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Archived: St Christopher's Bromley Good

Inspection Summary


Overall summary & rating

Good

Updated 9 December 2016

This inspection took place on 15 and 22 September 2016 and was announced. The service was last inspected on 25 November 2013 and at that time was meeting all the regulations we looked at.

St Christopher’s Bromley (Orpington) has charitable status and provides palliative and end of life care to a population of approximately 1.5 million people living in the five South East London Boroughs of Bromley, Croydon, Lewisham, Southwark and Lambeth. The hospice will accept initial referrals from anyone in the community who knows an adult with a life threatening or life limiting condition. Care, treatment and support is provided to people with a life threatening/life limiting illness, their families, carers and friends by a range of multi-disciplinary health and social care professionals including doctors, nurses, health care assistants, physiotherapists, occupational therapists, dieticians, social workers, chaplaincy, welfare officers, art and complementary therapists and volunteers. The hospice also offers information, advice, education/training and research opportunities to individuals, groups and institutions wanting to know more about end of life matters and the work undertaken by St Christopher’s at a local, national and international level.

Although the hospice has two different sites located at Orpington and Sydenham in Bromley, St Christopher’s considers itself to be a single provider with people in the local community, their families/carers, staff and volunteers visiting or working at both sites. This report relates specifically to the Orpington site which comprises of the Caritas day centre, café and garden, numerous clinical and meeting rooms for patients and their families, a large teaching room that forms part of the St Christopher’s education facilities and a dedicated Lymphoedema suite. The Lymphoedema service serves the whole of Bromley and operates both from Caritas House and also offers a home visiting service.

The Caritas centre offers people in the local community, their families and informal carers' physiotherapy, psychological support, social work services, bereavement counselling and spiritual care in an environment where they can relax, socialise, support each other and make use of a range of therapies to explore their experiences. Nurses agree a care plan with each outpatient and can refer individuals to other services such as group work programmes, exercise classes, the pop-up rehabilitation gym or clinic appointments with other members of the multi-professional team. People are offered an initial programme of 12 sessions after which their care plan is reviewed. The centre also provides people with information and trained volunteers are on hand to help people find the information they need. The hospice has increased the levels and range of supportive care services that run from the Caritas centre in 2015/16.

The specialist community palliative care team and outpatient team operates in collaboration with local primary health care teams to provide people, their families and/or carers with end of life care and support. Its primary task is to manage symptoms associated with people’s illnesses and to support them and their families through the illness and into bereavement. The team also provides a 24 hour consultancy service and training for primary health care teams, social and healthcare staff in other settings such as care homes, and domiciliary care agencies.

The hospice clinical nurse specialists work a shift system up until 10pm. Overnight, the advice and visiting service is managed by senior nurses on duty in the inpatient wards at the Sydenham site. Staffing levels for this reflect the need for community support. Medical advice, support and patient assessment is also available from the medical team 24 hours a day/seven days a week. In addition, the hospice has a hospice at home service providing practical nursing care to support patients and families at home in the last days of life. St Christopher’s

Inspection areas

Safe

Good

Updated 9 December 2016

The service was safe. People received a safe service from St Christopher's Bromley whether it was at the centre and/or in their own home. Staff were aware of what to do if they witnessed or suspected abuse was taking place.

Assessments were undertaken to identify any risks to people who received an inpatient service from the hospice and these were regularly reviewed. The hospice�s environment was safe and maintenance took place when needed.

Staffing levels were flexible and regularly reviewed to ensure there were the right number of staff on duty at anyone time to meet people�s needs. Staff and volunteers were appropriately checked to ensure they were suitable to provide care and support to people using the hospice.

Medicines were stored safely and systems were in place to ensure that people received their prescribed medicines when they needed them. Processes were in place to protect people against the risk of development and spread of infections and infectious diseases.

Effective

Good

Updated 9 December 2016

The service was effective. St Christopher's carried out research and acted as education facilitators at a local, national and international level to share best practice and ensure high quality outcomes for people with life-limiting conditions and those closest to them.

People and their families/carers received support from a very skilled and committed staff and volunteers. This was because staff and volunteers received comprehensive training which was monitored to ensure their knowledge was kept up to date. Managers, staff and volunteers knew their responsibilities in relation to the Mental Capacity Act 2005 and DoLS. People were involved in making decisions about their treatment and care needs. When complex decisions had to be made staff were aware how to make decisions in people�s best interests.

People were supported to receive the health care they needed both from staff who worked for the hospice and other external community health and social care professionals. There was a strong emphasis on the importance of eating and drinking well and a commitment to providing people with what they wanted to eat and drink in a flexible manner.

Caring

Good

Updated 9 December 2016

The service was caring. People and their families spoke consistently about the caring and compassionate attitude of staff and volunteers. People were involved in decisions about their care and felt staff listened to them. End of life care and treatment was provided in line with people�s wishes and preferences. People�s privacy and dignity were always respected.

The service ensured people were enabled to experience a comfortable, dignified and pain-free death, according to their wishes and preferences. Staff understood people�s emotional needs and focused on their wellbeing as well as that of their families. Bereavement services were available for children, adults and their families.

Responsive

Good

Updated 9 December 2016

The service was responsive. The hospice had developed a number of innovative approaches to reach more �harder to reach� groups in the local community which had resulted in a young person's social group and the Bromley Care Coordination (BCC) team being set up to support people who had been previously felt excluded from the hospice.

Advice for people, their families, carers, GPs and healthcare professionals was available 24 hours a day via a dedicated helpline. People told us that this lessened their anxiety and helped them to receive better care when they needed it.

People received person-centred care. Systems were in place to ensure that people�s physical, social and psychological needs and wishes were comprehensibly assessed. Detailed and current information about people�s needs and wishes and what was important to them was recorded and communicated to staff. This ensured staff understood people�s needs and preferences.

Care plans were kept under constant review and the service was flexible and responded quickly to people's changing needs and wishes.

The provider had a positive approach to using complaints, concerns and feedback to improve the quality of the service.

Well-led

Outstanding

Updated 9 December 2016

The service was well-led. The executive and senior management team demonstrated a strong commitment to providing people with high quality care.

Managers and staff worked to continually improve and develop the service. Systems were in place to routinely review the service�s performance and to look for innovative ways to improve.

The service had an open and honest culture. People's views were sought and valued and encouraged to get involved in developing the hospice. Staff also felt able to express their opinions and that they would be listened to.

The service worked collaboratively with external health and social care professionals and agencies to deliver and share best end of life practice and care for people with a life limiting illness.