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Sue Ryder - St John's Outstanding


Inspection carried out on 27 September and 3 October 2019

During a routine inspection

Sue Ryder – St John’s is operated by Sue Ryder, a national charitable organisation which specialises in providing palliative and neurological care to people living with life-limiting conditions. The hospice has 15 inpatient beds. Facilities include an inpatient unit, day therapy unit, palliative care hub, lounge, multi-faith and spiritual room, conservatory and garden.

The hospice provides end of life and palliative care for adults. We inspected all services provided.

We inspected this service using our comprehensive inspection methodology. We carried out a short-notice announced inspection on 27 September 2019. We gave staff two days’ notice that we were coming to ensure that everyone we needed to talk to was available. We also inspected on the 3 October 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.

Services we rate

Our rating of this service improved. We rated it as Outstanding overall.

We found outstanding practice in relation to:

  • Staff treated patients and their families with compassion and kindness, respected their dignity and privacy, and went above and beyond expectations to meet their individual needs and wishes. Staff were devoted to doing all they could to support the emotional needs of patients, families and carers to minimise their distress. Staff helped patients live every day to the fullest.

  • Services were delivered in a way to ensure flexibility, choice and continuity of care and were tailored to meet patients’ individual needs and wishes. The service planned and provided care in a way that fully met the needs of local people and the communities served. It also worked proactively with others in the wider system and local organisations to plan care and improve services.

  • It was easy for people to give feedback. Concerns and complaints were taken seriously and investigated, and improvements were made in response to feedback where possible. Patients could access services when they needed them.

  • Leaders ran services well using best practice information systems and supported staff to develop their skills. Staff understood the vision and values, and how to apply them in their work. Staff were motivated to provide the best care they could for their patients. There was a common focus on improving the quality and sustainability of care and people’s experiences. Staff were proud to work at the service and felt respected, supported and valued. Leaders operated effective governance processes and staff at all levels were clear about their roles and accountabilities. The service engaged well with patients, staff and the local community.

  • The palliative care hub service worked collaboratively with partner organisations to ensure patients received the best care possible at the end of life, in their own homes. Feedback from relatives and carers who had been supported by the palliative care hub was overwhelmingly positive, and staff were often described as “angels” and having gone above and beyond what was necessary.

  • Staff were involved in an innovative project to support patients to choose their own care home. The palliative social worker recognised that patients discharged from a hospice to a care home often had their choice and control compromised because they had to rely on others to choose a home on their behalf. To address this, staff visited all nursing homes who agreed to participate in the project and photographed the bedrooms. This meant patients who were not able to view nursing homes themselves were given more choice and control regarding where they would like to go. The photograph folders were also used by staff to open up discussions with patients about what to expect in a nursing home.

We found good practice in relation to:

  • Despite some staff vacancies, the service had enough staff to care for patients and keep them safe. Staff had training in key skills and understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients and acted on them. The service managed safety incidents well and learned lessons from them. Staff collected safety information and used it to improve services.

  • The service provided care and treatment based on national guidance and best practice. Staff gave patients enough to eat and drink and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, supported them to make decisions about their care and had access to good information. Key services were available seven days a week.

We found areas of practice that require improvement:

  • Patients preferred place of death was not always documented.

  • The real-time patient feedback rate was significantly below the Sue Ryder target.

  • Two ‘aroma steam’ machines required electrical safety testing.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (East)

Inspection carried out on 12 April 2016

During a routine inspection

This inspection took place on 12 and 13 April 2016 and was unannounced.

Sue Ryder St John's is a hospice that also provides specialist outpatient treatments and remote, telephone advice services. Fifteen beds are provided in the accommodation facilities at Sue Ryder St John's. At the time of our inspection four people were using the in-patient facilities.

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.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and how to report them. People had risk assessments in place to enable them to be as safe and independent as they could be.

There were sufficient staff, with the correct skill mix, on duty to support people with their care and treatment needs. Effective recruitment processes were in place and followed by the provider.

Medicines were managed safely. The processes in place ensured that the administration and handling of medicines, including controlled medicines, was suitable for the people who used the service.

Staff received a comprehensive induction process and on-going training. They were well supported by the registered manager, director and the provider and had regular one to one time for supervisions. Staff had attended a variety of training to ensure they were able to provide care based on current practice when providing care and treatment for people.

Staff gained consent before supporting people or providing care and treatment. People were supported to make decisions about all aspects of their life; this was underpinned by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff were knowledgeable of this guidance and correct processes were in place to protect people.

People were able to make choices about the food and drink they had, and staff gave support when required. specialist diets were catered for.

People were supported to access a variety of additional health professional when required. Alternative therapy was available including; aromatherapy, Indian head and Swedish massages, reflexology, reiki and aromatherapy.

There was an extensive support programme, manned 24 hours to provide a single point of contact for additional support. The service had a Black, Minority and Ethnic (BME) outreach worker who worked closely with the wider community.

Staff provided care and support in a caring and meaningful way. They knew the people who used the service well. People and relatives, where appropriate, were involved in the planning of their care and support. People’s privacy and dignity was maintained at all times.

A complaints procedure was in place and accessible to all. People knew how to complain.

Effective quality monitoring systems were in place. A variety of audits were carried out and used to drive improvement.

Inspection carried out on 1 November 2013

During a routine inspection

People we spoke with during our visit said things like ''staff make me feel better'' and ''it is nice and caring and thoughtful in here''. One said, ''I wouldn't change anything in here'' and another said 'they do the best they possibly can, cheery. I love the people.'' We saw staff responding promptly to requests to assist people. Staff had good records of people to ensure they were appropriately treated as either in- or out-patients. Staff told us how the teamwork for the clinic was supportive of them.

We saw that a wide and suitable menu was provided to all inpatients by the kitchen, made from fresh ingredients. In addition, people's nutritional needs were met by staff providing snacks at any time patients required them. The kitchen also provided a selection of sandwiches and other snacks for visitors or outpatients. One person commented that they always had sufficient water and juice provided.

When we visited Sue Ryder, St John's, we saw records of staff employed for the day clinic, the residential unit and the Partnership for Excellence in Palliative Support ( PEPS) service run from St John's. Records were kept to ensure that all staff were kept current in training that Sue Ryder considered mandatory for work at St John's. We saw that staff also had current training records. We saw records that showed staff were supported in achieving additional, relevant qualifications such as a foundation degree. This helped staff to provide effective care for people.

Inspection carried out on 24 October 2012

During a routine inspection

When we visited Sue Ryder, St John's we spoke with two people who had received either day care or residential care. One said they ''could not fault it''. The other said staff were 'very caring and thoughtful'. We saw that people received support and treatment appropriate to their needs, whilst being encouraged to maintain independence where possible. Staff respected people's privacy and treated them with dignity. Visitors were welcomed at St John's, enabling them to spend time with people and share mealtimes if they wished.

A refurbishment undertaken in 2011 included the provision of improved bathroom facilities, private quiet areas and good TV, radio and DVD services for people resident at St John's. All areas were bright and well maintained. A wealth of information on services, conditions and treatments was available to people.

Inspection carried out on 1 February 2011 and 27 January 2012

During a routine inspection

We spoke with someone who was accompanying a person receiving day treatment at the service. They told us that they visited the service regularly, and that staff had been very welcoming. We were told that they had been made to feel at home in respect of somewhere comfortable to wait, and facilities for making drinks and snacks.

Following our visit, we spoke to the Lead Commissioner for Palliative and End of Life Care for NHS Bedfordshire, who told us that they had no concerns about the service, and that the hospice provided very good care.

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