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St Giles Hospice - Walsall Outstanding

Reports


Inspection carried out on 6 and 8 March 2019

During a routine inspection

St Giles Hospice - Walsall is operated by St Giles Hospice Group and opened in March 2011.

The hospice at Walsall offers the following services:

  • 12 inpatient beds for specialist palliative care needs.
  • A ‘Hospice at Home’ service. This is led by a registered nurse and a team of health care assistants, who provide practical and emotional care in the home for patients in approximately the last two weeks of life.

All other services such as, spiritual support, complementary therapy, allied health professionals and community palliative care services were provided by a local NHS Trust.

Furthermore, all back office, education and governance structures were supported from a sister site organisation.

In May 2017, the hospice provider launched its new five-year strategy and as part of this underwent a re-brand.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 6 - 8 March 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 hospice service improved. We rated it as Outstanding overall.

Areas of outstanding practice

  • People’s individual needs and preferences were central to the delivery of tailored services. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs. The service made extensive efforts to meet patients and family’s individual needs. For example, services for children, young people and their families that allowed them to undertake activities together. There was extensive ongoing support and follow-on family support groups specifically for children and young people after they had suffered a bereavement.

  • There was a commitment to continuing development of the staff’s skills, competence and knowledge. This was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. The service also used objective structured clinical examinations (OSCE) to assess staff competence in a live manner.
  • There was compassionate, inclusive and effective leadership at all levels. Leaders demonstrated the high levels of experience, capacity and capability needed to deliver excellent and sustainable care. There was a deeply embedded system of leadership development.
  • There was an embedded and extensive team of volunteers who helped support the service. There was a volunteer strategy, a volunteer induction and training programme. Volunteers were proactively recruited, valued staff who were supported in their role in the same manner as substantive staff. The service regularly updated its policies and processes for using volunteers and innovative practice, and the use of volunteers helped to measurably improve outcomes for people.
  • Services were developed with the full participation of those who used them. The service took a leadership role in its health system to identify and proactively address challenges and meet the needs of the population.
  • Staff displayed determination and creativity to overcome obstacles to delivering care. There was strong collaboration, team-working and support across all functions and a common focus on improving the quality and sustainability of care and people’s experiences.
  • There were consistently high levels of constructive engagement with staff and people who used services. Rigorous and constructive challenge from people who used services, the public and stakeholders was welcomed and seen as a vital way of holding services to account.

We found areas of good practice:

  • The service had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. Staff had access to a robust training and competency programme to ensure they had the skills required to provide good quality care.
  • The service provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare professionals supported each other to provide good care.
  • The service planned and provided services in a way that met the needs of local people. The services provided reflected the needs of the population served and they ensured flexibility, choice and continuity of care. The facilities and premises were appropriate for the services that were delivered.
  • Managers at all levels in the service had the right skills and abilities to run a service providing high-quality sustainable care.
  • People who used the service were encouraged to contribute to improvements and developments to ensure the service was a reflection of the people who used it.
  • Staff felt positive and proud to work in the organisation. The culture centred on the needs and experience of people who used services. Staff told us that they felt pride in the organisation and the work they carried out to ensure patients received good quality care.

However:

  • The provider should ensure that allergies were recorded on the main treatment and prescription charts for all patients.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Inspection carried out on 9 September 2015

During a routine inspection

This inspection took place on 9 September 2015 and was unannounced.

St Giles Hospice - Walsall is a 12 bedded inpatient facility providing specialist palliative and end of life care for up to 12 people over the age of 18 who have cancer and other serious illnesses. People are able to receive care and treatment when they are too ill to remain living at home or to relieve their symptoms as well as on a respite basis. At the time of our inspection eight people were using the hospice service.

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 were protected from harm and abuse due to the arrangements in place to make sure risks to people were reduced. Where people were at risk due to their health and physical needs these had been identified with measures put in place to help people to manage and reduce any known risks. Staff and volunteers had been suitably recruited and there were sufficient staff with a variety of skills to meet people’s individual needs and to respond flexibly to changes.

Staff received the training and support they needed and were highly motivated to perform their roles and deliver sustained high quality care. This included staff having the skills to effectively manage people’s medicines so that these were available and administered safely to people. People were extremely confident and positive about the abilities of staff to meet their individual needs in the right way and at the right time for them. The management team supported staff to undertake relevant research and development, to ensure best practice and make improvements in care when required so that it remained effective in meeting people’s needs.

People told us they were supported with their nutritional needs with the assistance of the chef. They checked people’s choices with them as they served meals which were both nutritious and presented in a way which met people’s needs so that they could enjoy their meals comfortably.

Staff were kind and thoughtful to people. People told us staff spent time listening to them, did not rush them, and did all they could to meet people’s individual wishes and requests. 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 people who had the authority to do this.

People were treated as individuals and staff were motivated and committed to providing people with the best possible palliative and end of life care. Staff worked with people to enable them to live as full a life as possible and supported people in achieving their wishes with key comments from staff who believed they went the extra mile. People were supported to receive end of life care that met with their needs and wishes and to achieve a private, dignified and pain free death. People, their family members and staff were provided with the emotional and bereavement support they needed.

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 family members, staff, board of trustees were actively informed and involved in developing the service. Their views were used to continuously inform service improvements and development and to influence the services people received so that these remained innovative, effective and raised quality where needed. The management team were developing the hospice services so that they were inclusive and responsive to the needs of all people including those people who may not have traditionally used hospice services.

There was a strong leadership team which listened and supported people who used the service and staff. Staff at all levels were involved in the quality checks where a varied range of methods were used to determine the quality and safety of people’s care and treatment to maintain improvements so that people received the best possible care. This included checking services people received against inventive recognised standards for end of life care. This is also reflected the recognition and achievements of good practice awards which promoted high quality, safe and advanced care and treatment for people who used the hospice services.

Inspection carried out on 6 November 2013

During a routine inspection

We carried out this inspection to check on the care and welfare of people who used this service.

We spoke with the registered manager, a clinician, the clinical nurse lead and two further members of staff.

As part of the inspection, we spoke with two people who used the service and one family member of someone who used the service.

One person who used the service told us: �It is calm and peaceful. Staff are attentive. They come when I need them�.

We found that people�s views and experiences were taken into account in the way the service was provided and delivered in relation to their care and treatment.

We found that the care and welfare needs of people who used the service were being met.

We saw that there were safeguarding procedures in place at the service. The provider told us how the staff were trained to identify signs of abuse and how they dealt with it appropriately.

We found there were recruitment checks in place to ensure people were cared for, or supported by, suitably qualified, skilled and experienced staff.

We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.

Inspection carried out on 5 November 2012

During a routine inspection

We carried out this scheduled inspection of the inpatient unit at St Giles Hospice � Walsall to check on the care and welfare of people using this service.

We spoke at length with a person who used the service and a visiting relative. We also spoke with three members of staff to obtain their views about the hospice.

Due to the nature of the needs of people living at the hospice it was not always possible to speak directly to them to get their opinions. We used other methods such as questionnaires to obtain their views.

One person using the service told us, �They have accomplished more here in one week, than in months in the community. My previous symptoms have gone. I am sleeping well. The whole set up is magnificent. The staff are very professional�.

A relative told us,� I can�t fault them. They always keep me updated and keep [my relative] as comfortable as possible�.

We spoke with three members of staff who told us they felt supported by their manager and received regular training to enable them to provide specialist care.

During our inspection we observed that medications were kept safe and secure. People told us that they were regularly involved in their medication reviews.

We saw that the service had effective systems in place to monitor and improve the service. These systems involved consulting with people using and visiting the service.