. Services include an inpatient unit (IPU) with 12 beds in Yeovil. This means the hospice are able to prioritise beds for those people with more complex symptom control or end of life care needs.

Referral to the hospice was usually prompted by the presence of uncontrollable symptoms, physical, psychological and spiritual or complex end of life care needs or referral to other hospice services. The average length of stay was two weeks with some people being discharged home or to a local care home.

Most people are able to remain in their own home, supported by the community services. There are five community teams supporting people across Somerset, bringing the benefits of hospice care to those who can remain at home. 3800 people are supported across the Somerset community per year with an average of 300 on the community caseload at any one time.

The Sunflower Centre provides support for people who are well enough to live at home but would like the specialist support that St. Margaret’s can offer during the day. The centre at Yeovil is open Monday to Wednesday from 9.30am to 4.30pm and provides emotional, spiritual and social support, symptom control and management, as well as a range of complementary therapies. Practical advice on nutrition, rehabilitation, finance and benefits is also available. Carers are welcome to attend as well.

Other services include physiotherapy and lymphoedema clinics. (Lymphoedema is a chronic long term condition that causes swelling in body tissues. It can be a primary or secondary condition). Bereavement and counselling service were also offered to people and their relatives or friends.

The service provides specialist advice and input, symptom control and liaison with healthcare professionals. The hospice has a 24 hour out of hour’s advice line and central referral centre (CRC). One person reported , “It has been a great support to me…”

There was a registered manager in post; who was also the governance director 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.

There is a second St Margaret’s Hospice in Taunton which is rated outstanding. The two services work very closely together. Services are free to people, with St Margaret’s receiving some NHS funding and the remaining funds are achieved through fundraising and charitable donations. The hospices are largely dependent on donations and fund-raising and are assisted by over 1200 volunteers.

The service was clear

Inspection areas



Updated 19 July 2018

The service was safe.

Improvements had been made to ensure the service was safe. Following a serious incident a robust investigation had taken place and new policies and procedures and staff training had been introduced to reduce the risk.

People were safe because individual and environmental risks were assessed and steps taken to reduce them. Risks were managed positively and did not restrict people�s lifestyle choices unnecessarily.

The service had robust procedures in place to protect people from potential abuse and unsafe care.

There were sufficient numbers of staff with the necessary skills, experience and qualifications to meet people�s needs and preference.

People received their medicines on time and in a safe way.

Recruitment checks were undertaken before staff and volunteers began working at the service to ensure they were suitable to work with people.

The environment was safe and very well maintained. Excellent levels of infection prevention and control were maintained throughout the hospice.



Updated 19 July 2018

The service was effective.

Staff worked collaboratively as part of a multi-professional team to meet people�s needs. The team provided care and treatment based on national guidance and evidenced its effectiveness.

The provider ensured staff were competent for their roles through access to training, support, mentoring and appraisal. Staff morale was high and they described the service as a �great� place to work.

People received an excellent catering service. People had access to a variety of high quality foods and drink when they wanted them.

Staff understood their roles and responsibilities under the Mental Capacity Act 2005 and demonstrated an effective knowledge of the consent


The environment provided facilities to meet the needs of people using the service and their relatives. Improvements had been made to provide a �dementia friendly� environment.



Updated 19 July 2018

The service was exceptionally caring.

People were treated with the utmost dignity, respect and compassion. This was reflected in the feedback received from people who said staff were exceptionally caring.

People were supported by staff that were committed to providing high quality care and treatment. Staff had an excellent understanding of people�s needs. They had a holistic approach, providing emotional, spiritual and psychological support for people using the service and those close to them.

Staff went that extra mile for people by organising weddings, blessings and outings to events meaningful to them.

People were supported to maintain their independence with the use of aids and adaptations, and taught techniques to help manage their symptoms. People valued this support and described positive outcomes, leading to increased confidence and wellbeing.

Support for relatives and friends was an important part of the service provided. Relatives and friends had access to complimentary therapy, counselling and bereavement services.



Updated 19 July 2018

The service was responsive.

People received person-centred care. Systems were in place to ensure that people�s physical, social and psychological needs and wishes were comprehensibly assessed. Detailed and current information about people�s needs and wishes was available to staff to ensure people received the supported they required.

The service ensured people experienced a comfortable, dignified and pain-free death, according to their wishes and preferences.

The hospice board and senior management team had worked with the local community and local commissioning groups to plan and deliver services to meet the needs of local people into the future.

People benefitted from a highly effective multidisciplinary team. A 24 hour, seven day a week advice line provided support for people, their carers and other health professionals.

People knew how to raise a concern or complaint. The registered manager and senior management were open and honest with people when things went wrong. Complaints were investigated thoroughly, and analysed for trends and themes. Learning was identified and shared to improve people�s experience of the service.



Updated 19 July 2018

The service was well led.

Feedback from people, staff and external professionals was exceptionally positive about the quality of end of life care provided by the hospice. The board and senior management team had a clear vision and strategy to ensure the delivery of high quality care and treatment.

There was an open culture of incident reporting within the service and learning from incidents was key to providing a safe and effective service. Strong emphasis was placed on continuous improvement of the service and best practice.

The service monitored the effectiveness of care and treatment through participation in national and local audits, research and national and regional projects. They used the findings to improve outcomes for people. People�s views were sought and valued.

The hospice played a leading role in promoting end of life care within the local community and developed strong links with many community groups. The service worked in partnership with other organisations and professionals to ensure they followed best practice and provided a high quality service and supported other services to do the same.