St Barnabas House

Updated 25 May 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 carried out 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 was carried out on 22, 23 and 24 February 2016 by two inspectors and one pharmacist inspector. It was an unannounced inspection.

Before our inspection we looked at records that were sent to us by the registered manager and the local authority to inform us of significant changes and events. This included a Provider Information Return (PIR) which the registered manager had completed prior to our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. This helped us plan and inform our inspection.

We looked at the premises and equipment. We looked at 12 sets of records that related to people’s care and examined three people’s medicines charts. We looked at people’s assessments of needs and care plans and observed to check that their care and treatment was delivered consistently with these records. We looked at documentation that related to staff recruitment, training and management, and records relevant to the storage, ordering and administration of medicines. We observed the administration of medicines. We looked at checks that were carried out regarding the monitoring of the safety and quality of the service. We sampled the services’ policies and procedures.

We spoke with three people who stayed in the Inpatients Unit, nine of their relatives and four volunteers. We also spoke with relatives of four people who received support from the community palliative care service and the ‘Hospice at Home’ service in the community.

We spoke with one Trustee, the registered manager, two palliative care consultants , the Head of Community Services, the In-patient Unit (IPU) team leader, the Head of Family Services, a team leader and two care workers in the Hospice at Home team, three clinical specialist nurses and two nursing assistants in the IPU, one clinical specialist nurse in the Community Team, one nursing assistant and one team leader in the Day hospice, the Facilities Manager, the health and safety advisor, a Hospice at Home team leader, a fundraising manager, the artist in residence, a chef, and two volunteers.

We also spoke with three managers of care homes where the Hospice at Home team was providing support and advice, a GP and three district nurses who oversaw people’s care in the community. We obtained their feedback about their experience of the service.

At our last inspection on 05 March 2014 no concerns were found.

Updated 25 May 2016

St Barnabas House hospice is a local registered charity that provides specialist palliative care to adults with advanced progressive life-limiting illnesses, both within the hospice and in the comfort of their homes. Palliative care is the total care of people whose illness is not responsive to curative treatment.

The service includes a 20 bed In-Patient Unit, a Day Hospice with 18 places, a Community Palliative Care team, a Family Services team, a ‘Hospice at Home’ team and an Education Department. The care is delivered through a team that consists of doctors, nurses, social workers, counsellors, a chaplain, physiotherapists, complementary therapists, an artist-in-residence, a Hospice at Home team and volunteers. Services are free to people and St Barnabas House is largely dependent on donations and fund-raising by volunteers in the community.

This inspection was carried out on 22, 23 and 24 February 2016 by two inspectors and one pharmacist inspector. It was an unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. The registered manager was also the Director of Adult Nursing and oversaw the running of the service. They were part of a senior leadership team that included a chief executive officer and a deputy, a director of human resources, a finance director and an income generation director.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or ensure people were protected from harm.

There was a robust system in place to monitor accidents and incidents and identify how the risks of recurrence could be reduced.

There were sufficient staff on duty to meet people’s needs. Staffing levels were calculated and adjusted according to people’s changing needs. There were thorough recruitment procedures in place which included the checking of references.

Medicines were ordered, stored, administered and disposed of appropriately as per legal requirements. The hospice had opted to be part of a national study on benchmarking of medicines administration errors which meant that it continually reviewed its practices. The hospice shared learning with other local hospices and pharmacists at the local hospital. People could be confident that the service paid particular attention to all aspects of practice relevant to medicines.

There was an effective system in place to ensure people remained as safe as possible from the risk of acquiring an infection. The premises were cleaned and maintained to a high standard.

Staff understood how they should respond to a range of different emergencies and creative thinking underpinned practices in regard to keeping people safe from risk of fire, such as when practising fire drills.

People described the delivery of care as, "Exceptional" and "Second to none." They told us, “The staff are so knowledgeable and incredibly efficient, they are obviously very well trained as they have exceptional skills, they really understand me.”

