• Hospice service

Archived: St Mary's Hospice Limited

Overall: Good read more about inspection ratings

176 Raddlebarn Road, Selly Park, Birmingham, West Midlands, B29 7DA (0121) 472 1191

Provided and run by:
St. Mary's Hospice Limited

Important: The provider of this service changed. See new profile

All Inspections

17 September 2019 to 18 September 2019

During a routine inspection

St Mary’s Hospice is operated by St Mary’s Hospice Limited. Facilities include a 15 bedded inpatient unit, which includes single rooms with en-suite facilities and small multi-bedded bays. The 15 beds included two home from home beds which were commissioned separately by the local clinical commissioning group. In the reporting period July 2018 to June 2019 there were 1,759 individuals cared for in the inpatient and day case services at the hospice.

There is a “family centre” where patients and their families can stay together. There is access to a peace room for prayer or quiet reflection, a dementia friendly conservatory and gardens. Other facilities include a lounge offering refreshments and information for patients and visitors.

The hospice provides inpatient, outpatient and community care to people aged 18 years old and above. We inspected all services provided by the hospice.

We inspected this service using our comprehensive inspection methodology. We carried out the unannounced part of the inspection on 17 and 18 September 2019.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

The main service provided by this hospice was inpatient and community care. Where our findings on inpatient care for example, management arrangements also apply to other services, we do not repeat the information but cross-refer to the inpatient service level.

Our rating of this hospice stayed the same. We rated it as Good overall.

We found good practice in relation to inpatient care:

  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

  • The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean.

  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff were trained to use them. Staff managed clinical waste well.

  • Staff completed and updated risk assessments for each patient and removed or minimised risks. Staff identified and quickly acted upon patients at risk of deterioration.

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. Managers regularly reviewed and adjusted staffing levels and skill mix, and gave bank, agency and locum staff a full induction.

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date, stored securely and easily available to all staff providing care.

  • The service managed patient safety incidents well. Staff recognised and reported incidents and near misses. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support. Managers ensured that actions from patient safety alerts were implemented and monitored.

  • The service used monitoring results well to improve safety. Staff collected safety information and shared it with staff, patients and visitors.

  • The service provided care and treatment based on national guidance and evidence-based practice. Managers checked to make sure staff followed guidance. Staff protected the rights of patients’ subject to the Mental Health Act 1983.

  • Staff gave patients enough food and drink to meet their needs and improve their health. They used special feeding and hydration techniques when necessary. The service made adjustments for patients’ religious, cultural and other needs.

  • Staff assessed and monitored patients regularly to see if they were in pain and gave pain relief in a timely way. They supported those unable to communicate using suitable assessment tools and gave additional pain relief to ease pain.

  • Staff monitored the effectiveness of care and treatment. They used the findings to make improvements and achieved good outcomes for patients. The service had been accredited under relevant clinical accreditation schemes.

  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and development.

  • Doctors, nurses and other healthcare professionals worked together as a team to benefit patients. They supported each other to provide good care.

  • Key services were available seven days a week to support timely patient care.

  • Staff gave patients practical support to help them live well until they died.

  • Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health.

  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.

  • Staff provided emotional support to patients, families and carers to minimise their distress. They understood patients’ personal, cultural and religious needs.

  • Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.

  • The service planned and provided care in a way that met the needs of local people and the communities served. It also worked with others in the wider system and local organisations to plan care.

  • The service was inclusive and took account of patients’ individual needs and preferences. Staff made reasonable adjustments to help patients access services. They coordinated care with other services and providers.

  • Patients could access the specialist palliative care service when they needed it. Waiting times from referral to achievement of preferred place of care and death were in line with good practice.

  • It was easy for people to give feedback and raise concerns about care received. The service treated concerns and complaints seriously, investigated them and shared lessons learned with all staff. The service included patients in the investigation of their complaint.

  • Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. They were visible and approachable in the service for patients and staff. They supported staff to develop their skills and take on more senior roles.

  • The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. The vision and strategy were focused on sustainability of services and aligned to local plans within the wider health economy. Leaders and staff understood and knew how to apply them and monitor progress.

  • Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service promoted equality and diversity in daily work and provided opportunities for career development. The service had an open culture where patients, their families and staff could raise concerns without fear.

  • Leaders operated effective governance processes, throughout the service and with partner organisations. Staff at all levels were clear about their roles and accountabilities and had regular opportunities to meet, discuss and learn from the performance of the service.

  • Leaders and teams used systems to manage performance effectively. They identified and escalated relevant risks and issues and identified actions to reduce their impact. They had plans to cope with unexpected events. Staff contributed to decision-making to help avoid financial pressures compromising the quality of care.

  • The service collected reliable data and analysed it. Staff could find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements. The information systems were integrated and secure. Data or notifications were consistently submitted to external organisations as required.

  • Leaders and staff actively and openly engaged with patients, staff, equality groups, the public and local organisations to plan and manage services. They collaborated with partner organisations to help improve services for patients.

  • All staff were committed to continually learning and improving services. They had a good understanding of quality improvement methods and the skills to use them. Leaders encouraged innovation and participation in research.

However, we also found the following issues that the service provider needs to improve:

  • There were points during the reporting period when the service did not always use systems and processes to safely prescribe, administer, record and store medicines.

Heidi Smoult

Deputy Chief Inspector of Hospitals Midlands

28 July 2016

During a routine inspection

This inspection took place on 28 July 2016 and was unannounced. Further phone contact was made with people using the hospices community services, whose views we were unable to capture on the day of the inspection, on 2 August 2016.

