St Richard's Hospice

Updated 9 June 2016

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 took place on 14 and 15 March 2016 and was unannounced.

On the first day of this inspection the team consisted of two inspectors, one being a pharmacist and a specialist advisor who is a nurse with experience of palliative care and end of life care. (Palliative care is specialised medical care focusing on providing people with relief from symptoms and stress of a serious illness). On the second day one inspector concluded the inspection.

We checked the information we held about the service and the provider including statutory notifications. Statutory notifications include information about important events which the provider is required to send us.

We sought information about the quality of service from the local authority and the clinical commissioning team. In addition to this we received information from Healthwatch who are an independent consumer champion who promote the views and experiences of people who use health and social care. We used this information to help us plan this inspection.

We sent out questionnaires to people who use the services, their relatives and community professionals and staff seeking their views about the service.

We spoke with three people and one relative in the inpatient service, one person and one relative who attended an outpatient clinic, five people who attended the day hospice and one person who came into the hospice to meet us. We saw the care people received which included spending time with people who attended an outpatient clinic and the day hospice. We also attended two meetings with groups of staff and volunteers to discuss the needs of people who were using the inpatient and day hospice services.

After our inspection we spoke with five people who used the hospice at home service by telephone. We also sought the views about the quality of the services people were offered at the hospice from a range of professionals. These included a consultant in palliative medicine, dietician and a professor and consultant nurse in tissue viability.

We spoke the registered manager, medical director and chief executive. We also spoke with a range of staff which included the inpatient unit manager, care quality co-ordinator, social worker, head of family support, head of education, communication manager, respiratory nurse specialist, community nursing services manager, three nurses, three healthcare assistants, physiotherapist and pharmacist. In addition to this we spoke with a group of nine staff members which included community nurse specialists and healthcare assistants from the ‘hospice at home’ team about the services they provided to people living at home.

We looked at two people’s care documentation. We also looked at the documentation for nine people around the decisions made around resuscitation wishes and six people’s medicine records. We also looked at the reports relating to the management of the service. They included checks of the quality and safety of people’s care, projects, compliments and complaints.

Updated 9 June 2016

This inspection took place on 14 and 15 March 2016 and was unannounced.

St Richard’s Hospice provides care and treatment to people using the17 bedded inpatient unit, day service, community nurses and hospice at home service and outpatients 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. (Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illnesses). At the time of our inspection eight people were using the inpatient unit service.

There was a registered manager in post who was also known as the care director. 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 felt safe while receiving services from the staff team. Staff understood how to identify report and manage any concerns about people’s safety and welfare. There were arrangements in place to assess and manage risks to people’s safety. This included staff having the skills to effectively manage people’s medicines to ensure these were available and administered safely to people. There were sufficient staff with a wide variety of skills to meet people’s individual needs and to respond flexibly to changes in people’s identified risks.

Staff and volunteers had been suitably recruited and benefitted from an education and training programme which was well established. A strong partnership link had been made with a local university to deliver training around the subject of palliative end of life care. Staff were highly motivated and felt supported to continue with their learning. This supported staff to be effective in meeting the care and treatment of people with life limiting illnesses.

Staff and volunteers worked alongside people to enable them to live life as fully as possible. People were supported in achieving their goals with key comments from staff who held the belief of `people mattered`. People were treated with respect by staff who strived to support each person’s end of life care needs and wishes to achieve a private, dignified and pain free death. People who used the services and family members were provided with the emotional, spiritual and bereavement support they needed.

There was a strong sense of staff placing people at the heart of all the care and treatment provided. People benefitted from consistency of care and treatment due to the different services which had been developed both in the hospice and in people’s own homes. Staff understood what was important to people and worked closely with each other and family members and did all they could to meet each person’s individual wishes and requests. This included the determination to go the ‘extra mile’ when faced with adversity so people continued to receive the care and treatment they needed. Creative ways were explored to make sure food and drink were provided to a high standard and people could choose what to eat and drink and when.

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 a family member or a health and social care professional who had the authority to do this.

The management and staff team undertook work in the local community to promote greater awareness and understanding of end of life care. Strong relationships had been developed with local healthcare services so people received any specialist support they required. This helped people to receive seamless care and treatment through shared working.

People were at the centre of the management and staff’s core values of personalised end of life care aimed to provide quality of care and life to all people. To achieve this staff formed close partnerships with external health and social care professionals, educators and national organisations involved with end of life care. This helped to ensure that people received the right care at the right time and knowledge was appropriately shared and used to influence best practice for people’s care. This included care and treatment planning to make sure it was inclusive to meet the diverse and changing care needs of the local population.

People and their relatives were encouraged to share their views and opinions about the service. The management and staff team listened to what people had to say in the development of the services and took action to resolve any issues.

The registered manager showed an open and responsive management style. They provided strong leadership to the staff team and encouraged them to be ambitious in continuously improving their knowledge and skills. People were at the centre of the management and staff’s core values of personalised palliative and end of life care aimed to provide quality of care and life to everyone.

The management team and governors regularly assessed and monitored the quality of the care to ensure national and local standards were met and maintained. A culture of continuous improvement was encouraged through project work and research to identify best practice and make improvements in the care offered. This included focusing upon procedural arrangements for the management of medicines to make sure aspects of these were strengthened.