Staff had appropriate training and experience to support people with their individual needs. Staff told us, “The training we get here is just phenomenal.” The service had creative ways of training their staff that made sure they put their leaning in practice to deliver outstanding care that met people’s individual needs.

There was an effective system of communication between services that ensured effective continuity of care. Communication was very effective within the service, with people and with external healthcare professionals. This meant that duplications of documentation were reduced and people did not have to reply to the same questions during multiple assessments.

Staff knew how to communicate with each person and understood their individual needs. Consent was sought from people, obtained and recorded before any aspect of their care and treatment was carried out.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to hospices. Staff were trained in the principles of the MCA and the DoLS and were knowledgeable in the main principles of the MCA that they applied in practice. They assessed people’s mental capacity when necessary and when applicable they held meetings to make decisions on their behalf and in their best interest. This meant that people's rights were protected and respected.

Staff protected people effectively from the risks of poor nutrition, dehydration, swallowing problems and other medical conditions that affected their health. People praised the food that was offered and told us it was, “Truly excellent” and, “Remarkably good.”

People were referred to healthcare professionals when necessary and their advice was sought and acted on by staff.

The premises had been adapted to meet people’s needs effectively. They were well designed, welcoming, well maintained and suited people’s needs.

People were proactively supported to express their views and staff were skilled at giving people information and explanations they needed and the time to make decisions.

People valued their relationships with the staff team and told us that they often went ‘the extra mile’ for them, when providing care and support. The service took account of people’s cultural, religious and linguistic needs. The staff valued practice that acknowledged diversity and promoted equality.

Clear and comprehensive information about the service and its facilities was provided to people, relatives and visitors through a wide range of methods, to enable them to make informed choices.

Family support was recognised by staff as vital to people’s wellbeing and staff strived to meet the emotional and practical needs of people and their families. Continual emotional support for families was provided in addition to the provision of care for people.

People were at the heart of the service and were fully involved in the planning and review of their care, treatment and support. People, relatives, visitors and health care professionals shared very positive views and opinions about how people's needs were responded to. Individual needs were met and responded to in a way that may exceed people’s expectations. Staff anticipated how people felt when planning their care and support so people felt valued and understood. Staff delivered support to people according to their unique support plan and responded to their specific needs.

People took part in discussions with staff to express their views, preferences and wishes in regard to their care, support and treatment, and were invited to take part in ‘advance care plans’. Their views, wishes and plans were respected.

Staff understood how to respond to people’s artistic and emotional needs at times that mattered to people. Innovative activities were provided to stimulate people’s interests and creativity.

The service actively sought the views of others through creative and innovative methods. The feedback that was sought and obtained from people, relatives, healthcare professionals and staff was extremely positive. A comment included, “Your professionalism, warmth, responsiveness and effectiveness have been an inspiration.” People were actively encouraged to give their views and raise concerns or complaints. Complaints were addressed promptly and followed up with an action plan in order to drive improvement and lessons were learned as a result.

The service took a key role in the community and was actively involved in building further links. It had the support of approximately a thousand volunteers.

There was an open and positive culture which focussed on people. People’s feedback about the way the service was led described it as “Really excellent management” and, “If more businesses were run like this, the world would be a much nicer place”.

Staff praised the provider and the leadership team for their approach and consistent, effective support. All of the staff we talked with spoke extremely positively about the registered manager’s style of leadership and told us they led by example. They described them as, “Exceptional”, “Totally approachable” and, “Inspiring.” The registered manager worked in partnership with other organisations to raise standards of care at a national level.

The service took part in several projects to reach more effectively an increasing number of people in the community and meet their needs. A particular Outreach Project had been implemented and sustained over time which had a positive impact on people in the community as it promoted inclusion.

There was a robust system in place to maintain and monitor the quality of the service across all departments, which was effective in driving continuous improvement. Comprehensive audits were carried out about every aspect of the service to identify how it could improve. When needs for improvement were identified, remedial action was taken to improve the quality of the service and care.