St Mary’s Hospice provides palliative and end of life care, advice and clinical support for adults with life limiting illness and their families. The hospice provides care to people from a multidisciplinary team of nurses, doctors, counsellors and other professionals including therapists. The hospice has a 16 bed in-patient unit that accepts admissions for end of life and palliative care, symptom control and respite care. At the time of our inspection there were 14 people receiving care and treatment in the inpatient unit. The day hospice service offered a range of care and treatment to people diagnosed with life limiting conditions. This included specialist clinical advice, educational courses and complimentary therapy sessions. The hospice community services supported people in their own homes through a hospice at home team and/or a clinical nurse specialist team. The hospice also provided patient transport services.

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. 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 recognise the signs of abuse and how to raise an alert if they had any concerns. The provider ensured that there were sufficient numbers of staff on duty at all times to meet people’s needs effectively. Staffing levels were reviewed and adjusted according to people’s changing needs. There were flexible working arrangements within the hospice to provide additional staff as was required. The recruitment process operated by the provider was effective in ensuring staff employed were suitable and safe to work with people who were cared for by the service. Assessments of potential risks were clear and included the measures to take to reduce the risks identified to make sure people were protected from harm. Accidents and incidents were effectively reported, analysed and shared to ensure that action was taken to minimise the risks of recurrence. Medicines were prescribed, recorded, administered and disposed of in safe and appropriate ways.

People were well supported by staff that were well trained. The provider supplied a range of learning opportunities for staff to enhance their knowledge and levels of skills. New staff were well equipped to undertake their role through effective induction. Staff received an annual appraisal and an appropriate level of supervision, with open access to the support they needed from peers and management. When complex situations occurred reflective learning sessions or debriefs were organised. People’s consent was sought by staff before any support was provided. Records in relation to Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) were completed to a high standard, with the person’s knowledge, participation and agreement where possible. People were well supported to access the nutrition and hydration they needed and of their choice. The variety of health care professionals employed enabled people’s health and wellbeing to be responded to in a timely manner when their health needs changed.

People were supported by staff that were kind and caring. The hospice had a relaxed and homely feel with a sociable atmosphere but still had plenty of space for people to access quiet reflective time. People and their families had access to services which provided support and counselling with regards to their emotional, spiritual and religious needs. The hospice had a chaplaincy team and provided a rest room for people of all faiths, where a range of bibles were also accessible. People were communicated with effectively and provided with the information they needed. Staff involved people in all aspects of their care provision and ensured that family were also kept well informed. Staff supported people to access personal care respectfully and with the utmost discretion. Provision of education and equipment were just some of the ways that staff supported people to maintain their independence.

People received care and support that was tailored to their individual needs and improved their quality of life. People were involved in making decisions about their current and future care and planning their end of life care. A range of complementary therapies were available to help and support people’s relaxation and general wellbeing. This had a strong emphasis on personalised care and that had a positive effect on people. Initial assessments had been undertaken to identify people's support needs and which team within the hospice was best placed to provide the support people needed at that time. The provider supported people to be more independent in planning their care and how and where they wanted it to be delivered. They were keen to reduce the stigma and break down the taboos about hospice care. We saw that communication was effective both in inpatient and community services so that access to the most appropriate care was made available when people’s needs changed. People told us they felt confident and well informed about how to raise a complaint or any concerns.

Stakeholders were complimentary about the leadership and approachable nature of management. Staff displayed excellent team working and promoted clear communication throughout the service with an inclusive approach to care. Staff enjoyed their work and felt involved and valued by the provider. The provider promoted and encouraged an open and transparent but challenging culture. The provider actively sought to engage and access people to utilise the service through community groups and faith centres. The provider encouraged the involvement in the development of the service from staff at all levels. There was a comprehensive program of in-house regular audits of aspects of the service such as medicines, infection control, the environment, incidents and complaints. The hospice worked in partnership with other organisations that assisted them in the monitoring and development of the hospice service. The provider sought external reviews of its management performance and structure. The service was proactive in ensuring that stakeholders’ feedback was regularly sought and used to develop the service.

31 January 2014

During a routine inspection

We inspected the service that was provided in people's own homes, the Hospice at Home service. At the time of our visit there were five people receiving this service but over one hundred and fifty people had used it over the past 12 months.

We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Nurses and nursing assistants from the service worked with District Nurses from the NHS Community Healthcare Trust to provide end of life care for people in the their own homes.

There were sufficient numbers of staff on duty to meet people's needs. The service was staffed by Registered Nurses and nursing assistants who were supported by a manager and an administrator. The service also had flexible staffing arrangements to meet demands and people's changing needs. Staff were properly trained, supervised and appraised. They received support to deal with the challenging nature of their work providing end of life care in people's homes.

Information about the safety and quality of service that people received was gathered and scrutinised and used to improve the service. This included gathering the views of people who used the service and of other stakeholders in the service such as district nursing teams.

A family member of a person who used the service told us, "My [relative] likes them, they are very thorough and very caring...I don't know what we would do without them, they have been great."

27 February 2013

During a routine inspection

People's needs were assessed and care and treatment was planned and delivered in line with their care plans. People told us they were clear about the aims of care and treatment and they were very positive about their experience of the service. Before people received any care or treatment they were asked for their consent and we saw regular accounts of verbal consent from day by day discussions between people and staff in people's records. One person said, "It's very good here, very well run. If I wanted to I couldn't find anything to complain about."

There was written policy and procedures for recognising and responding to abuse of vulnerable people. People said they felt safe at the service and staff said there was an 'open culture' in which staff could raise any concerns and managers would act on them.

There were sufficient numbers of staff on duty to meet people's needs and people told us that there was always someone available when they needed them. People said that staff were competent and took time to listen to them. We found that the service was well supported with medical, care and ancillary staff and also volunteer workers.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found that people's medical and care records were up to date and kept securely. Records necessary for the safe running of the service and the building were also up to date.