Saint Francis Hospice

Updated 9 July 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 planned 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 took place on 18, 19, 20, 21 and 26 April 2016 and was unannounced. The inspection team consisted of a lead inspector, a pharmacist inspector, a specialist nurse advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Before our inspection, we asked the provider to complete a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information we held about the service which included a report of a visit carried out by Havering Healthwatch in October 2015. We also received feedback from four external palliative healthcare professionals and a commissioning and contracts officer.

During the course of the inspection we spoke with, either in person or on the telephone, 10 people who used the service, 12 relatives and two visitors. We also spoke, in person, to 25 members of staff and two volunteers. This included the chief executive, chair of board of trustees, registered manager, directors of corporate services and quality and care, health and safety officer, supplies manager, interim head of human resources, head of education, catering manager, pharmacist, interim Specialist Community and Crisis Support manager, manager of Hospice at Home team, volunteer services manager, in patient unit manager, eight nurses (including clinical nurse specialists), two senior healthcare assistants, a care coordinator, and four healthcare assistants. We spent time in the inpatient and day therapy units, observing care and support. We joined handover and multi-disciplinary meetings and met with the Hospice at Home and Specialist Community and Crisis Support teams.

We looked at six people’s care records and 17 medicines records. We looked at other records relating to the management of the hospice. This included five staff and three volunteer recruitment records. We also looked at duty rosters, accident and incident reports, complaints, compliments, health and safety, maintenance, governance and quality monitoring records.

Updated 9 July 2016

This inspection took place on 18, 19, 20, 21 and 26 April 2016 and was unannounced. The service was last inspected in February 2013 and at that time was meeting the regulations we looked at.

Saint Francis Hospice is an independent charity and one of the largest adult hospices in the UK. A team of specialist consultants, doctors, nurses, a range of other health and social care professionals and volunteers provide care and support to people with a life-limiting illness, their carers and family members. This is provided through an 18 bed in-patient unit and a day therapy unit. There were also two community teams based at the hospice, a “Hospice at Home” team, and a “Specialist Community and Crisis Support” team and these provided support in people’s own homes. At the time of our inspection there were 17 people receiving care in the in-patient unit and approximately 120 in the community and day therapy services.

The service had a registered manager. 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 and associated Regulations about how the service is run.

The service provided outstanding care and support. Management, staff and volunteers were highly motivated and committed to ensuring that people had the best possible care. The staff provided people with positive care experiences and ensured their care preferences were met. The hospice website contained feedback from people who used the service and comments included, "Coming to the hospice is the best thing that has happened to me in a long while. I look forward to seeing my friends, having a laugh as well as discussing my problems.” “I had no idea that a hospice was anything more than a place to spend your last couple of weeks in care, but after coming here I realised it was such an uplifting experience.” “You are not made to feel like you are ill and you get to see a doctor or a nurse if you need to. It is a really great asset.”

People received a strongly person centred service. They were supported to make choices and to have as much control as possible about what happened to them both before and after their death. They and their family members were consulted and involved in planning their care and supported to make decisions on their preferred place of death. People who used the service, their families and carers, staff, volunteers and outside organisations were all involved in developing the future of the service.

Staff were clear about their roles and responsibilities. People received care from a multi-disciplinary staff team who received excellent and effective training and good support from the management team. This provided them with the knowledge, skills and confidence to meet people’s needs in an outstanding and individualised manner. There was a very proactive approach to the personal development of staff and the acquiring of new skills and qualifications. A system of competency based assessments ensured staff could demonstrate the required knowledge and skills to meet people’s needs effectively. Volunteers also received training and support to assist them in their roles in the hospice and in the community.

The services were committed to deliver excellent care and to work collaboratively with partners to deliver and inspire better care for those affected by life limiting illness. Staff worked closely and in partnership with external health and social care professionals and other organisations to improve the service within the hospice and in the local community. Staff were encouraged and supported to undertake research and act as education facilitators to share best practice and ensure high quality outcomes for people with life-limiting conditions and those closest to them.

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 in a flexible manner. For example, staff went out to buy people specific food if it was not available at the hospice.

People were safe at the service. They were supported by kind, caring staff who treated them with respect. Strategies to minimise risk were robust and enabled staff to support people as safely as possible both in their own home and in the service. The provider’s recruitment process was robust and ensured that staff and volunteers were suitable to work with people who needed support. Safeguards ensured that people who were unable to make decisions about their care had their human rights protected.

The staff team worked closely with other professionals to ensure that people were supported to receive the healthcare that they needed wherever this was provided. Systems were in place to ensure that staff were trained and competent to administer people’s medicines safely and when they needed them.

There was a ‘no blame’ culture with staff encouraged to report any clinical incidents, accidents or near misses. These were fully investigated and used as a learning tool for improvements and to safeguard people from harm.

People’s cultural and spiritual needs were respected and care and support was provided in line with their culture and traditions. Staff had received training and were aware of different religious and cultural practices at the time of and after death. There was a dedicated room where people could spend time with their loved one after they had passed away to privately say their goodbyes. Relatives also used this room to prepare the body of their loved one in accordance with the traditions of their culture.

Relatives told us staff understood their emotional needs and focused on their wellbeing as well as the wellbeing of their family member. There was a family support team which provided pre and post bereavement counselling for patients, friends and relatives. They also provided a children’s counselling service if needed.

Although there were very few complaints and concerns raised the provider had a positive approach to using them to improve the quality of the service. Each complaint was investigated and, where necessary, appropriate action taken to improve the service provided.

The management structure showed clear lines of responsibility and leadership and there was a strong governance process in place. An external business school had been commissioned to review governance and as a result of this the governance structure was changed and strengthened to ensure that it was effective. Emphasis was placed on continuous improvement of the service. There was a robust audit program in place which was carried out over the course of the year. Where the need for improvement was identified, remedial action was taken to improve the quality of the service and care.

The management team demonstrated a strong commitment to providing people with a safe, high quality and caring service and to continually improve, extend and develop the service to reach as many people as possible. This included promoting the fact that the service was there for people with a range of life limiting conditions and needs not just for those with cancer. For example, by setting up a heart failure group. They also hosted and contributed to an event for younger people living with dementia and their carers to introduce them to the hospital and the support that was provided.

Robust systems were in place to enable people to receive support and advice whenever they need it. This included a new ‘Orangeline’ telephone service aimed at helping people to feel less lonely and isolated and also a 24/7 specialist advice line. The hospice also had a store of ‘recycled’ equipment which they provided to people at short notice. This meant that people did not have to wait for items they needed for their safety and comfort.