Archived: St Raphael's Hospice

St Raphael’s Hospice is a voluntary organization, part of the registered charity of the English Province of the Daughters of the Cross of Liege. The hospice provides end of life and palliative care to people living in the South London Boroughs of Sutton and Merton. The hospice accepts referrals made by GP’s, specialist nurses or hospital consultants. A team of specialist consultants, doctors, nurses, health care assistants and a range of other health and social care professionals, therapists and volunteers provide care, treatment and support to people with a life-limiting illness and their families/carers and friends.

The hospice comprises of a 14 bedded in-patient ward, the Jubilee day care centre, overnight family accommodation and a café known as the Orangery that is open to the public. There are various community teams that operate out of the hospice which include the Clinical Nurse Specialist Community Palliative Care Team (CPCT), “Hospice at Home” and “Hospice neighbours” services that provides people and their families care and support at home. The hospice also has a respite care service for people and a pastoral and counselling service for both people and their families. At the time of our inspection there were eight people staying on the ward at St Raphael’s and approximately 250 people receiving community palliative services at home.

The service had a registered manager who was also the hospice’s Director of Care Services (DCS). A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Management, staff and volunteers were highly motivated and committed to ensuring people and their families received the best possible end of life care, treatment and support. The hospice enabled people to experience a positive, comfortable and dignified death that was delivered in accordance with a person’s personal needs, choices and preferences. Practical and emotional support was provided to people and their families.

People received personalised care, treatment and support. People were supported to make informed choices about their end of life care and to have as much control as possible about what happened to them before and after their death. They were involved in planning their care and supported to make decisions on their preferred place of death. Consent to care was sought by staff prior to any support being provided.

The management team demonstrated a strong commitment to delivering people with high quality and safe end of life care. The management structure showed clear lines of responsibility and leadership. The service had developed effective governance systems and there was a strong emphasis placed on continuous improvement of the service. The service regularly reviewed their performance and where further improvements were identified appropriate actions were taken. Managers used learning from near misses, incidents and inspections to identify improvements that would positively enhance the lives of people receiving a service from St Raphael’s.

The hospice was committed to working collaboratively with others. Staff worked in close partnership with external health and social care professionals and other organisations to deliver and share best end of life practice and care for people affected by a life limiting illness.

People told us they were very happy with the service they received from St Raphael’s. We saw staff looked after people in a way which was kind, respectful and compassionate. Feedback we received from people, their families and external community health and adult social care professionals supported this. Staff ensured information they wanted to communicate to people was done in a way that people could understand.

People said they felt safe staying on the ward or receiving care and support in their own home from the community teams. Staff knew what action to take to ensure people were protected if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and strategies to prevent and manage identified risks were robust. This enabled staff to support people as safely as possible on the ward and at home. The service managed accidents and incidents appropriately and suitable arrangements were in place to deal with emergencies. The provider’s recruitment processes ensured staff and volunteers were suitable to work with people who received a service from the hospice.

The provider ensured regular maintenance and safety checks were carried out at the hospice to ensure the building and equipment remained safe. The hospice was clean and there were processes in place to protect people from the risk of infection.

Staff had built caring and friendly relationships with people and their families. We observed people and staff engaging in warm conversations throughout our inspection. There were sufficient staff to meet people’s needs, and staffing levels were regularly reviewed and adjusted accordingly to meet people’s needs. One-to-one staffing was provided to further support people and maintains their safety when required.

Staff were clear about their roles and responsibilities. People received care from a range of health and social care professionals who received effective training and good support from their line managers and senior staff. Training needs were regularly reviewed and staffs’ competency to continue undertaking certain tasks such as handling medicines or operating mobile hoists were routinely tested. Systems were in place to support staff and to enable them to reflect on their own practice and that of other staff. This help to ensure they had the right knowledge, skills and experience to meet people's individual needs and wishes. Volunteers also received training and support to assist them in their roles in the hospice and in the community.

People were supported to maintain relationships with people who were important to them. There were no restrictions on visiting times at St Raphael’s and families could stay overnight. People and their families/carers were able to access a wide range of group and individual social activities and educational classes at the day centre. People were supported to be as independent as they wanted and could be.

Personalised care plans reflected people’s specific needs and preferences in respect of how they wanted to be cared for, treated and supported. These plans and associated risk assessments were regularly reviewed and kept up to date. This gave staff clear guidance and instructions about how they should care and support people and their families.

There was strong emphasis on the importance of good nutrition and hydration and a commitment to providing people with what they wanted to eat and drink. There was an excellent choice of meals, snacks and drinks, and staff went out of their way to buy people specific food if it was not available at the hospice. People received the support they needed to remain healthy and well. People were supported to receive good health care both from the hospice and other external community health and social care professionals. People received their medicines as prescribed and staff knew how to manage medicines safely.

Staff were aware and respectful of people’s cultural and spiritual needs including before, during and after death. There was a multi-faith chapel at St Raphael’s where people could practice their faith or just spend time in peaceful reflection. There was also a chaplaincy service to support people and their families with their spiritual needs.

Staff were aware of who had the capacity to make decisions and supported people in line with the Mental Capacity Act 2005. Where appropriate, staff liaised with people’s relatives and involved them in discussions about people’s care needs. Managers and staff understood when a Deprivation of Liberty Safeguards (DoLS) authorisation application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The service had an open and transparent culture. The service had systems in place to obtain feedback from people, their families/carers, staff and other health and social care professionals about the hospice. Specifically about what they thought the hospice did well and what they could do better.

People felt comfortable raising any issues they might have about the hospice with managers and staff. Complaints or concerns raised about the hospice were investigated and, where necessary, appropriate action taken to resolve the issue. The provider had a positive approach to using them to improve the quality of the service.

We also talked to several members of staff that included the deputy manager, five nurses/carers, a GP, the head of training and three volunteers.

We saw patients received safe and appropriate care and support that was individualised. This was because there were enough suitably qualified, skilled and experienced staff to meet each patient's end of life care needs and wishes. We also saw patients and their families were treated with respect by staff and were involved in discussions about the care provided by the hospice.

We found patients were protected against the risks associated with poor medication handling practices because the provider had appropriate arrangements in place to manage medicines safely. This meant patients were given the medicines they needed, when they needed them. The provider also had effective quality checking systems in place to regularly monitor the standard of the end of life care patients received from St Raphael's.

In addition to inpatient facilities the service provides care and support to people in their own homes and their families. There is also a day centre providing various activities and courses for people to participate in.

The service provider is a religious organisation, The Congregation of the Daughters of the Cross of Liege, however the hospice cares for people of any or no faith. 25% of its funding is provided by the National Health Service and the remaining income comes from donations and fundraising events.

During our inspection we were able to speak to the medical director, members of the management team, staff and people using the service.